Epilepsy

Question 1

Temporal lobe focal symptoms

Answer 1

Automatisms
Abdominal nausea/pain
Dysphasia
Memory phenomena
Emotional disturbance (hippocampal involvement)
Hallucinations (uncal involvement)
Delusions

Question 2

Fontal lobe focal symptoms

Answer 2

Motor features
Jacksonian seizure
Motor arrest
Dysphasia/speech arrest
Post-ictal Todd's palsy

Question 3

Parietal lobe focal symptoms

Answer 3

Sensory disturbance
Motor symptoms (spread to percentile gyrus)

Question 4

Occipital lobe focal symptoms

Answer 4

Visual phenomena

Question 5

Structural causes of seizure

Answer 5

Cortical scarring
SoL
Stroke
Hippocampal sclerosis
Vascular malformation

Question 6

Developmental abnormalities causing seizure

Answer 6

Cortical dysgenesis

Dysembrioplastic neuroepithelial tumour

Question 7

Metabolic causes of seizure

Answer 7

Na disturbance
Hypercalcemia
Glucose disturbance
Uraemia
Liver disease
Drugs (TCAs, cocaine)

Question 8

3 questions when diagnosing a seizure

Answer 8

1. Was it a seizure?
2. What kind of seizure?
3. What are the triggers/causes?

Question 9

What anti-epileptic drugs do you do blood monitoring for?

Answer 9

Phenytoin

Phenobarbital

Question 10

Anti-convulsant intoxication triad

Answer 10

Ataxia
Nystagmus
Dysarthria

Question 11

When to withdraw anti-epileptic medication

Answer 11

After 2 years seizure-free

Question 12

Treatment for Partial seizure

Answer 12

1. Carbamazepine
2. Lamotrigine
3. Valproate

Question 13

Treatment for absence seizure

Answer 13

1. Valproate

2. Lamotrigine

Question 14

Treatment for generalised Gran-mal seizure

Answer 14

1. Valproate
2. Lamotrigine
3. Carbamazepine/Topiramate

Question 15

SEs Valproate

Answer 15

Appetite and weight gain
Liver failure
Pancreatitis
Reversible hair loss (grows curly)
Oedema
Ataxia
Tremor, thrombocytopenia, Teratogenic
Encephalopathy (hyperammonaemia)

Question 16

SEs carbamazepine

Answer 16

Leucopaenia
Diplopia, blurred vision
Impaired balance, drowsiness
Rash
SIADH

Question 17

SEs Lamotrigine

Answer 17

Maculopapular rash (risk Stephen Johnson)
Hypersensitivity
Diplopia
Photosensitivity
Aplastic anaemia
Tremor
Agitation

Question 18

SEs Phenytoin

Answer 18

Gum hypertrophy
Nystagmus
SLE
Hirsutism
Depression

Question 19

Management of seizure >3 mins

Answer 19

10mg rectal/IV diazepam/lorazepam

Question 20

Management of status epilepticus in community

Answer 20

10 mg rectal diazepam/buccal medazolam

Question 21

Management of status epilepticus in hospital

Answer 21

4mg IV lorazepam in 2mg/min

Repeat 10 mins later