Epilepsy

Question 1

Which investigation is mandatory in a fallen patient?

Answer 1

ECG

Question 2

What patients get a CT scan acutely?

Answer 2

skull fracture 
deteriorating GCS 
Focal signs 
head injury with seizure 
failure of GCS to improve 
suggested other pathology

Question 3

Post 1st seizure, how long should a car driver wait before driving again?

Answer 3

6 months

Question 4

Post 1st seizure, how long should a HGV driver wait before driving again?

Answer 4

5 years

Question 5

In epilepsy diagnosis, how long should a person driving a car wait to drive again?

Answer 5

1 year - 3 years if during sleep

Question 6

In epilepsy diagnosis, how long should a truck driver wait before driving again?

Answer 6

10 years off medication

Question 7

What is generalised epilepsy?

Answer 7

genetic predisposition in most
spike-wave abnormalities in EEG
childhood and adolescence
tonic clinic, absence, myoclonic, clonic, tonic, atonic

Question 8

What is the first line treatment for primary generalised epilepsy?

Answer 8

sodium valproate

Question 9

What is the problem with sodium valproate?

Answer 9

it is teratogenic

Question 10

What can be used as an alternative to sodium valproate?

Answer 10

lamotrigine

Question 11

what is focal onset epilepsy?

Answer 11

focal onset seizures with an underlying structural cause

Question 12

What is the first choice treatment in focal onset epilepsy?

Answer 12

carbamazepine

Question 13

What is a common form of focal onset epilepsy?

Answer 13

complex partial seizures with hippocampal sclerosis

Question 14

What are side-effects of sodium valproate?

Answer 14

weight gain
teratogenic
hair loss
fatigue

Question 15

What is a main side-effect of phenytoin?

Answer 15

enzyme induction

Question 16

When is phenytoin used?

Answer 16

acute seizure management

Question 17

name some new anticonvulsants

Answer 17

lamotrigine
levetiracetam
topiramate
gabapentin, pregabalin

Question 18

What is a problem with lamotrigine?

Answer 18

longtime to titrate to treatment dose

Question 19

What is the main problem with levotriacetam?

Answer 19

mood swings

but well tolerated generally

Question 20

What side-effects can be caused by topiramate?

Answer 20

sedation
dysphasia
weight loss

not very well tolerated

Question 21

What are gabapentin and pregabalin used for?

Answer 21

neuropathic pain

Question 22

Which type of contraceptive pill should not be used with anti-convulsant medication?

Answer 22

progesterone only

Question 23

what happens to the efficacy of the COCP with anticonvulsant use?

Answer 23

altered

Question 24

Which anti-convulsants can induce hepatic enzymes?

Answer 24

carbamazepine 
phenobarbital 
phenytoin 
topiramate 
oxcarbazepine

Question 25

What is status epileptics?

Answer 25

recurrent epileptic seizures without full recovery of consciousness with continuous seizure activity lasting more than 30 minutes

Question 26

what kinds of conditions can precipitate status?

Answer 26

``` severe metabolic disorders infection head trauma SAH withdrawal of AEDs treating absence seizures with CBZ ```

Question 27

What is convulsive status?

Answer 27

generalised convulsions without cessation using excess cerebra energy and poor substrate delivery causing lasting damage

Question 28

What is the immediate management of a seizure patient?

Answer 28

stabilise - ABC identify cause anti-convulsants