EPILEPSY + SEIZURES

Question 1

Describe a typical absence seizure

Answer 1

usually in childhood
a few a day
sudden start and end
unresponsive for 5-10 seconds

Question 2

Lip smacking is indicative of epilepsy affecting which lobe?

Answer 2

temporal lobe

Question 3

Generalised seizure in women of child-bearing age

Answer 3

lamotrigine

Question 4

How long is driving restricted after an epileptic seizure?

Answer 4

CAR:

• If no diagnosis + first seizure = 6 months
• if awake = 1yr
• if asleep = can still drive if no seizures awake for past 3yrs

BUS/LORRY

• If no diagnosis + first seizure = 5yr
• If diagnosis = must be seizure and medication free for 10yr

Question 5

Investigations for epilepsy

Answer 5

ECG
CT if skull #, deteriorating GCS, focal signs or head injury
EEG

Question 6

What does an EEG show for primary generalised?

Answer 6

generalised spike-wave abnormalities

Question 7

What is the cause of a
a) primary generalised
b) focal
seizure?

Answer 7

a) genetic

b) structural

Question 8

What is the difference between prodrome and aura?

Answer 8

prodrome are the changes in mood and behaviour

aura is the awareness before a seizure eg. dejavu, smells

Question 9

In which type of seizure do you get post-ictal dysphasia?

Answer 9

focal temporal

Question 10

Localising features of a temporal seizure

Answer 10

HEAD

Hallucinations (auditory/gustatory/olfactory)
Epigastric rising/Emotional
Automatisms (lip smacking/grabbing)
Deja vu/Dysphasia post-ictal

Question 11

Localising features of a frontal seizure

Answer 11

Movements of the head or legs
Posturing
Post-ictal weakness

Question 12

Localising features of a parietal seizure

Answer 12

paraesthesia

Question 13

Localising features of an occipital seizure

Answer 13

floaters/flashes

Question 14

manage a first ever seizure

Answer 14

admit for 24 hours

bloods, drug screen, EEG, CT/MRI

Question 15

What is the difference between a simple partial and a complex partial seizure?

Answer 15

complex has impaired awareness +/- post-ictal symptoms whereas simple does not

Question 16

What is a Jacksonian-March seizure?

Answer 16

a spreading frontal motor seizure with retained awareness

Question 17

What does tonic clonic mean?

Answer 17

tonic = limbs stiffen
clonic = limbs jerk

Question 18

What is an atonic seizure?

Answer 18

a sudden loss of muscle tone causing a fall

no LOC

Question 19

What are infantile spasms associated with?

Answer 19

tuberous sclerosis

Question 20

Can epilepsy be managed in primary care?

Answer 20

no, specialist review is needed following a 1st seizure

Question 21

During which phase of a tonic-clonic seizure does the patient become cyanosed?

Answer 21

tonic phase (1min)

Question 22

1st line treatment for a focal seizure

Answer 22

carbamazepine

Question 23

2nd line treatment for a focal seizure

Answer 23

lamotrigine
sodium valproate
topimarate

Question 24

1st line treatment for a generalised seizure

Answer 24

sodium valproate

Question 25

SE of sodium valproate

Answer 25

teratogenic, nausea, tremor, oedema, ataxia, pancreatitis, weight gain, liver failure, encephalopathy, thrombocytopenia ``` VALPROATE Appetite inc Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, tremor, thrombocytopenia Encephalopahy ```

Question 26

What is the biggest issue with lamotrigine?

Answer 26

takes months to titrate up to therapeutic dose

Question 27

SE of lamotrigine

Answer 27

rash, SJS, tremor, agitation, diplopia

Question 28

Sodium valproate MOA

Answer 28

Increases GABA activity and targets voltage channels

Question 29

Lamotrigine MOA

Answer 29

Sodium channel blocker

Question 30

Which type of seizure is made worse by carbamazepine?

Answer 30

general

Question 31

SE of carbamazepine

Answer 31

leucopenia, drowsiness, double vission, blurred vision, impaired balance

Question 32

Carbamazepine MOA

Answer 32

Binds to sodium channels increasing their refractory period

Question 33

Phenytoin MOA

Answer 33

Binds to sodium channels increasing their refractory period

Question 34

Phenytoin SE

Answer 34

LOTS | P450 inducer, dizziness, ataxia, drowsiness, gum hypertrophy, coarse facial features, peripheral neuropathy

Question 35

Treat acute seizure

Answer 35

10mg rectal diazepam

Question 36

If a patient in an acute seizure does not respond to rectal diazepam what is the term?

Answer 36

status epilepticus

Question 37

Which AED induce hepatic enzymes and affect contraception?

Answer 37

carbamazepine phenytoin topiramate

Question 38

Which forms of contraception shouldnt be used with enzyme-inducing AEDs?

Answer 38

COCP POP progesterone implant inc dose of morning after pill and depo