Neurology - Epilepsy

Question 1

What are seizures?

Answer 1

transient episodes of abnormal electrical activity in the brain

Question 2

Investigations

Answer 2

EEG
MRI brain
ECG

Question 3

what do tonic and clonic mean?

Answer 3

tonic - muscle tensing

clonic - muscle jerking

Question 4

what comes first tonic or clonic phase?

Answer 4

tonic

Question 5

associated features of generalised tonic-clonic seizures

Answer 5

tongue biting 
incontinence 
groaning 
irregular breathing 
post-ictal period

Question 6

post-ictal period - tonic clonic

Answer 6

prolonged

confused, drowsy and irritable

Question 7

managing tonic-clonic seizures

Answer 7

sodium valproate

lamotrigine/carbamazepine

Question 8

where do focal seizures start?

Answer 8

temporal lobe

Question 9

what do focal seizures affect?

Answer 9

hearing, speech, memory and emotions

Question 10

how can focal seizures present?

Answer 10

hallucinations
memory flashbacks
deja vu

Question 11

treatment for focal seizures - 1st line

Answer 11

carbamazepine or lamotrigine

Question 12

second line treatment focal seizures

Answer 12

sodium valproate

levetiracetam

Question 13

who do absence seizures typically occur in?

Answer 13

children

Question 14

describe an absence seizure

Answer 14

blank, stares into space and abruptly return to normal

Question 15

treating absence seizures

Answer 15

sodium valproate or ethosuximide

Question 16

atonic seizures

Answer 16

lapses in muscle tone

Question 17

what can atonic seizures be indicative of?

Answer 17

lennox-gastaut syndrome

Question 18

managing atonic seizures

Answer 18

sodium valproate

2nd - lamotrigine

Question 19

what do myoclonic seizures typically occur as part of?

Answer 19

juvenile myoclonic epilepsy

Question 20

describe myoclonic seizure

Answer 20

sudden jump

patient usually awake

Question 21

treating myoclonic seizures

Answer 21

sodium valproate

lamotrigine, topiramate

Question 22

infantile spasms

Answer 22

rare starts at 6 months

clusters of full body spasms

Question 23

infantile spasms prognosis

Answer 23

1/3 die by 25 but 1/3 are seizure free

Question 24

treating infantile spasms

Answer 24

prednisolone

vigabatrin

Question 25

what is first line for most types of epilepsy? what is the exception?

Answer 25

sodium valproate | focal epilepsy

Question 26

how does valproate work?

Answer 26

increase GABA activity | relaxing effect on the brain

Question 27

sodium valproate side effects

Answer 27

teratogenic liver damage and hepatitis hair loss tremor

Question 28

side effects of carbamazepine

Answer 28

agranulocytosis aplastic anaemia induces p450 - interactions

Question 29

phenytoin side effects

Answer 29

folate and vit D deficiency | osteomalacia

Question 30

ethosuximide side effects

Answer 30

night terrors | rashes

Question 31

lamotrigine side effects

Answer 31

SJS or DRESS | leuokopenia

Question 32

define status epilepticus

Answer 32

seizures lasting >5 minutes or more than 3 seizures in 1 hour

Question 33

non-pharmacological treatment status epilepticus

Answer 33

secure airway high concentration oxygen ABCDE - check glucose, IV access

Question 34

medical treatment status epilepticus community

Answer 34

10-20mg rectal diazepam | 10mg buccal midazolam

Question 35

medical treatment status epilepticus hospital

Answer 35

IV lorazepam 4mg repeat after 10 mins | IV phenytoin or phenobarbital

Question 36

final diagnosis for people presenting with first seizure

Answer 36

25% epilepsy | syncope, single seizure, psychiatry, narcolepsy etc

Question 37

important history from patient

Answer 37

``` preceding seizure warning symptoms level of awareness first recollection seizure markers - tongue biting, incontinence ```

Question 38

3rd party history - seizure

Answer 38

``` very important how were they before seizure eyes open or closed describe movements pallor, breathing, pulses duration time to recover ```

Question 39

3 categories of syncope

Answer 39

reflex (neurocardiogenic) orthostatic cardiogenic - arrhythmia

Question 40

provoked seizures

Answer 40

alcohol/drug withdrawal 24hrs after head injury eclampsia

Question 41

name some generalised seizures

Answer 41

tonic-clonic myoclonic absence atonic

Question 42

name some focal seizures

Answer 42

simple partial complex partial temporal lobe

Question 43

generalised vs focal seizures

Answer 43

``` generalised = no warning, under 25, absences, EEG general abnormality, FH focal = aura, any age, MRI ```

Question 44

automatisms

Answer 44

lip smacking | repetitive picking at clothing

Question 45

invesigations

Answer 45

ECG, bloods (glucose) | MRI, EEG

Question 46

DVLA rules

Answer 46

single seizure - 6 month ban if investigations normal and no further events seizure free for a year