Seizure Disorders

Question 1

define epilepsy

Answer 1

recurrent tendency to spontaneous abnormal electrical activity in the brain causing convulsions and abnormal behaviour

Question 2

what are the underlying causes of epilepsy

Answer 2

idiopathic
structural abnormalities
childhood febrile convulsions

Question 3

what structural abnormalities can predispose to epilepsy

Answer 3

SOL
developmental abnormalities
head injury

Question 4

what is a prodrome

Answer 4

the period before a seizure occurs where specific symptoms occur

Question 5

what features occur during a prodrome

Answer 5

deja vu
flashing lights
funny taste/smell
strange feeling in gut

Question 6

describe the period of a seizure

Answer 6

period in which the patient loses awareness/becomes unresponsive
generally lasts less than 5 minutes
associated with tongue biting and incontinence

Question 7

what features occur during the post-ictal state following a seizure

Answer 7

confusion
headache
muscle ache and weakness
Todd’s palsy

Question 8

what is Todd’s palsy

Answer 8

temporary weakness following a seizure

Question 9

what are the two different types of seizures that occur

Answer 9

focal

generalised

Question 10

what is the difference between focal and generalised seizures

Answer 10

focal - occurs in one area of the brain

generalised - abnormal activity in multiple area of the brain

Question 11

who is most likely to have partial seizures

Answer 11

older people

those with an underlying structural abnormality

Question 12

what is the difference between simple and complex partial seizures

Answer 12

simple - no loss of awareness or post octal symptoms

complex - loss of awareness, aura and post-ictal symptoms

Question 13

list some features of a partial seizure in the temporal lobe

Answer 13

dysphasia
emotional disturbance 
visual/auditory hallucinations 
lip smacking/grabbing
odd taste/smell
flashbacks

Question 14

list some features of a partial seizures in the frontal lobe

Answer 14

dysphasia
posturing movements
behavioural symptoms
Jacksonian seizures

Question 15

sensory disturbance is most likely a partial seizure in which lobe of the brain

Answer 15

parietal lobe

Question 16

who is most likely to develop generalised seizures

Answer 16

young people

Question 17

list some triggers for bringing on generalised seizures

Answer 17

flashing lights

sleep deprivation

Question 18

describe the tonic phase of a tonic clonic seizure

Answer 18

patient falls to the ground, becomes rigid and cyanosed as they stop breathing
tongue biting and urinary incontinence
usually lasts 1 minute

Question 19

describe the clonic phase of a tonic clonic seizure

Answer 19

asymmetrical convulsive jerks
eyes roll to the back of the head and breathing starts again
can last several minutes

Question 20

describe an absence seizure

Answer 20

brief lapse in awareness in which the patient stops what they are doing and stares blankly
EEG spike and wave at 4Hz

Question 21

describe myoclonic seizures

Answer 21

seizures that manifest as clonic like jerks without the tonic contractions

Question 22

give an example of a myoclonic seizure

Answer 22

juvenile myoclonic epilepsy

Question 23

describe the presentation of myoclonic epilepsy

Answer 23

presents in puberty
associated with early morning seizures
brought on by lack of sleep, bright lights and alcohol

Question 24

describe an atonic seizure

Answer 24

seizure that manifests as sudden loss of muscle tone with the maintenance of consciousness

Question 25

when is imaging indicated in epilepsy

Answer 25

to identify a structural abnormality

Question 26

what are the indications for an EEG

Answer 26

to classify epilepsy confirm non epileptic attacks evaluate patients being considered for surgery to confirm non-convulsive status epilepticus

Question 27

what is the first line management for generalised seizures

Answer 27

sodium valproate lamotrigine levetiracetram

Question 28

what is the first line management for focal seizures

Answer 28

carbamazepine

Question 29

which anti-convulsant is contraindicated in generalised seizures and why

Answer 29

carbamazepine makes generalised seizures worse

Question 30

when is sodium valproate not a first line drug for generalised seizures

Answer 30

for young women due to teratogenicity

Question 31

what are the side effects of sodium valproate

Answer 31

``` nausea tremor oedema ataxia weight gain liver failure/pancreatitis thrombocytopenia irreversible hair loss ```

Question 32

what are the side effects of lamotrigine

Answer 32

``` maculo-papular rash Steven-Johnson syndrome DIC tremor diplopia ```

Question 33

most epilepsy patients are on how many drugs

Answer 33

just one, usually increase dose to be suitable

Question 34

what is SUDEP

Answer 34

sudden unexplained death in epilepsy | increased risk if epilepsy is poorly controlled, patient smokes, drinks or takes drugs

Question 35

if a patient with epilepsy has a seizure, how long can they not drive for

Answer 35

car - 1 year | HGV - 10 years

Question 36

what are the issues that can occur with AEDs and contraception

Answer 36

most AEDs are liver enzyme inducers which reduce the efficacy of COCP and progesterone only contraceptives

Question 37

what must be discussed with pregnancy and epilepsy

Answer 37

pre-pregnancy counselling about risk of congenital anomalies with AEDs - take high dose folic acid drugs can also be passed through breast milk

Question 38

define status epilepticus

Answer 38

seizure that lasts more than 5 minutes multiple seizures within 30 minutes second seizure that occurs before the first is completely done

Question 39

what are the triggers for status epilepticus

Answer 39

``` stopping AEDs suddently infection head injury metabolic upset eclampsia ```

Question 40

how is status epilepticus managed

Answer 40

IV lorazepam, if no improvement after 10 minutes try another dose phenytoin second line

Question 41

if IV access cannot be established, how can status epilepticus be managed

Answer 41

rectal diazepam | buccal midazolam

Question 42

what is non-epileptic attack disorder

Answer 42

functional seizures at subconscious level | associated with past trauma

Question 43

describe the features of non-epileptic attack disorder

Answer 43

long seizures lasting 10-20 minutes symmetrical florid convulsions with large movements no improvement with anticonvulsants