epilepsy

Question 1

What is epilepsy

Answer 1

Epilepsy is a neurological disorder characterized by recurring seizures, which are sudden, abnormal electrical activity in the brain.

Question 2

At what age does epilepsy occur most frequently

Answer 2

childhood to adolescence

Question 3

What are the risk factors that can predispose a patient to getting epilepsy

Answer 3

Young patients may develop epilepsy either due to genetics or a premature birth

older patients may develop epilepsy because of dementia

All people can develop epilepsy when there is a change in structure to the brain

Question 4

What are the three phases of a seizure

Answer 4

pre ictal
ictal
post ictal

Question 5

what is the pre ictal phase of a seizure

Answer 5

when a patient begins to feel “off” some people may get dejavu or begin to smell strange smells etc

Question 6

What is the ictal phase of a seizure

Answer 6

the start to the end of a seizure where there is intense electriccal activity in the brain

Question 7

what is the post ictal phase of a seizure

Answer 7

the afterward and recovery stage where a patient has had a seizure

Question 8

What are the 4 different types of seizures

Answer 8

absence

myoclonic

tonic + atonic

tonic clonic

Question 9

what is an absence seizure

Answer 9

an absence seizure is most common in children and presents as them being blank and unresponsive for a couple of seconds with a high frequency

Question 10

what is a myoclonic seizure

Answer 10

myoclonic seizures most commonly occur after waking up and present with muscle jerks but the patient is conscious

Question 11

what is a tonic seizure

Answer 11

where the patients muscles are stiff during the seizure

Question 12

what is an atonic seizure

Answer 12

where the patients muscles are floppy during the seizure

Question 13

what is a tonic clonic seizure

Answer 13

a seizure in which the patient is not conscious and has stiff muscles while jerking and shaking

in the post ictal phase they will feel fatigued and confused.

Question 14

Seizures can have different onsets in addition to different types name the four different types of onset

Answer 14

Focal onset

Generalized onset

Unknown onset

Unclassified onset

Question 15

what is a focal onset

Answer 15

focal onset is when the seizure stays in one part of the brain and stays there and can either be an aware focal onset or unaware focal onset relating to if they are conscious or not

Question 16

what can a focal onset develop into

Answer 16

tonic clonic seizure

Question 17

what is generalized onset

Answer 17

when the seizurre affects both sides of the brain without warning and the patient losing conscious except in one type of seizure

Question 18

what type of seizure has a generalized onset but the patient is aware of it

Answer 18

myoclonic seizures

Question 19

what is unknown onset

Answer 19

after looking at the information we cant determine whether something has a focal onset or a generalized onset

Question 20

what is unclassified onset

Answer 20

we havent got enough information to determinee if the seizure has a generalized or focal onset

Question 21

What are the two types of epilepsy syndrome

Answer 21

dravet

lennox - gastaut

Question 22

what is dravet syndrome

Answer 22

A syndrome that develops from birth and is resistant to anti-epilepsy medication

Question 23

what can trigger dravet syndrome

Answer 23

hyperthermia

infection

flashing lights

emotional stress

excitement

Question 24

what is lennox gastaut syndrome

Answer 24

when a young patient <10 presents with delayed intellectual development with regular syndrome they are said to haave this

Question 25

what are the two things we need to look out for as a medical emergency when it comes to epilepsy

Answer 25

high frequency (cluster seizures) long duration (prolonged convulsive seizure or status epilepticus)

Question 26

what are cluster seizures

Answer 26

cluster seizures are when a patient experiences more than 3 seizures in 24 hours

Question 27

what is a prolonged convulsive seizure

Answer 27

when a seizure lasts for longer than 2 minutes from regular seizure

Question 28

how do we treat a prolonged convulsive seizure

Answer 28

clobazam or midazolam

Question 29

what is status epilepticus

Answer 29

a seizure that lasts for longer than 5 minutes

Question 30

how do we treat status epilepticus

Answer 30

buccal midazolam rectal diazepam if no response call 999 repeat dose after 10 mins if still no response give - levetiracetem - phenytoin - sodium valporate or phenobarbital generalized anasthesia

Question 31

how does epilepsy actually occur

Answer 31

over firing of excitatory symptoms and failure of inhibitory action potentials

Question 32

what ions are associated with excitatory signals

Answer 32

na+ ca2+

Question 33

what ions are associated with inhibitory signals

Answer 33

cl - k +

Question 34

what are the channels associated with excitatory signals

Answer 34

NMDA

Question 35

what are the substances associated with excitatory signals

Answer 35

Glutamate Acetylcholine

Question 36

what is the substance associated with inhibitory signals

Answer 36

GABA

Question 37

what are the four drugs that we need to use brand specific prescribing and dispensing called

Answer 37

carbamazepine phenobarbital phenytoin primidone are all classed as catagory 1 epileptic drugs

Question 38

What is first line in focal seizures for treatment

Answer 38

levitiracetem lamotrigine

Question 39

what is first line in patients with generalized tonic clonic seizures

Answer 39

sodium valporate (not pregnant women however)

Question 40

what is the first line in patients able to give birth

Answer 40

lamotrigine levetiracetem

Question 41

what is the first line in absence seizures

Answer 41

ethosuximide

Question 42

what medications can absence seizures be exacerbated by

Answer 42

carbamazepine gabapentin oxcarbazepine phenobarbital phenytoin pregabalin

Question 43

what is the first line in myoclonic seizures

Answer 43

sodium valporate (not in pregnant patients)

Question 44

what is the first line in myoclonic seizures for patinets that can give birth

Answer 44

levetiracetem

Question 45

what is the first line in tonic / atonic seizures

Answer 45

sodium valporate

Question 46

what is the first line in tonic / atonic seizures for patients that can give birth

Answer 46

lamotrigine

Question 47

what medications are NOT associated with antiepileptic hypersensitivity syndrome

Answer 47

sodium valporate levetiracetem ethosuximide

Question 48

how long should patients watch out for symptoms of antiepileptic hypersensitivity syndrome

Answer 48

2 months

Question 49

what symptomss of antiepileptic hypersensitivity syndrome are most common

Answer 49

rash swollen lymph nodes fever

Question 50

how long must a patient be seizure free to stop taking anti-epileptic medications

Answer 50

2 years min

Question 51

How long is the duration over which we wean down aa paitent on anti-epileptics

Answer 51

3 months min

Question 52

what two drugs lengthens the wean down period

Answer 52

benzodiazapines barbituates

Question 53

If someone who drives undergoes a seizure what must they do

Answer 53

stop driving and inform the DVLA

Question 54

when someone has their first unprovoked seizure how long must pass before they are allowed to drive

Answer 54

6 months

Question 55

If a patient has epilepsy but wants to drive what criteria must they meet

Answer 55

medication adherence follow up adherence be seizure free for 1 year minimum not have a history of unprovoked seizures

Question 56

Case: a patient has had a seizure during their sleep but wants to know what the criteria is for being allowed to drive

Answer 56

a year must pass from the date of the seizure unless The patients seizures only occur while they are asleep (3 year process)

Question 57

Case: a patient is currently in the process of changing their medication how long must they wait before they can drive again

Answer 57

6 months

Question 58

Case: a patient is going through the process of withdrawing from their medication how long must they wait before they can drive again

Answer 58

6 months from last dose

Question 59

Case: a patient is going through a change in their medication but has a seizure how long must they wait before they can drive again

Answer 59

1 year

Question 60

what is the min dose of carbamazepine that is clinically appropriate

Answer 60

100mg OD

Question 61

what is the max dose of carbamazepine that is clinically appropriate

Answer 61

400mg od

Question 62

aside from epilepsy what can carbamazepine be used for

Answer 62

trigeminal neuralgia bipolar disorder diabetic neuropathy

Question 63

what is carbamazepine contraindicated in

Answer 63

acute porphyria atrioventricular conduction problems bone marrow depression acute liver disease severe leukopenia

Question 64

Much like valporate what patient groups is vit d reccomended in

Answer 64

patients who are immobile patients who dont get enough sun patients who dont get enough ca2+ in diet

Question 65

what are the common side effects of carbamazepine

Answer 65

dizzy drowzy luekopenia thrombocytopenia GI Weight gain

Question 66

What are the notable side effects of carbamazepine

Answer 66

agranulocytosis alopecia bone marrow disorders photosensitivity

Question 67

what enzyme does carbamazepine induce

Answer 67

cyp3a4

Question 68

what does caramazepine interact with

Answer 68

cyp3a4 inhibitors such as clarithromycin ketoconazole biologics ending in ir amiodarone ticragrelor