Seizures And Epilepsy

Question 1

Does a normal EEG or MRI rule out a seizure?

Answer 1

Nope.

Question 2

What is considered the best diagnostic test for seizures?

Answer 2

Electroencephalography EEG

But a normal result does not RULE OUT seizures

Question 3

What is the most common cause of status epilepticus

Answer 3

Discontinuation of anticonvulsant drugs

Question 4

A patient comes in the ED with loss of consciousness accompanied by urinary incontinence, generalised body stiffness and jerky movement lasting 1-2 minutes, what is the most likely diagnosis?

Answer 4

Seizure until proven orherwise

Question 5

What are two commonest causes of an acute symptomatic seizure

Answer 5

Neurological cause or Metabolic cause

Question 6

What is the commonest cause of seizures in the elderly

Answer 6

Stroke accounts for 30% of seizures in adults

Question 7

Do the majority of patients with epilepsy have a reversible cause?

Answer 7

Nope

Question 8

Name three seizures types that has loss of consciousness

Answer 8

Generalized tonic-clonic seizures; Absence seizure; Focal unaware seizures

Question 9

What is the most common seizure in adults?

Answer 9

Complex focal seizures (temporal lobe seizure) also known as Focal unaware seizure

Last less than 3 minutes and have a post ictal state

Question 10

Which age group are more likely to have absence seizures?

Answer 10

Children

Last 5-10 seconds and can be associated with hyperventilation

Spontaneous remission before adulthood

Question 11

List three commonest features of the post ictal atate

Answer 11

Headaches, confusion and somnolence

Question 12

List 4 triggers of seizures in epilepsy

Answer 12

Sleep deprivation, alcohol, flashing lights and menstruations

Question 13

Name three most common medications that trigger seizures.

Answer 13

Antipsychotics, antidepressants and quinolone antibiotics

They lower the seizure threshold

Question 14

List 5 commonest causes of provoked seizures.

Answer 14

Cerebrovascular accidents, remote head trauma, developmental brain problems, brain tumours and neurodegenerative diseases.

Question 15

Feature of psychogenic non epileptic seizures

Answer 15

Biting the tip of the tongue, seizures lasting more than 2 minutes, seizures having a gradual onset, eyes being closed during a seizure, and side-to-side head movements.

Question 16

List features that are unusual in psychogenic non-epileptic seizures

Answer 16

Severe tongue biting, urinary/Fecal incontinence and biting inside the mouth

Question 17

When is a Lumbar puncture typically indicated in seizures?

Answer 17

Signs and symptoms of meningism
Immunocompromised patients

Question 18

What is the best diagnostic test for seizures?

Answer 18

EEG not only do they diagnose the seizure but determine the type of seizure

Question 19

Why is neuroimaging usually indicated in adults>40 in seizures?

Answer 19

To rule out stroke, malignancy and intracerebral hemorrhage

Question 20

What is the immediate treatment of an active seizure?

Answer 20

Lorazepam or midazolam or clonazepam or diazepam 10 mg slow IV never IM

Old saying is still

Question 21

What is a life threatening adverse effect of benzodiazepine

Answer 21

Respiratory depression

Question 22

What should you do if after the second dose of lorazepam/midazolam/clonazepam/diazepam the patient is still seizing or does not recover consciousness between the fits?

Answer 22

Give phenytoin in sodium chloride in a different line treatment to those drugs and refer urgently.

Question 23

Name one adverse effect of phenytoin in the heart

Answer 23

Dysrhythmia

Question 24

What is the treatment of generalized tonic-clonic seizures long term?

Answer 24

Lamotrigine or carbamazepine

Question 25

Which anticonvulsant are teratogenic?

Answer 25

Sodium valproate and phenytoin

Question 26

What is the treatment of generalized tonic-clonic seizures in HIV patients?

Answer 26

Adults: Lamotrigine Children: Sodium valproate

Question 27

What is the treatment of partial seizures?

Answer 27

Carbamazepine or lamotrigine

Question 28

What is the treatment of absence seizures and juvenile myoclonic epilepsy

Answer 28

Sodium valproate Or lamotrigine

Question 30

What should be checked in every routine visit for epilepsy?

Answer 30

Symptoms, side effects of medications, other medications, alcohol/drug abuse, depression and family planning

Question 31

What is the most common adverse effect of lamotrigine, phenytoin and carbamazepine?

Answer 31

Rash ( considered urgent so referral is paramount)

Question 32

What are the two common adverse effects of levetiracetam?

Answer 32

Suicidal thoughts or behaviour and psychosis Others include aggression, depression and irritability

Question 33

List two adverse effects of sodium valproate requiring urgent attention.

Answer 33

Jaundice and nausea/vomiting/abdominal pain Check ALT if >100 stop the drug

Question 34

Which anticonvulsant can lead to unsteadiness, slurring and double vision

Answer 34

Phenytoin

Question 35

When to use levetiracetam?

Answer 35

Woman of child bearing age and on/needing ART or switching from valproate and lamotrigine is not suitable or tolerated

Question 36

What is the indication for phenytoin?

Answer 36

If on phenytoin and well controlled If there was a head trauma as prophylaxis