Epilepsy

Question 1

Two main types of seizures

Answer 1

Focal or generalised

Question 2

Types of focal seizures

Answer 2

With impairment of consciousness (complex), without impairment of consciousness (Simple), and evolving to bilateral convulsive seizure (secondary generalised)

Question 3

Types of generalised seizures

Answer 3

Absent seizures, tonic-clonic, myoclonic, atonic seizures

Question 4

Triggers of seizures

Answer 4

Poor sleep, alcohol, drugs, withdrawal, stroke, intracranial haemorrhage, SOLs, metabolic disturbances

Question 5

Features of absent seizures

Answer 5

Often children, pause briefly, <10 secondarys, and then carry on where they left off

Question 6

Features of tonic-clonic seizures

Answer 6

Patients lose consciousness, limbs stiffen and start jerking. Post ictal common

Question 7

Features of myoclonic seizures

Answer 7

Sudden jerk of limb, trunk or face

Question 8

Features of atonic seizures

Answer 8

Sudden loss of muscle tone, causing fall, whilst consciousness

Question 9

Which seizures does carbamazepine worsen

Answer 9

Absent and myoclonic seizures

Question 10

Features of complex focal seizures

Answer 10

Patients lose consciousness after aura or onset. Post-ictal symptoms common

Question 11

Most common origin site for complex focal seizures

Answer 11

Temporal lobe, with post ictal confusion

Question 12

Features of simple focal seizures

Answer 12

Do not lose consciousness, only experience focal symptoms. Post-ictal symptoms do not occur

Question 13

Features of secondary generalised focal seizures

Answer 13

Experience of focal seizure, which evolves to generalised seizure, typically tonic clonic. 2/3 of patients with focal seizures

Question 14

Post ictal featurs of seizures

Answer 14

Lasts 5-30 minutes after seizure, confusion, drowsiness, nausea, HTN and headache

Question 15

Features of temporal lobe focal seizure

Answer 15

Automatisms (lip-smacking), deja vu/jamais vu, emotional disturbance (sudden terror), olfactory gustatory or auditory hallucination

Question 16

Features of frontal lobe focal seizure

Answer 16

Motor features such as Jaksonian march, dysphasia or Todd’s palsy

Question 17

Features of parietal lobe focal seizures

Answer 17

Sensory symptoms such as tingling, numbness, motor symptoms due to spread of electricity to pre-central gyrus in frontal lobe

Question 18

Features of occipital lobe focal seizure

Answer 18

Visual symptoms such as spots and lines in visual field

Question 19

First line treatment for focal seizure

Answer 19

Carbamazepine or lamotrigine in first line

Question 20

First line treatment for absent seizures

Answer 20

Sodium valproate or ethosuximide

Question 21

First line treatment for tonic clonic seizures

Answer 21

Sodium valproate or lamotrigine

Question 22

First line treatment for myoclonic seizures

Answer 22

Sodium valproate, Levetiracetam or Topiramte

Question 23

First line treatment for atonic seizures

Answer 23

Sodium valproate or lamotrigine

Question 24

Cautions of sodium valproate

Answer 24

Women of childbearing age due to high risk of neural tube defects

Question 25

Alternative for sodium valproate

Answer 25

Lamotrigine

Question 26

Drugs more effective in focal seizures

Answer 26

Carbamazepine, gabapentin and phenytoin

Question 27

Drugs effective in all types of seizures

Answer 27

Lamotrigine, levetiracetam and valproate

Question 28

Side effects of phenytoin

Answer 28

Acne, anorexia, constipation, dizziness, gingival hypertrophy and tenderness, hirsutism, insomnia, paresthesia, rash, tremor

Question 29

Side effects of sodium valproate

Answer 29

Anaemia, confusion, convulsion, deafness, extrapyramidal disorders, gastric irritation, haemorrhage, headache, hyponatraemia, stupor, somnolence, thrombocytopenia, transient hair loss, tremor, weight gain, teratogen

Question 30

Side effects of carbamazepine

Answer 30

Ataxia, blood disorders, blurred vision, fatigue, hyponatraemia, oedema, skin problems, SIADH, drowsiness, diplopia

Question 31

Side effects of lamotrigine

Answer 31

Blurred vision, aggression/agitation, arthralgia, ataxia, back pain, diarrhoea, diplopia, dizziness, headache, insomnia, N+D, rash, tremor

Question 32

Side effects of topiramate

Answer 32

Abdominal pain, aggession, agitation, alopecia, anxiety, confusion, constipation, DNV, dyspepsia, movement disorders, mood changes, myalgia, parasthesia, tremor, weight loss