Epilepsy Symposia

Question 1

What is epilepsy

Answer 1

Recurring, unprovoked, spontaneous seizures

Question 2

What does a generalised onset mean?

Answer 2

Electrical discharges appear to start over the whole brain at the same time

Question 3

What does partial/facial onset mean?

Answer 3

Electrical discharges appear to start in one cortical region and then may remain localised or spread over the whole brain

Question 4

Describe frontal lobe seizures

Answer 4

Forced head and eye deviation to contralateral side
Difficulty speaking, unresponsiveness
Repetitive movements
Pt can be fully aware whilst it is happening

Question 5

Epileptogenesis

Answer 5

Process where parts of normal brain converted to hyperexcitable brain

Question 6

Epileptic seizure

Answer 6

Explosion of synchronous activity

Rhythmic firing of AP by neurons

Question 7

What are febrile convulsions/seziures

Answer 7

Fever-induced

Can be due to point mutation in Na+ channel causing abnormally slow inactivation

Question 8

Describe temporal lobe seizures

• physical
• cognitive
• affective

Answer 8

Preceded by warnings of deja vu, rising epigastric sensation, followed by lip-smacking and speech arrest 
Hallucinations 
Pallor/flushing 
Can mimic panic attacks 
Changes in smell

Question 10

Parietal lobe seizures

Answer 10

Positive sensory symptoms
Tingling, pain
Distortion of body shape
Sensory Jacksonian March

Question 11

Describe the tonic phase in a tonic clonic seizure

Answer 11

Continuous muscle spasms 
Will fall 
May have cyanosis due to thorax muscle contracting 
Tongue biting 
Incontinence

Question 12

Describe the clonic phase in a tonic clonic seizure

Answer 12

Rhythmic jerking slows & gets larger in amplitude as the seizure ends

Question 13

Describe the postictal phase in a tonic-clonic seizure

Answer 13

Coma 
Drowsiness
Headache 
Confusion 
Muscle aching

Question 14

Jacksonian march

Answer 14

Simple, partial seizures
Patient aware- localised discharge

Symptoms

• Lip smacking
• sudden muscle contraction
• sudden head and eye deviation
• lasts very briefly

Question 15

Describe occipital lobe seizures

Answer 15

Visual hallucinations
Amaurosis on onset
-blackout

Question 16

perampanel

Answer 16

AMPA receptor antagonist

non-competitive inhibitor

reduce spread / generalisation of seizure

well tolerated with improved alertness

Question 17

Carbamazepine, oxcarbazepine and eslicarbazepine

Answer 17

Anticonvulsant
competitively inhibit the voltage gated sodium channel by binding with the receptor in its inactive state, prolonging the period between successive firings (prevents burst firing)

Question 18

First line treatment for primary generalized epilepsy

Answer 18

sodium valproate

lamotrigine

Question 19

First line treatment for partial (focal onset) epilepsy

Answer 19

carbamezapine

lamotrigine

Question 20

Name drugs that can exacerbate generalized seizure types such as myoclonus and absences

Answer 20

• phenytoin
• carbamazepine
• gabapentin/pregabalin

Question 21

Benzodiazepines

-side effects
acute/long term

Answer 21

Acute:
Drowsiness
Ataxia		
Hyperactivity
Personality Change
Cognitive impairment

Long Term:
tolerance/dependence

Question 22

Phenytoin

-side effects
acute/long term

Answer 22

Acute:

Ataxia, Diplopia, Nystagmus

Long Term:

Gingival hyperplasia
Osteomalacia
Cerebellar atrophy

Question 23

Sodium Valproate

-side effects
acute/long term

Answer 23

Acute:

sedation
nausea and vomiting
tremor

Long Term:

Hair thinning
Weight gain
Menstrual irregularities
Encephalopathy

Question 24

difference between provoked seizures versus epilepsy

Answer 24

provoked caused by acute insults such as metabolic disturbance, withdrawal, stroke, alcohol

Question 25

Causes of epilepsy

Answer 25

CVS 
Alcohol
Tumour 
Post-traumatic
Idiopathic

Question 26

Idiopathic (Primary) Generalized Seizures

Answer 26

- tonic clonic - absences - myoclonic >onset in childhood or adolescence >usually no focal symptoms/signs >often a number of seizure types cluster >a polygenic cause is presumed with no identifiable structural lesion on imaging >generalized (all leads) spike and wave discharges on EEG, photosensitivity may be present

Question 27

Juvenile Myoclonic Epilepsy

Answer 27

``` >commonest form of primary generalized epilepsy >3-12% all epilepsy >juvenile onset, probably lifelong >early morning myoclonic jerks (ask) >photosensitive, sleep deprivation triggers >+/- absences >generalized tonic clonic seizures – >occur without warning ```

Question 28

Tonic clonic seizures “grand mal”

Answer 28

-occurs without warning –risk of injury -tonic phase continuous muscle spasm, fall, cyanosis, tongue biting, incontinence -clonic phase rhythmic jerking slows and gets larger in amplitude as attack ends -post-ictal (post-seizure) phase coma, drowsiness, confusion, headache muscle aching

Question 29

Absences - “petit mal”

Answer 29

- abrupt - short, 5-20 seconds - multiple times/day, can lead to learning difficulties - unresponsive, amnesia for the gap, rapid recovery - tone preserved (or mildly reduced) - eyelid flickering - absences only, tend to remit in adulthood (childhood absence epilepsy)

Question 30

simple partial seizure (SPS)

Answer 30

patient aware - aura

Question 31

complex partial seizure (CPS)

Answer 31

aura/warning with a level of reduced awareness

Question 32

Secondary Generalized Tonic Clonic Seizures – (GTCS)

Answer 32

warning/aura –eg epigastric rising sensation, altered smell, déjà vu, fear cannot abort attack onset sudden duration 1-3 minutes then falls , loses consciousness as seizure generalizes rigidity/ convulsive jerks/ excess salivation incontinence/tongue bite common red/blue, wakes in ambulance/A&E

Question 33

First line treatment for absent seizures

Answer 33

Ethosuximide