Epilepsy

Question 1

What is focal epilepsy caused by?

Give a common example

Answer 1

Focal structural abnormality

Hippocampal sclerosis

Question 2

Give examples of symptoms you might be in a frontal lobe seizure.

Answer 2

Repetitive muscle/muscle group clonus

Posturing

Personality change

Question 3

Give examples of symptoms you might be in a parietal lobe seizure.

Answer 3

Pain

Indescribable sensory phenomena

Question 4

Give examples of symptoms you might be in a temporal lobe seizure.

Answer 4

Automatism

Deja vu

Dysphoria/euphoria

Unusual speech

Question 5

Focal epilepsy tends to present in childhood.

T/F?

Answer 5

False

Focal epilepsy tends to affect older people as it is caused by structural abnormalities

Question 6

What causes generalised seizures?

Answer 6

Abnormal brain activity in a connecting pathway in the brain

Question 7

Describe tonic-clonic seizure.

Answer 7

Patients stiffen (tonic), jerk (clonic) and are confused/drowsy afterwards

Question 8

Describe atonic seizure

Answer 8

Patient loses tone of muscles without loss of consciousness

Question 9

Describe absence seizure

Answer 9

Brief lapse in awareness where patients stop speaking and stare (seen in children)

Question 10

Describe myoclonic seizure

Answer 10

Sudden jerk of limb, trunk or face

Question 11

Generalised epilepsy tends to present in childhood.

T/F?

Answer 11

True

Question 12

What is functional attack disorder and how can you clinically differentiate it from epilepsy?

Answer 12

Condition caused by past traumas which presents with seizures related to trauma, stress or anxiety

Traumatic event in childhood

Co-ordinated movement during seizure

Describe familiar aura (e.g. sweet smell/taste, not indescribable)

Question 13

How do you manage functional attack disorder?

Answer 13

Exclude epilepsy (EEG)

Counselling (when patient is ready to confront trauma)

Question 14

What investigations would you order in newly presenting epilepsy?

Answer 14

ECG
Essential investigation to look for prolonged QR syndrome which is fatal if missed

EEG
Classifies epilepsy

Question 15

Management of an acute seizure?

Answer 15

IV/rectall benzodiazepine

IV phenytoin

Question 16

First line management of focal epilepsy

Answer 16

Carbamazepine or lamotrigine

Question 17

First line management of generalised epilepsy

Answer 17

Sodium valproate

Question 18

Second line management of focal epilepsy

Answer 18

Levetiracetam or sodium valproate or topiramate

Question 19

Second line management of generalised epilepsy

Answer 19

Lamotrigine or levetiracetam

Question 20

Third line management of generalised epilepsy

Answer 20

Dual therapy

sodium valproate, lamotrigine, levetiracetam

Question 21

Third line management of focal epilepsy

Answer 21

Dual therapy
(carbamazepine, lamotrigine, levetiracetam, topiramate)

Unless they are over 60

Question 22

Last line management of focal epilepsy

Answer 22

Excisional sugery (if one epileptogenic focus)

Vagus nerve stimulation (if more than one epileptogenic focus)

Question 23

Patient given new diagnosis of epilepsy.

How long does she lose her driving license for?

Answer 23

Until 1 year seizure free

Question 24

Patient has first seizure.

How long do they lose their license for?

Answer 24

6 months seizure free

Question 25

Patient who works in HGV has a seizure How long until she can drive her HGV?

Answer 25

5 years

Question 26

Patient who works in HGV is given new diagnosis of epilepsy How long under she can drive her HGV?

Answer 26

10 years seizure free off medication

Question 27

Patient with known epilepsy is acting strangely on the ward. What should this raise suspicion of?

Answer 27

Non-convulsive status epilepticus

Question 28

What is status epilepticus? Why is it an emergency?

Answer 28

Seizure without spontaneous recovery Brain can't sustain high metabolic demands of a seizure

Question 29

What is the management of status epilepticus?

Answer 29

Benzodiazepines IV/IM (maximum of 2 doses)

Question 30

What increases the chances of sudden death in epilepsy?

Answer 30

Sudden Unexpected Death in Epilepsy (SUDEP) risk increased with - nocturnal seizure - drug use - poor medication compliance

Question 31

Mechanism of action of carbamazepine

Answer 31

Na channel blocker which decreases neuronal activity

Question 32

Mechanism of action of lamotrigine

Answer 32

Na channel blocker which decreases neuronal activity

Question 33

Mechanism of action of topiramate

Answer 33

Na channel blocker which decreases neuronal activity

Question 34

Mechanism of action of sodium valproate

Answer 34

Increases GABA synthesis

Question 35

Mechanism of action of levetiracetam

Answer 35

Inhibits SV2A which inhibits neurotransmitter release

Question 36

Which anticonvulsant is useful for focal seizures but can worsen generalised seizures?

Answer 36

Carbamazepine

Question 37

What anticonvulsant should be avoided in young women?

Answer 37

Sodium valproate (teratogenic)

Question 38

What is first line management of generalised epilepsy in a pregnant women?

Answer 38

Lamotrigine, levetiracetam

Question 39

Which anticonvulsant can cause mood swings?

Answer 39

Levetiracetam

Question 40

Which anticonvulsant should be avoided in obesity?

Answer 40

Sodium valproate Causes weight gain

Question 41

Which anticonvulsant can cause weight loss?

Answer 41

Topiramate

Question 42

17 year old girl started on carbamazepine. What should you ask about before sending her away?

Answer 42

Contraception Carbamazepine is hepatic enzyme induced and reduces effectiveness of COCP

Question 43

Women with epilepsy wants to get pregnant. What do you give her?

Answer 43

5mg folic acid daily