Epilepsy/seizure

Question 1

What is a jacksonian march?

Answer 1

Attacks start in one part of body and gradually spread to others

Question 2

What is Todds palsy?

Answer 2

A paresis of affected limb lasting hours after partial seizure - stroke mimic

Question 3

What is epilepsy? and criteria?

Answer 3

Neurological disorder marked by sudden, recurrent episodes of sensory disturbance, LOC or convulsions ass with abnormal electrical activtiy in the brain

-At least two unprovoked seizures more than 24 hours apart

Question 4

What genetic disorders are more likely to have epilepsy?

Answer 4

Downs syndrome - 10%
Angelmans = 80%
Prader-Willi - 20%

Question 5

Who gets epilepsy?

Answer 5

Children or over 60s
More common in learning disability
Genetic disorders
First degree relatives with condition

Question 6

What drugs can cause epilepsy?

Answer 6

Isonazid, tricyclic antidepressants
Binge alcohol drinking
Drug - benzodiazapenes or alcohol withdrawal

Question 7

What metabolic disorders can cause epilepsy?

Answer 7

Hyponatremia/hyper, hyper/ocalcemia
Uraemia, hypoglycaemia

Question 8

Causes of epilepys - list

Answer 8

Idiopathic
Genetic/congenita
Drugs
Metabolic/electrolyte disorders
CNS infections eg meningitis
Autoimmune disease
Brain neoplasm
Head injury/cranial surgery
Neurodegenerative diseases
1/3 - anatomical/sy,ptomatic eg cerbrocascualr disease, tumour, head injury

Question 9

What is Sodium valproate used ofr? contraindications?

Answer 9

generalised seizures
- Teratogenic, lvier damage

Question 10

What is Carbamazepine used for + contraindications?

Answer 10

focal seizures
- Teratogenic, myelosurpession, ataxia, diplopia

Question 11

What is phenytoiin used for? Containdications?

Answer 11

• Phenytoin
  
  • Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia

Question 11

What is phenytoiin Containdications?

Answer 11

• Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia

Question 12

What drug is used fro absence seizures?

Answer 12

Ethosuximide

Question 13

What syndrome is a contraindication for lamotrigine?

Answer 13

Steven-Johnson syndrome

Question 14

Driving advice in epilepsy

Answer 14

Driving advice in epilepsy –
Car/ Bike:
Epileptic seizure – no driving for 1 year without seizure
One off seizure – no driving for 6 months without seizure
Bus/ coach:
More than one seizure – no driving for 10 years without seizure and not on AEDs
One off seizure – no driving for 5 years without seizure and not on AEDs

Question 15

Treatment of status epilepticus

Answer 15

1st line = benzodiazapine

• IV lorazepam 4mg
  
  • Repeat after 10 mins
  • Consider PR diazepma or buccal midazolam if no IV access

2nd line = AED-20 mins

• eg Phenytoin, Levetriacetam, valproate
• Loading dose then infusion

3rd line = anaesthetise + ventialte - 30 mins

• ITU e/EEG monitoring

Question 16

First line treatment of myoclonic seizures in males

Answer 16

Sodium valproate

Question 17

What do myoclonic seizures NOT display?

Answer 17

LOC
Incontinence
Tongue biting
Post ictal period of fatigue

Question 18

What seizures is ethosuximide used for?

Answer 18

Absence

Question 19

When is lamotrigine/topirimate used in men?

Answer 19

3rd line for myoclonic seizures after sodium valproate and levetriacetam have failed

Question 20

What is first line for women with myoclonic seizures?

Answer 20

Levetiracetam

Question 21

Why is sodium valproate not offered to women of child bearing age?

Answer 21

It is severely teratogenic - neurodevelopmental delay

Question 22

When do you treat epilepsy?

Answer 22

After the second seizure unless meet crtieria for after first one

Question 23

Criteria for epilepsy treatment after first seizure

Answer 23

Neurological deficit
Structural abnormality on scan
EEG - unequivocal epileptic activity
Patient or faimly - furture risk of seizure is unacceptable

Question 24

Generalised tonic clonic, tonic or atonic, myclonic first line, absence seizures second line medication?

Answer 24

Men - sodium valproate Women - Lamotrigine (not in myoclonic) or levetiracetam (not in tonic or atonic)

Question 25

Focal seizures treatment 1st line and second line

Answer 25

1st - lamotrigine or levetiracetam 2nd - carbamazepine, oxcarbexapine or zonisamide

Question 26

What medication may exacerbate absence seizures?

Answer 26

Carbamazepine

Question 27

Differentials for seizures

Answer 27

Syncope Migraine Transient ischaemic attack Cardiac arrhythmias Paroxysmal vertigo Acute encephalopathy Sleep disorders e.g. narcolepsy, parasomnias Transient global amnesia Involuntary movement disorder Panic attacks Non-epileptic seizures

Question 28

Where is a UMN lesion?

Answer 28

Above anterior horn cell in spinal cord or motor nuclei in cranial nerves

Question 29

Function of the cerebellum

Answer 29

- Co-ordinates movement - Maintains equilibrium + muscle tone - complex regulatory + feedback system with many neural cnnections

Question 30

What is myasthenia gravis? What is antibodies test for it'

Answer 30

Disorder of neuromuscular transmission anti-ACHR antibodies

Question 31

What is a non convulsive seizure

Answer 31

Non-Convulsive Status Epilepticus (NCSE) is a persistent change in the level of consciousness, behaviour, autonomic function, and sensorium from baseline associated with continuous epileptiform EEG changes, but without major motor signs

Question 32

Features of temporal lobe seizure

Answer 32

Lip smacking Post-ictal dysphasia With or without consciousness impairment Aura: psychic/deja vu Hallucinations Rising epigastric snesation

Question 33

Frontal lobe vs occipital vs pariteal lobe features of sezirue s

Answer 33

Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march Parietal lobe (sensory) - Paraesthesia Occipital lobe (visual) - Floaters/flashes

Question 34

What is epilepsy

Answer 34

**Epilepsy** - disorder of the brain due to tendency to seizures manifested as at least two unprovoked seizures occuring >24 hours apart **OR** one unprovoked seizure and a high probability of more occuring due to predisposing factors eg brain lesion **OR** diagnosis of epilepsy syndrome

Question 35

What is a partial/focal seziure

Answer 35

Simple motor seizure Often tempiral and frontal lobe Remain conscious

Question 36

What is simple partial vs complex partial seizure

Answer 36

Complex - altered consciousness No memeory or awareness but can still interact

Question 37

Features of temporal lobe seizure onset and pathology

Answer 37

Focal onset 2/3 Deja vu, unfamiliarity, brink of revelation Medial or hippocampal scarring from childhood febrile convulsions

Question 38

Clinical features of focal sezirue

Answer 38

Chewing, bite tongue, work face Heat, foosebumps, fear Odd smell often unpleasant eg burning, plastic petrol etc

Question 39

Frontal lobe seizure featres

Answer 39

Bizarre, bilateral Cycling of lef, pelvic thrusting Brief and frequent Nocturnal Head cersions - away from origin Defnecers postion - one flexed arm other extended

Question 40

What is defencers position in frontal lobe seizure

Answer 40

ONe arm flexed one extended

Question 41

Features of occipital lobe seizures

Answer 41

Eye symptoms, movements, eyelid flickering, crude visual manifestations often lights Metabolic conditions and stroke can cause

Question 42

What stroke often causes perception distortion

Answer 42

Parietal lobe eg size of hands vs self etc

Question 43

Questions to ask about prodromal symptoms epilepsy

Answer 43

Aura Syncopal Head injuroes Drugs - anitHPTN, recreational

Question 44

Investgiations psot seizure

Answer 44

Cranial imaging -CT/MRI EEG

Question 45

Management of epilepsy

Answer 45

A-E AIRWAY Antiepielptic drug

Question 46

Which antiepileptic is safest in pregnancy

Answer 46

Lamotrigine

Question 47

Appearnace of epileptic seizure

Answer 47

Pre - deja vu, focal SM Stiffens - TONIC phase Red/blue face, eyes open. Sustained convulsion UL flexed, LL extended Tonic cry, grunting then stertor post ictal Prolonged recovery, amnestic phase Mat have no recollection hours after event