Epilepsy

Question 1

Give some risk factors for epilepsy

Answer 1

Birth problems
Developmental delay
Past seizures
Head injury
Family history

Question 2

Give examples of drugs that can precipitate epileptic seizures

Answer 2

Theophylline
Tramadol
Penicllins/cephalosporins
Anti-emetics
Opioids

Question 3

What investigation must a patient receive if they have presented with seizure?

Answer 3

ECG

Question 4

When do patients with seizures get a CT scan?

Answer 4

Skull fracture
Deteriorating GCS
Focal signs
Head injury

Question 5

What are the only indications for EEG?

Answer 5

Classify epilepsy
Confirm non-epileptic attacks
Surgical evaluation
Confirm non-convulsive status

Question 6

A patient presents with a one-off seizure. For how long are they not allowed to drive cars?

Answer 6

6 months

Question 7

A patient presents with a one-off seizure. For how long are they not allowed to drive HGVs?

Answer 7

5 years

Question 8

A patient has a number of epileptic attacks while awake and has lost consciousness. For how long are they not allowed to drive cars?

Answer 8

1 year

Question 9

An epileptic patient had a single awake seizure, but has since been only having asleep seizures. For how long (from the last awake seizure) is a patient not allowed to drive cars?

Answer 9

3 years

Question 10

For how long must an epilepsy patient have been off medication and not had a seizure before being able to drive HGVs?

Answer 10

10 years

Question 11

What is the cause of epilepsy?

Answer 11

Unprovoked discharges of electrical activity in the brain

Question 12

Epileptic seizures tend to be caused by high frequency excitatory/inhibitory action potentials

Answer 12

Excitatory

Question 13

Epilepsy is commonest at what age?

Answer 13

Over 50

Question 14

What is SUDEP?

Answer 14

Sudden unexplained death in epilepsy patients

Question 15

Give some causes of SUDEP

Answer 15

Aspiration during seizure
Sudden cardiac event
Brain waves stop working

Question 16

What can increase the risk of SUDEP?

Answer 16

Nocturnal seizures
Drugs
Alcohol

Question 17

What occurs in focal epilepsy?

Answer 17

A single part of the brain is abnormal leading to a specific seizure

Question 18

What happens if the focal lesion impacts the cortical network?

Answer 18

Generalised seizures can occur

Question 19

What occurs in generalised epilepsy?

Answer 19

There is an abnormality in the pathways around the brain

Question 20

Give examples of generalised seizures

Answer 20

Absence
Myoclonic
Atonic
Tonic
Tonic clonic

Question 21

Give examples of focal seizures

Answer 21

Motor
Sensory
Psychic

Question 22

Focal epilepsy is commoner in which age group? Why?

Answer 22

Over 50s - more likely to have structural brain abnormality

Question 23

What test can be done in under 30s to determine the type of epilepsy?

Answer 23

EEG

Question 24

What symptoms may be seen in juvenile myoclonic epilepsy?

Answer 24

Early morning jerks

Generalised seizures

Question 25

What treatment is generally given for primary generalised epilepsy?

Answer 25

Sodium valproate

Question 26

Which patients will not normally get sodium valproate? Why?

Answer 26

Young women - teratogenic

Question 27

What drug is given as an alternative to sodium valproate?

Answer 27

Lamotrigine

Question 28

What drugs are given to treat focal onset epilepsy?

Answer 28

Carbamazepine | Lamotrigine

Question 29

What drugs are used to treat absence seizures?

Answer 29

Sodium valproate | Ethosuximide

Question 30

What drugs can be used in myoclonic seizures?

Answer 30

Sodium valproate Levetiracetam Clonazepam

Question 31

What is the main drug used in atonic, tonic and tonic clonic seizures?

Answer 31

Sodium valproate

Question 32

What medications are affected and should not be used in women taking carbamazepine?

Answer 32

Progesterone only pill | Progesterone implants

Question 33

Why must a woman requiring the morning after pill see her doctor if she is taking carbamazepine?

Answer 33

As she will require a higher dose

Question 34

What is status epilepticus?

Answer 34

Recurrent epileptic seizures without full recovery of consciousness

Question 35

What are the types of status epilepticus?

Answer 35

Generalised convulsive Non convulsive status Epilepsia partialis continua

Question 36

Give some precipitants of status epilepticus

Answer 36

``` Severe metabolic disorders Infection Head trauma SA haemorrhage Withdrawal of anti-convulsants ```

Question 37

What is the effect of status epilepticus on the metabolic state?

Answer 37

It is massively increased to maintain convulsion

Question 38

What can occur due to an increased metabolic state?

Answer 38

Hypoxia Hypotension Hyperthermia Rhabdomyolysis

Question 39

What is the first-line drug given in status epilepticus?

Answer 39

Benzodiazepines

Question 40

What other anti-convulsants are used in status epilepticus?

Answer 40

Phenytoin Levetiracetam Sodium valproate