Epilepsy

Question 1

What is epilepsy?

Answer 1

A neurological condition characterised by recurrent seizures due to episodes of abnormal electrical activity in the brain.

Defined as 2 or more unprovoked epileptic seizures more than 24 hours apart.

Question 2

What are the differentials for epilepsy?

Answer 2

1. Non epileptic attack disorder
2. Alcohol withdrawal
3. Hypoglycaemia/metabolic

Question 3

What are seizures?

Answer 3

Transient episodes of abnormal electrical activity in the brain.

Question 4

What types of seizure are generally seen in adults?

Answer 4

1. Generalised tonic-clonic seizures
2. Focal seizures
3. Myoclonic seizures
4. Tonic seizures
5. Atonic seizures

Question 5

What types of seizure are more common in children?

Answer 5

1. Absence seizures
2. Infantile spasms
3. Febrile convulsions

Question 6

What are tonic-clonic seizures?

Answer 6

Involve** tonic (muscle tensing) and clonic (muscle jerking) movements** associated with complete loss of consciousness.

Patients may experience aura before, and there may be **tongue biting, incontinence, groaning & irregular breathing.
- Prolonged post-ictal period where person is confused, tired, irritable or low.

Question 7

What are focal seizures?

Answer 7

Occur in an isolated brain area, often temporal lobes, affecting hearing, speech, memory & emotions. Patients remain awake.

Question 8

How can focal seizures present?

Answer 8

1. Hallucinations
2. Memory flashbacks
3. Deja vu
4. Doing strange things on autopilot

Question 9

What are myoclonic seizures?

Answer 9

Sudden, brief muscle contractions (jerk, twitch, like a sudden jump) but the patient remains awake.

Question 10

What are tonic seizures?

Answer 10

Sudden onset of increased muscle tone where the entire body stiffens, causing a fall, but lasts only a few seconds.

Question 11

What are atonic seizures?

Answer 11

Sudden loss of muscle tone, often resulting in a fall, also known as ‘drop attacks’. They don’t last more than 3 minutes.

Question 12

What are absence seizures?

Answer 12

Usually seen in children where the patient becomes blank, stares into space, and then returns to normal.

They are unaware of surroundings and don’t respond, typically lasting 10-20 seconds.

Question 13

What are infantile seizures?

Answer 13

West syndrome, which is rare, characterised by clusters of full body spasms.

Hypsarrhythmia is a characteristic EEG finding and is associated with developmental regression.

Question 14

At what age do infantile spasms start?

Answer 14

In infancy at around 6 months.

Question 15

What is the characteristic EEG finding for infantile spasms?

Answer 15

Hypsarrhythmia.

Question 16

What are febrile convulsions?

Answer 16

Tonic-clonic seizures that occur in children during a high fever and are not caused by epilepsy or other pathology.

They typically occur between the ages of 6 months to 5 years.

Question 17

What are the differentials for seizures?

Answer 17

1. Vasovagal syncope
2. Pseudoseizures
3. Cardiac syncope
4. Hypoglycaemia
5. Hemiplegic migraine
6. TIA

Question 18

What investigations are done for seizures?

Answer 18

1. EEG - electroencephalogram
2. MRI brain
3. ECG - to exclude heart problems
4. Serum electrolytes
5. Blood glucose
6. Blood cultures, urine cultures & lumbar puncture if sepsis, encephalitis or meningitis is suspected.

Question 19

What information does a patient need to know when diagnosed with epilepsy?

Answer 19

1. DVLA remove license until seizure criteria are met.
2. Showers > baths - drowning is a major risk factor.
3. Caution with swimming, heights, traffic.
4. Caution with heavy, hot or electrical equipment.

Question 20

What is the treatment for epilepsy?

Answer 20

Question 21

How does sodium valproate work?

Answer 21

Increases activity of GABA.

Question 22

What are the side effects of sodium valproate?

Answer 22

1. Teratogenic
2. Liver damage
3. Hair loss
4. Tremor
5. Reduced fertility

Question 23

What is status epilepticus?

Answer 23

A medical emergency defined as either a **seizure lasting more than 5 minutes **or multiple seizures without regaining consciousness.

Question 24

What is the management for status epilepticus?

Answer 24

1. Secure airway
2. High concentration O2
3. Check blood glucose levels
4. IV access

Question 25

What is the medical treatment for status epilepticus?

Answer 25

1. **Benzodiazepine** first line, repeated if seizure continues. 2. **IV levetiracetam, phenytoin or sodium valproate**. 3. **Phenobarbital** or **general anaesthesia**.

Question 26

What benzodiazepines can you use for status epilepticus?

Answer 26

1. Buccal midazolam 2. Rectal diazepam 3. IV lorazepam