Neurology - Epilepsy

Question 1

What is epilepsy

Answer 1

it is associated with reduced GABA levels in the brain leading to abnormal cell to cell message propagation

Question 2

What are the signs and symptoms of a febrile seizure

Answer 2

fever
face may turn blue or red
eyes rolling upward
loss of consciousness
muscles and limbs jerk in unnatural movements

Question 3

Who is at risk of febrile seizures

Answer 3

> 38 degrees childen

Question 4

How do we cool febrile seizures

Answer 4

paracetamol 
ibuprofen 
remove clothes
cool sponging
cool bath

Question 5

What is the classification of epilepsy

Answer 5

split into generalized and partial

Question 6

What can generalized epilepsy be split into

Answer 6

tonic/clonic
absence
myoclonic/atonic

Question 7

What can partial epilepsy be split into

Answer 7

simple partial
complex partial
simple sensory

Question 8

What are epilepsy triggers

Answer 8

idiopathic
trauma
CNS disease
social

Question 9

What trauma can trigger epilepsy

Answer 9

head injury

Question 10

What Cns diseases can trigger epilepsy

Answer 10

tumor, stroke

CJD, meningitis encephalitis

Question 11

What social aspects can cause epilepsy

Answer 11

late nights, alcohol, hypoglycemia

flashing lights

Question 12

What are tonic clonic seizures

Answer 12

prodromal aura
loss of consciousness/continence
initial tonic (stiff)
clonic (contraction/relaxation)
post-ictal drowsiness

Question 13

What is Petit Mal seizures

Answer 13

short lived episodes (5-15 seconds)
loss of awareness - eyelids flutter, vacant stare, stops activity, loss of response

childhood usually
can be multiple attacks in single day

Question 14

What are medical risks of tonic clonic seizures

Answer 14

injury

asphyxia

Question 15

How can we try to minimize injury from tonic clonic seizures

Answer 15

protect where possible

remove objects from the mouth if possible

Question 16

How can we try to reduce the impact of asphyxia

Answer 16

use supplemental oxygen
guedel airway if possible
suction secretions

Question 17

What are social risks

Answer 17

pregnancy
sudden death
social

Question 18

What is the risk with pregnancy

Answer 18

metabolism upset and drug reactions

risk to unborn child

Question 19

Why may sudden death occur in tonic clonic seizures

Answer 19

asphyxiation or aspiration

Question 20

What are social issues with sonic clonic seizures

Answer 20

certain occupations can’t be done

can’t drive

Question 21

What are precipitators for tonic/clonic seizures

Answer 21

withdrawal/poor medication compliance

epileptogenic drugs

fatigue/stress

infection

menstruation

Question 22

What are epileptogenic drugs

Answer 22

some GA agents
alcohol
tricyclics

Question 23

What are partial seizure

Answer 23

motor localized to one region of brain

may move/spread to other motor areas (jacksonian seizure)

Question 24

What are the changes that can occur in partial seizures

Answer 24

sensory

may effect visual, auditory, taste, smell

Question 25

What is complex partial seizures result in

Answer 25

automatism - repetitive purposeless movements | lip smacking and grimacing

Question 26

How do complex partial seizures occur

Answer 26

When diff areas of the brain are effected to produce connective movements

Question 27

What is the preventative treatment for epilepsy

Answer 27

anticonvulsant drugs

Question 28

What are the anticonvulsant drugs for tonic-clonic seizures

Answer 28

gabapentin, phenobarbitone, lamotrigine

Question 29

What drug is used for absence seizures

Answer 29

levitiracetam

Question 30

What is the treatment for emergency in epilepsy

Answer 30

most require supportive tx ONLY if UNCONSCIOUS - airway and oxygen status epileptics requires benzodiazepines

Question 31

What are the drugs used for epilepsy

Answer 31

gaba receptor actions sodium channel actions

Question 32

What are the gala receptor action drugs

Answer 32

valproate - gaba transaminase inhibitor benzodiazepines - gaba receptor action on CL- enhanced

Question 33

What are the sodium channel action drugs

Answer 33

carbamazepine - stbailises | phenytoin

Question 34

What are the surgeries for epilepsy

Answer 34

removal of focal neurological lesions - brain tumours (benign)

Question 35

What are focal seizures

Answer 35

identifiable point of origin within the brain | not well controlled by meds

Question 36

What are dental aspects of epilepsy

Answer 36

complications of fits complications of treatment know emergency care

Question 37

What are the complications of fits dentally

Answer 37

oral soft tissue injury | dental injury/fracture

Question 38

What are the complications of tx dentally

Answer 38

``` gingival hyperplasia (phenytoin) bleeding tendency (valproate) folate deficiency (rare) ```

Question 39

how do we assess risk of fit

Answer 39

``` good and bad phases ask when last 3 fits took place ask about compliance with medcaiton ask about changes in medication treat at times of low risk ```