Epilepsy

Question 1

What is epilepsy.

Answer 1

Abnormal neuronal activity, leading to seizures.
It is a recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures.
These may take many forms, but for each individual patient they tend to be stereotyped.

Question 2

What are most cases of epilepsy due to.

Answer 2

Idiopathic (66%, often familial).

Question 3

What are the classes of epilepsy. (6)

Answer 3

Partial seizures. 
Generalised seizures. 
Absence seizures. 
Tonic-clonic seizures. 
Atonic seizures. 
Myoclonic seizures.

Question 4

What characterises a partial seizure. (2)

Answer 4

Abnormal electrical discharge originating from discrete regions of the brain.
They can be simple (patient fully conscious), or complex (decreased awareness).

Question 5

What characterises a generalized seizure.

Answer 5

Abnormal electrical discharge involving the entire brain.

Question 6

What characterises of an absence seizure. (3)

Answer 6

‘Petit mal’.
Sudden brief lapses of consciousness without los of postural control.
>10s.

Question 7

What characterises a tonic-clonic seizure. (4)

Answer 7

‘Grand mal’.
Involves jerking movements.
LOC.
Post-ictal confusion and drowsiness.

Question 8

What characterises an atonic seizure. (3)

Answer 8

Sudden loss of postural muscle tone.
Lasts 1-2seconds.
No LOC.

Question 9

What characterises a myoclonic seizure. (2)

Answer 9

Sudden contractions of the limbs, face or trunk.

Usually followed by unconsciousness.

Question 10

What is the main complication that can arise from epilepsy.

Answer 10

Status epilepticus.

Question 11

What investigations should be carried out in a patient presenting with epilepsy. (10)

Answer 11

FBC. 
UandEs. 
Calcium. 
Magnesium. 
Glucose. 
LFTs. 
Urine/serum toxins. 
EEG. 
CT/MRI brain. 
EEG.

Question 12

What is the treatment for epilepsy.

Answer 12

Anti-epileptics.

Question 13

What are convulsions.

Answer 13

Convulsions are the motor signs of electrical discharges.

Question 14

What is the prevalence of active epilepsy.

Answer 14

1%.

Question 15

What is a non-epileptic cause of seizures.

Answer 15

Metabolic abnormalities.

Question 16

What are the main elements of a seizure. (3)

Answer 16

Prodrome.
Aura.
Post-icatal period.

Question 17

What is a prodrome. (3)

Answer 17

It rarely precedes the seizure, and it may last for hours or days.
It is not part of the seizure itself.
The patient or others notice a change in mood or behaviour.

Question 18

What is an aura. (3)

Answer 18

It is part of the seizure of which the patient is aware.
It may precede its other manifestations.
It may be a strange feeling in the gut, or an experience such as deja vu or strange smells or flashing lights.

Question 19

What does the presence of an aura imply.

Answer 19

It implies a partial (focal) seizure, often, but not necessarily, from the temporal lobe.

Question 20

What may occur post-ictally in a patient with epilepsy. (6)

Answer 20

Headache.
Confusion.
Myalgia.
Sore tongue.
Temporary weakness after a focal seizure in motor cortex (Todd’s palsy).
Dysphagia following a focal seizure in the temporal lobe.

Question 21

What are some structural causes of epilepsy. (6)

Answer 21

Cortical scarring (post-traumatic). 
Developmental. 
Space occupying lesion.
Stroke. 
Hippocampal sclerosis. 
Vascular malformation.

Question 22

What are some other causes of epilepsy. (3)

Answer 22

Tuberous sclerosis.
Sarcoidosis.
TB.

Question 23

What are some non-epileptic causes of epilepsy. (5)

Answer 23

Trauma. 
Stroke. 
Haemorrhage. 
Raised ICP. 
Alcohol or benzodiazepine withdrawal.

Question 24

What are some metabolic causes of epilepsy. (5)

Answer 24

Metabolic disturbances. 
Liver disease. 
Infection (meningitis, encephalitis, syphilis, HIV). 
Raised temperature. 
Drugs (tricyclics, cocaine, tramadol).

Question 25

What are the three aspects of diagnosis epilepsy. (3)

Answer 25

Are they really seizures? What type of seizures it is? Are there any triggers?

Question 26

What should you assess in a first ever epileptic seizure. (3)

Answer 26

Is it really the first seizure? Was the seizure provoked? Investigate - bloods, drug screen, EEG.

Question 27

What should be offered to any patient after a seizure.

Answer 27

Counselling - advice about dangers, until the diagnosis is known.

Question 28

What is involved in a partial seizure in the occipital lobe.

Answer 28

Visual phenomena such as spots, lines, flashes.

Question 29

What is involved in a partial seizure in the parietal lobe. (2)

Answer 29

Sensory disturbances. | Motor symptoms.

Question 30

What is involved in a partial seizure in the frontal lobe. (5)

Answer 30

``` Motor features. Jacksonian march. Motor arrest. Subtle behavioural disturbances. Dysphasia or speech arrest. Post-ictal Todd's palsy. ```

Question 31

What is involved in a partial seizure of the temporal lobe. (7)

Answer 31

Automatisms. Abdominal rising sensation or pain. Dysphasia. Memory phenomena (deja vu). Uncal involvement may cause hallucinations of smell or taste or a dreamlike state. Hippocampal involvement may cause emotional disturbances. Delusional behaviour.

Question 32

What do you treat generalized tonic clonic seizures with. (2)

Answer 32

Sodium valproate or iamotrigine are first line. | Then carbamazepine or topiramate.

Question 33

What do you use to treat absence seizures. (3)

Answer 33

Sodium valproate. Iamotrigine. Or ethusuximide.

Question 34

What do you use to treat tonic, atonic and myoclonic seizures. (2)

Answer 34

Sodium valproate or iamotrigine are first line. | Avoid carbamazepine and oxcarbazepine which may worsen seizures.

Question 35

What do you use to treat partial sseizures and secondary generalized seizures. (3)

Answer 35

Carbamazepine is first line. | Then sodium valproate, iamotrigine.

Question 36

How many drugs should you treat epilepsy with.

Answer 36

ONE.

Question 37

What is sudden unexpected death in epilepsy. (3)

Answer 37

It is more common in uncontrolled epilepsy. It may be related to nocturnal seizure associated apnoea or asystole. Those with epilepsy have a mortality rate 3 times greater than controls.

Question 38

What are the side effects of valproate. (8)

Answer 38

``` Appetite increase, weight gain. Liver failure. Pancreatitis. Reversible hair loss. Oedema. Ataxia. Teratogenicity, tremor, thrombocytopenia. Encephalopathy. ```