Epilepsy

Question 1

Differential diagnosis for blackout / fainting?

Answer 1

• Syncope
• First seizure
• Hypoxic seizure
• Concussive seizure
• Cardiac arrhythymia
• Non-epileptic attack (narcolepsy / migraine etc.)

Question 2

Important questions for the patient after blackout episode?

Answer 2

• Feelings before / after
• Level of responsiveness during / after attack
• Motor involvement?
• Breathing / vocalization
• Behaviour after attack
• Incontinence?

Question 3

Most common cause of syncope? Prodrome symptoms?

Answer 3

• Vasovagal syncope: fainting due to overreaction to certain triggers (emotion / sight of blood etc.)

Prodrome:

• Light headedness / nausea / sweating / feeling warm
• Tinnitus (noise/ringing in ears)
• Tunnel vision

Question 4

What is a hypoxic seizure? Concussive seizure?

Answer 4

Hypoxic:
- Occurs when person kept upright during a faint, patient may have a succession of collapses & seizure-like activity may occur

Concussive:
- Occurring after any blow to the head

Question 5

How are cardiac arrhythmias and seizures related?

Answer 5

• Cardiac arrhythmia can cause blackout

- Seizures can cause cardiac arrhythmias

Question 6

How does a non-epileptic attack present? Who is at risk?

Answer 6

• Can resemble a seizure, may involve bizarre body movements
• More common in women, people with a history of abuse

Question 7

Investigations of suspected first seizure?

Answer 7

• Blood glucose
• ECG
• Alcohol & drug history
• CT head
• Calcium / Magnesium / U&E / LFT / EEG

Question 8

What is an epileptic seizure?

Answer 8

• An intermittent disturbance of consciousness, behaviour, emotion, motor function or sensation that is believed to be due to abnormal neural discharges
• Epilepsy is a condition in which seizures occur

Question 9

What are the different classes of seizure according to the International League Against Epilepsy (ILEA)?

Answer 9

• Tonic-clonic seizures
• Myoclonic seizures
• Clonic seizures
• Tonic seizures
• Atonic seizures
• Absence seizures

Question 10

How are focal seizures different from generalized seizures?

Answer 10

• Focal seizures are due to disruption of electrical impulses in one part of the brain
• Generalized seizures due to abnormal electrical discharge involving the entire brain

Question 11

How can focal seizures progress?

Answer 11

Simple focal and complex focal seizures can become secondary generalized seizures

Question 12

Difference between a simple partial/focal seizure and a complex partial/focal seizure?

Answer 12

• Simple: Person is aware they are having a seizure

- Complex: person is unaware

Question 13

What age do generalized and focal seizures tend to occur? Is there a prodrome for either?

Answer 13

Generalized:
- people <25 years old, no warning before seizure

Focal/Partial:
- Any age, may get an aura before

Question 14

Differences in causes of generalized and focal seizures?

Answer 14

Generalized:
- Usually genetic/idiopathic/metabolic etc., may have history of myoclonic jerks

Focal:
- Cause can be any focal brain abnormality

Question 15

Investigations when suspected epilepsy?

Answer 15

• EEG for primary generalized epilepsy
• MRI / CT for patients with possible focal onset seizure
• Video-telemetry if uncertain about diagnosis

Question 16

Treatment for primary generalized epilepsies?

Answer 16

• Sodium valproate
• Lamotrigine
• Levetiracetam

Question 17

Treatment for partial/focal and secondary generalized epilepsies?

Answer 17

• Lamotrigine

- Carbamazepine

Question 18

What is an absence seizure? Treatment?

Answer 18

• Seizure causing lapse in awareness, “staring into space”

- Ethosuximide

Question 19

Treatment for status epilepticus?

Answer 19

First line:
- Lorazepam (buccal/intra nasal), Midazolam (oral), Diazepam (IV / rectally)

Second Line:
- Valproate, Phenytoin

Question 20

Side effects of the different drugs used to treat seizures?

Answer 20

cba typing them now but in the slides

Question 21

What is status epilepticus?

Answer 21

According to slides: prolonged or recurrent tonic-clonic seizures persisting for more than 30mins with no recovery period between seizures

According to google: a single seizure lasting more than 5 mins or two or more seizures within 5 mins without the person returning to normal between them

Question 22

Who is usually affected by status epilepticus?

Answer 22

• Usually occurs in patients with no previous history of epilepsy (stroke, tumour, alcohol)

Question 23

Prognosis of status epilepticus attack?

Answer 23

• Mortality greatest in the very young and the very old (29% for those <1 year old)
• 90% of deaths due to underlying cause, mortality greatest when secondary to stroke, encephalitis, mass lesions & trauma

Question 24

Possible causes of epilepsy?

Answer 24

• Idiopathic
• Genetic
• Metabolic (alcohol withdrawal / low glucose)
• Post-trauma
• Hypoxic damage
• Brain tumours
• Cerebrovascular disease
• Alzheimers disease