Epilepsy

Question 1

in a falls history, what aspects should be asked about in the “before” segment

Answer 1

pallor
light headedness
triggers - flashing lights 
posturing of limbs 
head turning

Question 2

in a falls history what aspects should be asked about in the “during” segment

Answer 2

tonic
clonic
rigidity
responsiveness and awareness

Question 3

in a falls history what aspects should be asked about in the “after” segment

Answer 3

speed of recovery

disorientation

Question 4

risk factors for epilepsy

Answer 4

complicated birth 
delayed development 
previous seizures including febrile 
head injury
family history 
drugs 
alcohol

Question 5

list drugs precipitating epileptic seizures

Answer 5

theophylline 
tramadol 
opioids
penicillins 
cephalosporins 
quinolones 
lithium 
lidocaine 
antidepressants 
anticholinergics 
prochlorperazine

Question 6

which single investigation should all people who have had a fall/collapse get?

Answer 6

ECG

Question 7

which cardiac condition is it vital not to miss in terms of falls

Answer 7

LQTS

Question 8

who gets a CT scan acutely

Answer 8

skull fracture
deteriorating GCS
focal neurological deficit head injury with seizure failure of GCS 15/15 after 4 hours
suggestion of other pathology

Question 9

what is an EEG and is it a good test to diagnose epilepsy after a collapse

Answer 9

electroencephalogram

it is a dreadful test and should not be used to diagnose epilepsy after a collapse

Question 10

what is an EEG used for

Answer 10

to classify epilepsy
confirm non-epileptic attack/non-convulsive status
surgical evaluation

Question 11

differential diagnoses of collapse

Answer 11

syncope
seizure 
hypoglycaemia 
pseudoseizure 
sleep phenomena 
parasomnias
migraine 
cataplexy 
tonic spasms of MS

Question 12

how long until you are able to drive a car after your first seizure

Answer 12

6 months

Question 13

how long until you are able to drive a HGV/PCV after your first seizure

Answer 13

5 years

Question 14

1 seizure = epilepsy, true or false

Answer 14

false

Question 15

when can you drive a car if you have epilepsy

Answer 15

1 year being seizure free

or 3 years during sleep

Question 16

when can you drive a HGV/PCV if you have epilepsy

Answer 16

after being medication free for 10 years

Question 17

define epilepsy

Answer 17

a tendency to recurrent spontaneous epileptic seizures

Question 18

define seizure

Answer 18

abnormal synchronisation of electrical activity

• excitatory
• inhibitory

Question 19

what is SUDEP

Answer 19

sudden unexplained death in epilepsy

Question 20

how are seizures classified

Answer 20

focal/partial

generalised

Question 21

describe focal seizures

Answer 21

irritation occurs in a certain area of the brain eg stroke, haemorrhage, demyelination, tumour

Question 22

focal seizures can have secondary generalisation, true or false

Answer 22

true

Question 23

describe generalised seizures

Answer 23

abnormal electrical activity all over the brain

Question 24

how can epilepsy be classified

Answer 24

focal

generalised

Question 25

how can focal epilepsy be classified

Answer 25

simple | complex

Question 26

describe simple focal epilepsy

Answer 26

consciousness NOT impaired

Question 27

describe complex focal epilepsy

Answer 27

consciousness IS impaired

Question 28

define focal epilepsy

Answer 28

recurrent focal seizures +- 2ndary generalisation

Question 29

how can generalised epilepsy be classified

Answer 29

``` absence atonic tonic tonic clonic / primary generalised myoclonic ```

Question 30

define generalised epilepsy

Answer 30

recurrent generalised seizures

Question 31

what group of epilepsy is Juvenile Myoclonic Epilepsy and what is the best treatment

Answer 31

primary generalised | Na valproate but lamotrigine is used as an alternative

Question 32

what group of epilepsy is Complex partial epilepsy with hippocampal sclerosis and what is the best treatment

Answer 32

focal epilepsy carbamazepine or lamotrigine occurs in <30 yo

Question 33

what is the benefit of anti epileptic drugs AEDs

Answer 33

to reduce likelihood of having more seizures in the first place

Question 34

AEDs are prescribed after 1 seizure, true or false

Answer 34

FALSE | not prescribed after a one off seizure

Question 35

carbamazepine is used for focal/generalised epilepsy only

Answer 35

focal | makes generalised epilepsies worse

Question 36

what is phenytoin and what is it used for | side effects?

Answer 36

anti-convulsant acute management only enzyme inducer

Question 37

what is Na valproate and what is it used for

Answer 37

Na channel inhibitor anti convulsant | all types of epilepsy

Question 38

side effects of Na valproate

Answer 38

TERATOGENIC weight gain hair loss fatigue

Question 39

what is carbamazpine and what is it used for

Answer 39

Na channel blocker anti convulsant | focal epilepsy only

Question 40

what is lamotrigine and what is it used for

Answer 40

Na channel blocker anti convulsant | focal and generalised epilepsies

Question 41

what is a side effect of lamotrigine and what is done as a result

Answer 41

Steven Johnson Syndrome | dose is slowly titrated up

Question 42

what is levetiracetam | side effects?

Answer 42

anti convulsant | well tolerated but can cause mood swings

Question 43

what is a side effect of topiramate

Answer 43

``` weight loss parasthesia poor cognition sedation dysphasia enzyme inducer ```

Question 44

which anti convulsants induce hepatic enzymes and why is this a problem

Answer 44

``` carbamazepine oxcarbazine phenobarbitol phenytoin primodone topiramate They alter the efficacy of the OCP ```

Question 45

Progestogen only pills and implants can be used with antoconvulsants, true or false

Answer 45

FALSE, they should not be used

Question 46

how should contraception be managed in ladies on anti-convulsants

Answer 46

need higher dose of contraceptive pill and morning after pill

Question 47

management of women wanting to get pregnant on AEDs

Answer 47

preconceptual counselling risk benefit balance with drugs high dose folic acid + vit K

Question 48

what is status epilepticus SE

Answer 48

recurrent epileptic seizure without full recovery of consciousness continuous seizure lasting >30 min

Question 49

what types of status epilepticus are there

Answer 49

generalised convulsive non-convulsive continuous focal seizures

Question 50

list precipitants of SE

Answer 50

``` severe metabolic disorders abrupt withdrawal of AEDs infection trauma SAH treating absence seizures with carbamazepine ```

Question 51

why is SE so dangerous

Answer 51

multi organ failure | excitotoxicity results in neuronal death

Question 52

investigations in SE

Answer 52

ABCDE bloods - FBC, LFT, U+E +- CT scan

Question 53

pharmacological management of SE

Answer 53

``` benzodiazepines: buccal/IM midazolam twice maximum with 5 minute intervals phenytoin Na valproate keppra thiopentone, propofol - ICU! ```