Epilepsy/seizures

Question 1

What is the definition of a seizure and epilepsy?

Answer 1

Seizure = convulsion/transient abnormal event caused by paroxysmal discharge of cerebral neurons 
Epilepsy = continuous tendency to have seizures

Question 2

How common are seizures?

Answer 2

2% of the UK population have 2 or more seizures during their lives

Question 3

What is the pathophysiology of epilepsy/seizures?

Answer 3

• Excessive excitation of neurons
• Caused by paroxysmal discharge = malfunction of ion channels
• Classified into partial or general seizures (or unclassified)
• General is more common
• Focal seizures often start at the temporal lobe
• Status epilepticus
• MEDICAL EMERGANCY
• Continuous seizures without recovery of conciousness

Question 4

What are the risk factors/aetiology for epilepsy and seizureS?

Answer 4

• Childhood – absent seizures
• Tendency to develop generalised tonic-clonic seizures in adult life
• Flashing lights
• Cerebrovascular disease
• Cerebral tumours
• Alcohol
• Sleep deprivation
• Post traumatic events
• CNS infections
• Cranial surgery
• Metabolic e.g. hypoglycaemia, acute hypoxia, electrolyte imbalance, hepatic failure
• Family history
• Genetics

Question 5

What are the signs/symptoms of epilepsy and seizures?

Answer 5

• Generalised tonic colonic seizures
• Sudden onset of rigid tonic phase
• Followed by convulsions
• Muscles jerks
• Lasts seconds-minutes
• Tongue biting
• Incontinence of urine
• Followed by drowsiness/coma for several hours
• Absence seizures
• Stops activities/stares
• Becomes pale for a few seconds
• 3Hz spike and wave on the EEG
• Myoclonic, tonic and akinetic seizures
• Isolated muscle jerk
• Intense stiffening of body
• Cessation of movement, falling and loss of consciousness
• Simple partial seizure
• Not affecting consciousness/memory
• Complex partial seizure
• Affecting awareness/memory before, during or immediately after
• Partial seizure evolving to tonic clonic seizure = secondary generalisation
• Normally starts at the temporal lobe
• Associated with olfactory and visual hallucination, blank staring, feelings of unreality or familiarity

Question 6

What diseases present similarly to epilepsy and seizures?

Answer 6

• Syncope
• Cardiac arrhythmias
• TIA

Question 7

What investigation are conducted for suspected epilepsy/seizures?

Answer 7

• Glucose
• Electrolytes
• Ca
• U&E
• LFTs
• EEG
• ECG – for altered consciousness
• CT
• MRI

Question 8

How does epilepsy affect the patients ability to drive?

Answer 8

May drive only if patient has been seizure free for a year

For driving heavy goods vehicles must be seizure free for > 10 years

Question 9

What is the surgical treatment for epilepsy/seizures?

Answer 9

• Amputation of anterior temporal lobe

Question 10

What is the pharmacological treatment for epilepsy/seizures?

Answer 10

• Antiepileptic drugs
• IV diazepam/lorazepam – used for seizures longer than 3 minutes or repeated seizure
• Rectal diazepam/buccal midazolam – status epilepticus

Question 11

What is the non pharmacological treatment for epilepsy/seizures?

Answer 11

• Avoid swimming alone

* Avoid dangerous sports