Epilepsy

Question 1

What are seizures?

Answer 1

Transient episodes of abnormal electrical activity in the brain

Question 2

What are the different types of seizures?

Answer 2

• Generalised tonic-clonic
• Focal seizures
• Myoclonic
• Tonic
• Atonic

Question 3

What do generalised tonic-clonic seizures involve?

Answer 3

Tonic (muscle tensing)
Clonic (muscle jerking)
Aura
Post-ictal period

Question 4

What do focal seizures involve?

Answer 4

• Occur in isolated brain area, usually temporal lobe
• Affects hearing, speech, memory and emotions
• Can remain aware or lose awareness during these
• Strange smells, tastes, sight or sound can be present
• Deja vu, unusual emotions and abnormal behaviours also present

Question 5

How do myoclonic seizures present?

Answer 5

• Brief sudden muscle contractions like abrupt jumps/jolts

Question 6

How do tonic seizures present?

Answer 6

• Sudden increase in muscle tone where the body stiffens

Question 7

How do atonic seizures present?

Answer 7

• Sudden loss of muscle tone resulting in a fall
• Usually only very brief and patients are aware during these episodes
• Often begin in childhood

Question 8

How do infantile spasms present?

Answer 8

• Clusters of full body-spasms
• Associated with developmental regression and poor prognosis
• Hypsarrhythmia on EEG

Question 9

How do febrile convulsions present?

Answer 9

• Tonic-clonic seizures which occur in children with a high fever
• Common between 6 months and 5 years
• Usually no lasting damage

Question 10

How are seizures investigated?

Answer 10

• EEG
• MRI brain can be used
• Bloods to exclude other pathology e.g. glucose, cultures, electrolytes

Question 11

How should patients with epilepsy be managed?

Answer 11

• Specific driving advice
• Take showers rather than baths and they need particular caution with swimming, heights and dangerous equipment

Question 12

What is the pharmacological treatment for epilepsy types?

Answer 12

Generalised TC - Valproate for men, Lamotrigine/Leviteracetam for women
Focal - Lamotrigine/Leviteracetam
Myoclonic - Valproate for men, Levetiracetam for women
Tonic/Atonic - Valproate for men, Lamotrigine for women
Absence - Ethosuximide

Question 13

What is status epilepticus?

Answer 13

• Seizures more than 5 minutes
• Seizures without regaining consciousness

Question 14

How should status epilepticus be managed?

Answer 14

ABCDE approach
- Secure airway
- Give oxygen
- Check blood glucose levels
- IV access

Question 15

What is the medical treatment for status epilepticus?

Answer 15

• First line: Buccal midazolam in the community or rectal diazepam
• If IV access present, IV Lorazepam
• After 2 doses of benzodiazepines, use IV leviteracetam, phenytoin, valproate