epilepsy (see DM)

Question 1

what is an epileptic seizure

Answer 1

a transient episode of abnormal neurological function caused by sudden excessive or hypersynchronous cortical neuronal activity

Question 2

6 types of generalised seizure

Answer 2

1. absence;
2. myoclonic;
3. tonic;
4. atonic;
5. clonic;
6. tonic clonic;

Question 3

syncope (6) vs seizure (9)

Answer 3

syncope:
1. prodromal symptoms (light headedness etc.);
2. pallor;
3. fall;
4. hypotonia;
5. brief duration;
6. no post-ictal confusion

seizure:
1. variable warning;
2. fall
3. initial tonic phase;
4. cyanosis;
5. clonic jerking;
6. duration (minutes);
7. tongue biting;
8. incontinence;
9. post-ictal confusion

Question 4

what is status epilepticus

Answer 4

a dangerous condition in which epileptic fits follow one another without recovery of consciousness between them- medical emergency

Question 5

status epilepticus Mgx

Answer 5

1. ABCDE
2. benzodiazepine given e.g. buccal midazolam, PR diazepam or IV lorazepam

Question 6

what is SUDEP

Answer 6

sudden unexplained death in epilepsy

Question 7

absence (6) vs complex partial (6) seizure

Answer 7

absence:
- brief
- no warning
- EEG generalised 3Hz spike wave
- abrupt onset
- abrupt cessation
- specific drug treatment

complex partial:
- prolonged
- may have warning
- EEG focal abnormalities
- post-ictal period
- automatisms
- most AED used for treatment

Question 8

what is an epilepsy syndrome?

Answer 8

a syndrome defines by non-random clustering of clinical features which occur consistently together

Question 9

what hormone can be used to distinguish between a seizure and pseudoseizure

Answer 9

prolactin (raise in seizure)

Question 10

if a pt has one seizure and normal brain scan what is the chance of recurrance

Answer 10

40% chance and increases in risk as number of seizures increases

Question 11

7 epilepsy syndromes

Answer 11

1. childhood absence epilepsy;
2. juvenile myoclonic epilepsy;
3. autosomal dominant nocturnal frontal lobe epilepsy;
4. benign childhood focal epilepsy;
5. west syndrome;
6. lennox-gastaut syndrome;
7. temporal lobe epilepsy due to mesial temporal scelrosis;

Question 12

how might benign childhood focal epilepsy present

Answer 12

mouth abnormalities - mouth area of the homonculous is affected

Question 13

west syndrome presentation

Answer 13

Violent flexor spasms of the head, trunk and limb followed by extension of the arms; severe brain impairment

Question 14

what drugs does childhood absence epilepsy respond well to

Answer 14

1. ethosuximide
2. sodium valporate

Question 15

how does childhood absence epilepsy present

Answer 15

frequent absence seizures (up to 100/day) seen in children -> onset is usually 5-8 and more common in girls

Question 16

when does childhood absence epilepsy usually remit at

Answer 16

puberty

Question 17

what is juvenile myoclonic epilepsy

Answer 17

myoclonic seizures that arise in teenage years -> these are usually preceded by absence seizures (may even be up to 10 years prior); generalised tonic-clonic seizures may also arise at the same time as myoclonus

Question 18

4 precipitating factors of juvenile myoclonic epilepsy

Answer 18

1. sleep deprivation
2. fatigue
3. alcohol
4. emotional stress/excitement

Question 19

juvenile myoclonic epilepsy EEG (3)

Answer 19

1. irregular 3-6Hz spike/poly spike and slow way discharge;
2. photoparoxysmal responses;
3. focal abnormalities

Question 20

juvenile myoclonic epilepsy prognosis

Answer 20

lifelong seizures though generally well controlled with medication

Question 21

juvenile myoclonic epilepsy Mgx

Answer 21

1. lifestyle advice
2. sodium valporate
3. lamotrigine
4. clonazepam
5. levetiractem

Question 22

what drugs should be avoided in juvenile myoclonic epilepsy

Answer 22

vigabatrin, tiagabine, carbamezapine (may exacerbate myoclonus)

Question 23

what is temporal lobe epilepsy

Answer 23

the most common form of focal epilepsy - seizures arise in the temporal lobe

Question 24

what are the two types of temporal lobe epilepsy

Answer 24

1. mesial temporal lobe (limbic);
2. lateral temporal lobe (neocortical)

Question 25

mesial temporal lobe epilepsy presentation examples

Answer 25

1. olfactory/gustatory hallucinations 2. fear 3. deja vu/jamais vu 4. epigastric sensation 5. behavioural arrest 6. altered awareness/consciousness 7. contralateral dystonic arm posturing 8. lip smacking, swallowing etc. automatisms

Question 26

mesial temporal lobe seizure duration/post-ictal

Answer 26

duration of minutes, followed by post-ictal confusion, dysphagia and gradual recovery

Question 27

what will MRI show of someone with mesial temporal lobe epilepsy

Answer 27

hippocampal atrophy/sclerosis

Question 28

what facial abnormality might be seen in someone with mesial temporal lobe epilepsy

Answer 28

facial asymmetry - flattening of the contralateral naso-labial fold

Question 29

mesial temporal lobe epilepsy mgx

Answer 29

seizures usually still occur with medication -> surgery my be the only option

Question 30

what may cause SUPED to occur (4)

Answer 30

1. breathing - A seizure typically may cause a person to briefly stop breathing -> can result in hypoxia if last too long; 2. heart rhythm - Rarely, a seizure may cause a dangerous heart rhythm or cardiac arrest; 3. brain function - Seizures may suppress or interfere with the function of vital areas in the brainstem; 4. other (unknown)

Question 31

causes of excess mortality in epilepsy (7)

Answer 31

1. underlying disease 2. suicide 3. seizure related accidents 4. status epilepticus 5. drug reactions 6. aspiration pneumonia 7. SUDEP

Question 32

risk factors for SUDEP (6)

Answer 32

1. young; 2. generalised tonic-clonic seizures; 3. uncontrolled epilepsy 4. learning diability 5. seizures occuring during sleep 6. poor adherence to antiepileptic drug regimens

Question 33

causes of depression in epilepsy (4)

Answer 33

1. underlying cause of seizure; 2. physiological effects of recurrent seizures; 3. iatrogenic factors (AEDs, post operative, force normalisation); 4. psychosocial consequences of epilepsy

Question 34

treatment pathway for epilepsy (basic)

Answer 34

first monotherapy AED -> second monotherapy AED trial -> polytherapy AED trial -> epilepsy surgery evaluation

Question 35

what type of epilepsy is most suitable to surgery

Answer 35

lesional temporal lobe epilepsy

Question 36

why are areas of the brain temporarily lesioned in the epilepsy surgery work up

Answer 36

to see what the side effects of this lesion are prior to permanent resection

Question 37

contraindications for epilepsy surgery (4)

Answer 37

1. multi focal epileptogenic regions 2. non-localisable epileptogenic zone 3. epileptogenic region in eloquent cortex 4. patient reluctance

Question 38

4 ways of neuromodulation in epilepsy (if surgery and AED not sutiable)

Answer 38

1. vagal nerve stimulation 2. responsive neurostimulation 3. deep brain stimulation 4. trigeminal nerve stimulation

Question 39

side effects of vagal nerve stimulation (4)

Answer 39

1. hoarsness/voice alteration 2. coughing 3. dyspnoea 4. parasethesia i.e. effects of CN X stimulation