L13: Brain Rhytms Epilepsy

Question 1

What is a seizure as a result of

Answer 1

Excessive asynchronous neuronal discharge

Question 2

What is an epilepsy

Answer 2

A tendency to recurrent seizures (2+ seizures over 24 hours apart)

Question 3

What are the risk factors for epilepsy

Answer 3

Underlying CNS problem
Family history
Prolonged atypical febrile convulsion

Question 4

What are the 2 seizure types

Answer 4

Focal (partial)
Bilateral convulsive (generalised)

Question 5

Wha is focal (partial seizure)

Answer 5

When the network is confined to one area of the brain

Question 6

What is bilateral (generalised) seizure

Answer 6

Network starts in both sides of the brain simultaneously

Question 7

What are the symptoms of focal seizures

Answer 7

depends on where the seizure originates and spreads to:
Somatosensory symptoms of one side of the body e.g tingling
Motor symptoms of jerking of body and head
Autonomic symptoms of sweating, flushing, pallor, tightness of throat and epigastric sensation (butterfly stomach)
Visual symptoms of flashes of light
Auditory (hearing) symptoms of ringing or hissing noises

Question 8

What are the generalised seizures types

Answer 8

Absence 
Myoclonic 
Tonic 
Tonic clonic 
Atonic

Question 9

What is a tonic clonic (convulsion) seizure

Answer 9

A seizure that has 2 phases of:
Tonic: stiffness of muscles
Clonic: jerking phase

Question 10

What is a absence seizure

Answer 10

Sudden alteration of awareness person may seem like they are daydreaming and this can be unnoticed by other and are followed by normal activity later

Question 11

What is myoclonic seizures

Answer 11

Sudden jerk of both of the upper limbs

Question 12

What is tonic seizure

Answer 12

Sudden stiffening of the body

Question 13

What is atonic seizure

Answer 13

Loss of muscle tone

Question 14

What are the types of partial seizures

Answer 14

Simple: person is aware but cannot control function or behaviour

Complex: impaired conscious with no control over functions and behaviour

Question 15

What has to happen for a diagnosis of epilepsy

Answer 15

2 or more stereotyped seizure attacks

Question 16

What phases can a seizure have

Answer 16

Ictal phase

Post ictal phase

Question 17

What is the ictal phase

Answer 17

Seizure itself

Question 18

What is the post ictal phase

Answer 18

Phase after the seizure with confusion, fatigue or muscle pain

Question 19

What is the ictal phase associated with

Answer 19

Warning smell 
Vocalisation 
Frothing of mouth 
Incontinence 
Lateral tongue biting

Question 20

What are the post ictal symtoms

Answer 20

Headache

Myalgia (muscle pain)

Question 21

If the seizure occurs in the frontal lobe what can appear

Answer 21

Minimal post ictal confusion

Bizarre behaviours

Question 22

How can we examine someone with a seizure

Answer 22

ECG
Blood test
Imaging MRI
EEG

Question 23

Why is an ECG essential

Answer 23

A change in heart rhythm can lead to a seizure or vice versa

Question 24

With a blood test what do we look for

Answer 24

Kidney and liver function
Infective screen for meningitis illness- inflammation indicators
Drug levels of cocaine, alcohol and anti-psychotics

Question 25

What increases the risk of seizures

Answer 25

Excessive alcohol intake

Question 26

What is an ECG used for

Answer 26

Establish localisation

Question 27

What are the causes of seizures

Answer 27

``` Genetic Previous febrile convulsion Infection Autoimmune Metabolic Toxic Tumours ```

Question 28

What can previous febrile convulsions lead to

Answer 28

Scarring in the hippocampus

Question 29

What type of infection can lead to seizures

Answer 29

Meningitis | Encephalitis

Question 30

What are the metabolic factors that can lead to seizures

Answer 30

Hypocalcaemia Hyponatriemia Hypoglycaemia

Question 31

What are the toxic factors that can lead to seizures

Answer 31

Alcohol Cocaine Amphetamine Anti depressants

Question 32

What are the common structural lesions that can cause seizures

Answer 32

Diseases of small vessels Intracranial tumour Hippocampus sclerosis

Question 33

What are the advantages of using a EEG

Answer 33

Painless | Non invasive

Question 34

What are the disadvantages for using an eeg

Answer 34

Seizures can be deep enough to record it

Question 35

When does treatment with medication for epilepsy start

Answer 35

After the second seizure

Question 36

What medication is used to treat epilepsy

Answer 36

Anti epileptic drugs

Question 37

When we start anti-epileptic drug treatment how long does it last

Answer 37

At least 2 years from the last seizure

Question 38

What are the factors we have to consider before starting anti epileptic drugs

Answer 38

1) drugs can bring side effects so the doses have to be titrated very slowly 2) valproate can be teratogenic for a fetus

Question 39

What are the surgical options for epilepsy

Answer 39

- resection i.e take out the tumour - vagal nerve stimulation - deep brain stimulation

Question 40

What is vagal nerve stimulation

Answer 40

1) Implantation of a pacemaker into the chest wall that has a lead going up to the vagus nerve in the neck 2) when there is a increase in heart rate the lead delivers an electrical impulse to shorten the seizure

Question 41

What are the lifestyle advices that we can give for epilepsy

Answer 41

Minimise alcohol and drugs Regular sleep Ketogenic diet

Question 42

What is a status epilepticus

Answer 42

A convulsive seizure that lasts for over 5 minutes without recovery (emergency situation)

Question 43

What are the anti-epileptic drugs used in focal epilepsy

Answer 43

Carbamazepine Lamotrigine Oxcarbazepine

Question 44

What are the anti-epileptic drugs used in generalised seizures

Answer 44

Sodium valproate (teratogenic) Lamatrigine Levetiracetam