Epilepsy and seizures

Question 1

What is epilepsy?

Answer 1

Epilepsy is a common neurological condition characterised by recurrent seizures.

Question 2

What is presentation of a seizure?

Answer 2

• TLOC
  
  • Tongue biting
  • Incontinence of urine
  • Post-ictal phase

Question 3

What are causes of seizures?

Answer 3

Epilepsy
toxins, illicit substances, medications that lower seizure thresholds, or metabolic derangements can provoke generalised seizures

Focal seizures can be caused by structural cause e.g. tumour

Question 4

What is classification of seizures?

Answer 4

Focal seizure: :starts in area of the brain, with varying levels of awareness

Generalised: starts in both sides of the brain, and always affect awareness with consciousness lost immediately.
• Motor e.g. tonic clonic, tonic, clonic, myoclonic
• Non-motor e.g. absence

Question 5

What investigations should you do in someone with a seizure?

Answer 5

In unprovoked: EEG and MRI

In provoked: usually CT head if FND/not recovering to baseline.

Bloods: glucose, toxicology.

CK, lactate, and prolactin raised in seizure (orolactin in generalised)

Question 6

When should AED be started?

Answer 6

AED therapy is generally recommended after a second unprovoked seizure and should be considered after a first unprovoked seizure if:

* EEG shows unequivocal epileptic activity 
* Brain imaging shows a structural abnormality 
* Ongoing neurological deficit or abnormality 
* Patient/family considers the risk of further seizures unacceptable

Question 7

What drugs used in epilepsy?

Answer 7

Focal: usually carbamazepine

Generalised: usually sodium valproate

Others: lamotrigine (not myoclonic) levetiracetam

Question 8

What are side effects of AED?

Answer 8

Acute: fatigue
Chronic: decreased BMD, folate deficiency, gingival hypertrophy, alopecia, weight change

SJS, agranulocytosis

Birth defects

Drug interactions

Question 9

What are the car DVLA restrictions with elipepsy?

Answer 9

First unprovoked seizure:
• No driving for 6 months

Epilepsy or multiple unprovoked seizures/abnormality on imaging:
• No driving for 12 months

Question 10

When can AED be withdrawn?

Answer 10

2 years if seizure free

Question 11

What is status epilepticus?

Answer 11

Continuous seizure activity for a prolonged period of time(>5 minutes) or repetitive seizures that occur without regaining consciousness

Question 12

How is status epilepticus treated

Answer 12

ABCDE

Treat hypoglycaemia and alcohol abuse

Give normal AED

IV or rectal benzodiazepine, repeat after 10 mins if necessary

If persists: IV phenytoin, continuous ECG monitoring

ITU

Question 13

What are differentials for seizures/epilepsy

Answer 13

Febrile convulsions
Alcohol withdrawal seizures
Psychogenic non-epileptic seizures

Question 14

What is refractory epilepsy

Answer 14

Epilepsy not responding to AED

May be due to wrong diagnosis, wrong drug or dose, compliance with drugs