Epilepsy

Question 1

What is epilepsy?

Answer 1

Umbrella term for condtion when there is a tendency to have seizures

Question 2

What are seixures?

Answer 2

Abnormal electrical activity in brain

Question 3

What is a generalised tonic-clonic seizures?

Answer 3

Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements

Question 4

What can be ass with a generalised tonic clonic seizure?

Answer 4

Tongue biting, incontinence, goraning, irregular breathing

Question 5

What happens after a seizure?

Answer 5

Post ictal period

Question 6

What happens in the post ictal period?

Answer 6

Confused, drowsy, feels irritable or low

Question 7

Where do focal seizures start in the brain?

Answer 7

Temporal lobes

Question 8

Tonic clonic vs focal seizure treat

Answer 8

Swap first and second line
1st - sodium valproate or levetriacetam
2nd - carbamazepine or lmaotrigine

Question 9

How can focal seizures present?

Answer 9

• Hallucinations
• Memory flashbacks
• Déjà vu
• Doing strange things on autopilot

Question 10

How long do absence seizures normally last?

Answer 10

10-20s

Question 11

What can atonic seizures be indicative of?

Answer 11

Lennox-Gastaut syndrome

Question 12

What is lennox-gastaut syndrome

Answer 12

‘epileptic and developmental encephalopathy’ because the epileptic seizures and the abnormal EEG are thought to be important in these childrens’ developmental delay and learning difficulties.
v severe
4 years

Question 13

What is an atonic seizure?

Answer 13

Brief lapses in muscle tone

Question 14

What do myoclonic seizures occur in children as a part of?

Answer 14

Juvenile myoclonic epilepsy

Question 15

What is West syndrome?

Answer 15

Infantile spasms starting at around 6 months characterised by clusters of full body spasms

Question 16

Prognosis of West syndrome

Answer 16

1/3 die by 25
1/3 seizure free

Question 17

First line treatments for West syndomre

Answer 17

Preednisolone
Vigabatrin

Question 18

What are febrile seizures caused by?

Answer 18

Fever

Question 19

What age children do febrile seizures occur in?

Answer 19

6 months to 5 years

Question 20

Outcome of febrile convjulsions

Answer 20

Good
1/3 will have another
Slight increased chance of developing epilepsy

Question 21

Investigation for epilepsy

Answer 21

EEG - electroecnephalogram

Question 22

When to use an EEG to investigate epilepsy?

Answer 22

After the second simple-tonic clonic seizure

Question 23

When is an MRI considered for investigatiing seizures?

Answer 23

Child under 2 years when has first seizure
Focal seizures
No response to first line anti-epileptic medications

Question 24

What additional investigations except brain imaging can be used to rule out seizure causes?

Answer 24

ECG
Blood electrolytes - Na, K, Ca, Mg
Blood glucose - hypo/diabetes
Blood cultures, urine cultures and lumbar puncture - sepsis, encephalitis or meningitis

Question 25

What advise parents about with childs epilepsy?

Answer 25

Safety precautions Recognising, managing and reporting seizures Avoid situations where seizure may put child in danger

Question 26

Dangerous situations for children with seizures

Answer 26

sHOWERS NOT BATHS Cautious swimming unless close supervision and seizures well controlled Cautious with: heights Traffic Heavy, hot or electrical equipment

Question 27

How do maintenance epileptic drugs work?

Answer 27

Raising seizure threshold and reducing liekelihood patient having a seizure

Question 28

How does sodium valproate work?

Answer 28

Increase activity of GABA, relaxing effect on brain

Question 29

Side effects of sodium valproate

Answer 29

Teratogenic Liver damage and hepatitis Hair loss Tremor

Question 30

Side effects of carbamazepine

Answer 30

Agranylocytosis Aplastic anaemia Induces P450 system

Question 31

Phenytoin side effects

Answer 31

Folate and vitamin D deficinecy Megoloblastic anaemia (folate deficiency) Osteomalacia - vit D def

Question 32

Ethosuximide side effects

Answer 32

Night terrors Rashes

Question 33

Lamotrigine side effects

Answer 33

Stevens-Johnson syndrome or DRESS synrome = life threatening skin rashes Leukopenia

Question 34

Management of seizures

Answer 34

* Put the patient in a safe position (e.g. on a carpeted floor) * Place in the recovery position if possible * Put something soft under their head to protect against head injury * Remove obstacles that could lead to injury * Make a note of the time at the start and end of the seizure * Call an ambulance if lasting more than 5 minutes or this is their first seizure

Question 35

What are epilepsy syndrome?

Answer 35

Typical age of onset Specific seizure types and developmental antecedents/consequneces, physical exam EEG and radiographic characteristics Helps in pronosis but not a diagnosis

Question 36

What is childhood absence epilepsy?

Answer 36

3-4 onset Similar EEG and physical appearances Treat for around 2 years Normally grwo out of it

Question 37

Epilepsy imitators

Answer 37

Syncope and anoxic seiaures Behavioural psychological and psychiatric disorders

Question 38

Examples of cynxope and anoxic seizures

Answer 38

Vasovagal syncope Breath

Question 39

Take history of seizure

Question 39

Take history of seizure

Question 40

What is febrile status epilepticus

Answer 40

Longer than 5 mins of seiuzreu

Question 41

How old are children who get febrile seizures?

Answer 41

6 months to 5 years

Question 42

Common infections causing febrile seizures

Answer 42

Viral infections Tonsilitis Otitis media Gastroenteritis Post immunisation

Question 43

Why is it important to investigate febrile seizures under one?

Answer 43

Difficult to differentiate between meningitis and viral cause in under one years old

Question 44

Serious causes of febrile illness in children

Answer 44

Meningitis UTI Chest infections

Question 45

What to do after febrile seizure

Answer 45

Watch on ward Blood tests Urine tests CSF if strong sus meningitis

Question 46

When need to medicate febrile seziures

Answer 46

Staus epilepticus - over 5 mins