Epilepsy

Question 1

What is epilepsy?

Answer 1

Condition characterised by seizures

Question 2

What are seizures?

Answer 2

Transient episodes of abnormal electrical activity in the brain

Question 3

What types of seizures are seen in adults?

Answer 3

Generalised tonic-clonic seizures
Partial seizures (or focal seizures)
Myoclonic seizures
Tonic seizures
Atonic seizures

Question 4

What types of seizures are seen in adults?

Answer 4

Absence seizures
Infantile spasms
Febrile convulsions

Question 5

What is a partial seizure?

Answer 5

Occur in an isolated brain area, often the temporal lobe

Question 6

What do partial seizures affect?

Answer 6

Hearing, speech, memory and emotions

Question 7

Are patients awake in a partial seizure>

Answer 7

Yes

Question 8

What are symptoms associated with partial seizures?

Answer 8

Déjà vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours

Question 9

How do myoclonus seizures present?

Answer 9

With sudden, brief muscle contractions

Question 10

What can myoclonic seizures occur as part of>

Answer 10

Juvenile myoclonic epilepsy

Question 11

What do tonic seizures involve/

Answer 11

Increased muscle tone, where the entire body stiffens

Question 12

What do tonic seizures result in?

Answer 12

A fall if the patient is standing

Question 13

What do a tonic seizures involve?

Answer 13

A sudden loss of muscle tone, often resulting in a fall

Question 14

When do atomic seizures begin?

Answer 14

In childhood

Question 15

What may atonic seizures indicate?

Answer 15

Lennox-Gastaut syndrome.

Question 16

Who are absent seizures typically seen in?

Answer 16

Children

Question 18

Do absent seizures stop?

Answer 18

They stop as the get older

Question 19

What is the differential diagnosis in epilepsy?

Answer 19

Vasovagal syncope
Pseudoseizures
Cardiac syncope
Hypoglycaemia
Hemiplegic migraine
TIA

Question 20

What investigations should be done?

Answer 20

electroencephalogram (EEG)
MRI brain

Question 21

What additional investigations can be considered?

Answer 21

ECG
Serum electrolytes
Blood glucose
Blood cultures, urine cultures and lumbar puncture

Question 22

What is the treatemnt of generalised tonic clonic seizures?

Answer 22

Men, Women who cannot have children = sodium valproate
Women able to have children= lamotrigine or levetiracetam

Question 23

Partial or focal seizure management?

Answer 23

Lamotrigine or Levetiracetam

Question 24

Myoclonic seizures management?

Answer 24

Men and women who cannot have children = sodium valproate
Women able to have children = Levetiracetam

Question 25

Tonic and atonic seizure management?

Answer 25

Men, women who cannot have children = sodium valproate Women who can have children = lamotrigene

Question 26

Absent seizure treatment?

Answer 26

Ethosuximide

Question 27

How does sodium valproate work?

Answer 27

Increase the activity of gamma-amino uteric acid (GABA) => calming effect of the brain

Question 28

What are side effects of sodium valproate?

Answer 28

Teratogenic (harmful in pregnancy) Liver damage and hepatitis Hair loss Tremor Reduce fertility

Question 29

What can sodium valproate cause in pregnancy?

Answer 29

Neural tube defect and developmental delay

Question 30

What is status epilecticus?

Answer 30

Medical emergency Seizure lasting more than 5 minutes Multiple seizures without regaining consciousness in the interim

Question 31

What does management of of status epilecticus involve?

Answer 31

ABCDE approach: Securing the airway Giving high-concentration oxygen Checking blood glucose levels Gaining intravenous access (inserting a cannula)

Question 32

What is the medical treatment for status epilecticus?

Answer 32

First line = benzodiazepine, repeated after 5-10 mins if the seizure continues Second line= IV levetiracetam, phenytoin or sodium valproate Third line = phenobarbital or general anaesthesia