Epilepsy

Question 1

What is epilepsy?

Answer 1

A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures

Question 2

What fraction of epilepsy is idiopathic?

Answer 2

2/3

Question 3

What are some causes of epilepsy?

Answer 3

Cortical scarring, space-occupying lesions, stroke

Question 4

What is a prodrome?

Answer 4

Change in mood or behaviour lasting hours or days before a seizure

Question 5

What does it suggest if a patient experiences an aura?

Answer 5

A partial seizure

Question 6

What might a patient experience postictally?

Answer 6

Headache, confusion, myalgia, sore tongue, temporary weakness after focal seizure in motor cortex, dysphagia after a temporal lobe seizure

Question 7

What is a focal/partial seizure?

Answer 7

Focal onset with features that can be referable to a single lobe

Question 8

What are the subcategories of focal seizure?

Answer 8

Simple partial seizure, complex partial seizure, partial seizure with secondary generalisation

Question 9

What manifestations are typical of a temporal focal seizure?

Answer 9

Aura, deja vu or jamais vu, auditory hallucinations, anxiety, automatisms

Question 10

What manifestations are typical of a frontal focal seizure?

Answer 10

Motor features, Jacksonian march, post-ictal Todd’s palsy

Question 11

What manifestations are typical of a parietal focal seizure?

Answer 11

Sensory disturbances

Question 12

What manifestations are typical of an occipital focal seuzure?

Answer 12

Visual phenomena

Question 13

What are generalised seizures?

Answer 13

Simultaneous electrical discharge throughout the whole cortex, bilateral and symmetrical motor manifestations and always associated with loss of consciousness and lack of awareness

Question 14

What is an absence seizure?

Answer 14

Pale and stare blankly for a few seconds

Question 15

What is a tonic-clonic seizure?

Answer 15

Grand mal, loss of consciousness, limbs stiffen and then jerk

Question 16

What is a myoclonic seizure?

Answer 16

Sudden jerk of limb, face or trunk

Question 17

What is an atonic seizure?

Answer 17

Sudden loss of muscle tone causing a fall

Question 18

What could be provoking causes of a seizure?

Answer 18

Trauma, stroke, haemorrhage

Question 19

What investigations would you do?

Answer 19

EEG, MRI/CT, bloods to rule out potential causes, genetic testing

Question 20

How are seizures due to non-epileptic attack disorder different to epileptic seizures?

Answer 20

More gradual onset, prolonged, abrupt termination, closed eyes

Question 21

What is first line management of focal/partial seizures?

Answer 21

Carbamazepine or lamotrigine

Question 22

What is first line management of generalised tonic-clonic seizures?

Answer 22

Sodium valproate if not able to child bear, lamotrigine if able to

Question 23

What is first line management of absence seizures?

Answer 23

Sodium valproate if not able to child bear, ethosuximide if able to

Question 24

What is first line management of myoclonic seizures?

Answer 24

Sodium valproate if not able to child bear, levetiracetam/topiramate if able to

Question 25

What is first line management of tonic or atonic seizures?

Answer 25

Sodium valproate if not able to child bear, lamotrigine if able to

Question 26

What is a common side effect of sodium valproate?

Answer 26

Nausea

Question 27

What is a common side effect of lamotrigine?

Answer 27

Rash

Question 28

How should you switch AEDs?

Answer 28

Introduce the new drug slowly then withdraw the old drug once the new one is established

Question 29

When might you consider surgery?

Answer 29

If single epileptogenic focus can be identified

Question 30

What are some potential complications?

Answer 30

Falls, injuries, sudden unexpected death in epilepsy

Question 31

What are some risk factors?

Answer 31

FH, Premature babies, abnormal cerebral blood vessels, drugs

Question 32

What is a tonic seizure?

Answer 32

High tone and therefore rigid, stiff limbs

Question 33

What is a clonic seizure?

Answer 33

Rhythmic muscle jerking

Question 34

What is a simple partial seizure?

Answer 34

No affect on consciousness or memory, no post-ictal symptoms

Question 35

What is a complex partial seizure?

Answer 35

Memory/awareness affected, most commonly from temporal lobe, post-ictal confusion if temporal

Question 36

What is a partial seizure with secondary generalisation?

Answer 36

Partial start that develops into a generalised seizure

Question 37

How do you manage prolonged seizures?

Answer 37

Benzodiazepines

Question 38

Generally, what drugs would you give?

Answer 38

Sodium valproate to males, lamotrigine to females