Epilepsy

Question 1

What is the differential diagnosis of blackouts?

Answer 1

Syncope

First seizure

Hypoxic seizure

Concussive seizure

Cardiac arrhythmia

Non-epileptic attack:

• narcolepsy, movement disorder, migraine)

Question 2

What are the types of primary generalised seizures?

Answer 2

Tonic-clonic seizures

Myoclonic seizures

Clonic seizures

Tonic seizures

Atonic seizures

Absence seizures

Question 3

What are the features of partial seizures?

Answer 3

May get an “aura”

Any age – cause can be any focal brain abnormality

Simple partial and complex partial seizures can become secondarily generalised

Focal abnormality on EEG

MRI may show cause

Question 4

What techniques are used in the investigation of epilepsy?

Answer 4

1) EEG - Primary generalised epilepsies
2) MRI - Patients < 50 with focal onset seizures. > 50 CT usually adequate
3) Video-telemetry - If still uncertain after 1 & 2

Question 5

What is epilepsy?

Answer 5

Seizures which occur spontaneously, characterised by distrubance of consciousness, behaviour, emotion, motor function or sensation which is believed to result from abnormal neuronal discharges

Question 6

What are the drug treatments for epilepsy?

Answer 6

Primary generalised seizures:

• Sodium valproate
• Lamotrigine
• Levetiracetam

Partial and secondary generalised secondary seizures:

• Lamotrigine
• Carbamazepine

Question 7

What is the treatment of status epilepticus?

Answer 7

1st line:

• Midazolam
• Lorazepam
• Diazepam

2nd line:

• Phenytoin
• Valproate

3rd line:

• Anaesthesia

Question 8

What are the DVLA regulations in relation to epilepsy?

Answer 8

Group 1 license:

• Seizure free for a year OR
• Only had seizures arising from sleep for a year
• If ever had a daytime seizure, but then changed to nocturnal pattern then this pattern must be established for 3 years before they can hold a license

HGV License:

• Seizure free for 10 years and not on anti-epileptic medication