epilepsy

Question 1

causes epilepsy

Answer 1

primary generalised epilepsy (JME), developmental (neuronal migration), hippocampal sclerosis, trauma and surgery, tumour, vascular (stroke, CVA), encephalitis/inflammatory, metabolic (low calcium, sodium), Alzheimers, drugs, alcohol

Question 2

what drugs are implicated in epilepsy as a cause

Answer 2

ciclosporin, lidocains, quinolones, TCAs, antipsychotics

Question 3

what can hippocampal sclerosis be due to

Answer 3

childhood febrile convulsions

Question 4

what is JME

Answer 4

myoclonic starts in teenager can go unrecognised and later have a generalised tonic clonic. life long treatment neded. occur in the morning after waking

Question 5

when does loss of consciousness occur

Answer 5

in complex partial and all generalised seizures

Question 6

what are the generalised seizures

Answer 6

absence, tonic clonic, myoclonic, atonic

Question 7

signs of temporal partial seizure

Answer 7

automaticisms- lip smacking, singing, kissing, chewing; dysphasia; memory- deja vu; emotional disturbance; abdominal rising sensation; delusional; emotional disturbance

Question 8

signs of occipital partial seizure

Answer 8

visual- flashes, spots, lines

Question 9

signs of parietal partial seizure

Answer 9

sensory disturbance- tingling, numbness

Question 10

signs frontal partial seizure

Answer 10

behavioural; dysphasia; motor- peddling movement of the legs, post ictal Todds palsy

Question 11

what is Todds palsy

Answer 11

focal weakness in a part of the body after a seizure

Question 12

investigations

Answer 12

FBC, ESR, renal, LFT, calcium, glucose, ECG, MRI, EEG

Question 13

management - DVLA

Answer 13

must not drive 12 months after last seizure. If it is the first seizure then 6 months off driving

Question 14

management of a single seizure

Answer 14

no treatment unless high risk of recurrence

Question 15

first line generalised tonic clonic

Answer 15

sodium valproate, lamotrigine

Question 16

first line absence

Answer 16

sodium valproate, lamotrigine

Question 17

what drug should you not use in absence of myoclonic

Answer 17

carbamazepine

Question 18

first line myoclonic

Answer 18

levetiracetam, valproate, topiramate

Question 19

first line partial with or without 2ary generalisation

Answer 19

carbamazepine, lamotrigine

Question 20

side effects sodium valproate

Answer 20

Valproate; Appetite incr- weight gain; Liver failure; Pancreatitis; Reversible hair loss; Oedema; Ataxia; Teratogenecity, tremor, thrombocytopenia; Encephalopathy

Question 21

side effects carbamazepine

Answer 21

leucopenia, diplopia, rash, blurred vision

Question 22

side effects lamotrigine

Answer 22

maculopapular rash (stevens jonhson), diplopia, photosensitivity, blurred vision, tremor, anaemia

Question 23

side effects levetiracetam

Answer 23

psych side effects- depression, agitation; D&V, dyspepsia, drowsy, diplopia, blood dyscrasia

Question 24

side effects phenytoin

Answer 24

decr intellect, depression, coarse facial features, acne, gum hypertrophy

Question 25

which drugs interfere with contraception

Answer 25

hepatic enzyme inducing AEDs- carbamazepine, phenytoin, phenobarbital

Question 26

what is status epilepticus

Answer 26

continuous seizures lasting >30mins.

Question 27

why could status happen in a patient with pre existing epilepsy

Answer 27

recent medication reduction or withdrawal, progressive disease, metabolic, intercurrent illness

Question 28

why could status happen in someone with no Hx epilepsy

Answer 28

metabolic- decr glucose, Na, incr Ca; alcohol; toxicity; CVS; SAH; SOL; cerebral infection;; febrile illness

Question 29

complications of status- cerebral

Answer 29

oedema, incr ICP, haemorrhage, infarction, damage 2ary to hypoxia, seizure, metabolic

Question 30

complications of status- systemic

Answer 30

DIC, severe dehydration, metabolic acidosis, hypothermia, pancreatitis, renal and hepatic failure

Question 31

complications of status- cardioresp

Answer 31

arrhythmias, resp failure, shock, cardiac arrest, hyper/hypotension, pulmonary oedema, PE, aspiration pneumonia

Question 32

management of status- early treatment

Answer 32

IV lorazepam 2-4mg, rectal diazepam

Question 33

management of status- when seizure duration >10mins

Answer 33

IV phenytoin (phenobarbital if already on phenytoin)

Question 34

if doesn't respond to phenytoin (status)

Answer 34

general anaesthetic, transfer to ITU, midazolam, thiopental

Question 35

how can you differentiate a real seizure and a pseudoseizure

Answer 35

real seizure- increase in prolactin. do EEG