EPILEPSY

Question 1

Broadly, what are the types of epileptic seizures?

Answer 1

1. Partial
2. Generalized
3. Unclassified

Question 2

What are the types of PARTIAL seizures?

Answer 2

1. simple

2. complex (with IMPAIRED consciousness)

Question 3

What are the diff. types of generalised seizures?

Answer 3

1. Absence- pt stares in to mid air
2. TONIC-CLONIC seizure: pt collpases and WRITHES on the ground
3. ATONIC- pt becomes FLACCID and collapses
4. MYOTONIC- rhythmic jerking

Question 4

Pt comes in with complaint of seizure. What is done?

Answer 4

• blood work + glucose
• EKG
• EEG
• CT/ MRI brain imaging
• LP (meningitis/ encephalitis is suspected)

Question 5

What is meant by having a partial seizure?

Answer 5

• involved only ONE part of the brain

Question 6

What is meant by generalized seizure?

Answer 6

• involves the ENTIRE brain

Question 7

Can a partial seizure become generalized?

Answer 7

• YES

- it may start off as a partial seizure and then it may become generalized

Question 8

Name some psychic symptoms.

What are they usually a.w?

Answer 8

• dysphasia
• deja vu
• fear
• HALLUCINATIONS
• distortions of time

—–SEEN with partial seizures (involvment of HIGHER cortical areas)

Question 9

What are autonomic symptoms that may occur with seizures?

Answer 9

• sweating
• piloerection
• pupillary changes
• epigastric rising sensation

Question 10

Which autonomic symptom acts as an aura with medial TEMPORAL LOBE epilepsy?

Answer 10

• epigastric sensation

Question 11

What actually is an AURA?

Answer 11

• a SIMPLE, PARTIAL SEIZURE

- no altered consciousness (affects only part of the brain > some symptoms)

Question 12

What are some examples of auras?

Answer 12

1. flashing lights (if OCCIPITAL lobe is involved)
2. Muscle jerking (motor cortex is affected) —jacksonian seizure
3. sudden Smell

Question 13

How to differentiate cardiac syncope from seizures?

Answer 13

• NO post-ictal state of confusion is seen with cardiac syncope
  -in seizures: confusion and lack of alertness
  (mins> hrs)

Question 14

What is the common site of partial seizures?

Answer 14

TEMPORAL LOBE

Question 15

What condition of the brain leads to the involvement of the temporal lobe?
Dx is by _____

Answer 15

• MESIAL Temporal Sclerosis
• —aka hippocampal sclerosis (Neuronal loss in hippocampus)

– MRI

Question 16

Juvenile myoclonic seizures are commonly seen in whom______?

And how may it progress>

Answer 16

children

• 5y.o: absence seizures first
• 15 y.o: MYOCLONIC seizures …GRAND MAL after

Question 17

What is the HALLMARK of JME?

Answer 17

• MYOCLONIC jerks on awakening from sleep

- shock-like, irregular movements of both arms

Question 18

What is the first line rx of JME?

Answer 18

• SODIUM VALPROATE

Question 19

What drug is C.I for myoclonic, tonic and atonic seizures?

Answer 19

• Carbamazepine and Oxcarbamazepine

Question 20

What is childhood absence epilepsy like?

Answer 20

• sudden impairment of consciousness
• NO change in body tone
• REMITS by puberty

Question 21

What helps to identify the type of seizure?

Answer 21

-EEG

Question 22

Will a pt have post-ictal confusion with absence epilepsy?

Answer 22

NO

Question 23

How to treat childhood ABSENCE epilepsy>

Answer 23

-ETHOSUXIMIDE

Question 24

Women having eclampsia is treated with what?

Answer 24

MgSO4

Question 25

How to treat the COMPLEX partial seizures that arise from hippocampal sclerosis?

Answer 25

- LAMOTIGRINE | - CARBAMAZEPINE

Question 26

How to treat IIary generalized seizures?

Answer 26

- LAMOTIGRINE | - CARBAMAZEPINE

Question 27

What is the use of carbamazepine?

Answer 27

-FOCAL onset seizure | auras

Question 28

Why is SODIUM VALPROATE not that great a choice for seizure?

Answer 28

many S.Es | wgt GAIN, HAIR LOSS, teratogenic/FATIGUE

Question 29

When is phenytoin used?

Answer 29

ACUTE management only

Question 30

Which is ideal anti-convulsants and why?

Answer 30

- LEVETIRACETAM | well-tolerated/ moodswings

Question 31

Can lamotigrine be given for BOTH focal and generlaized seizures?

Answer 31

YES

Question 32

Which anti-convulsant also acts as a sedative?

Answer 32

TOPIRAMATE | ----also causes WGT loss

Question 33

How do anti-convulsants affect contraceptives?

Answer 33

- AEDs are enzyme inducing - ----MORNING after pill should be INCREASED - - efficacy of COC pill is altered - depot progesterone needs MORE freq. dose and implants suck

Question 34

Name some anti-convulsants.

Answer 34

carbamazepine phenytoin phenobarbitol topiramate

Question 35

What is status epilepticus?

Answer 35

- recurrent epileptic seizures WITHOUT full recovery of consciousness - LASTs MORE than 30 mins

Question 36

What are the diff. types of STATUS epilepticus>

Answer 36

- generalized convulsive Status epilepticus - NON-convulsive status (altered state) - epilepsia partialis continua (continual focal seizures/ consciousness preserved)

Question 37

What precipitates status epilepticus?

Answer 37

- infection/ trauma/ sub-arachnoid hemorrhage/ abrupt WITHDRAWAL of anti-convulsants - metabolic disorders (PYRIDOXINE/ hyponatremia)

Question 38

How to treat absence seizures?

Answer 38

CBZ

Question 39

What is the danger of status epilepticus?

Answer 39

- excess cerebral energy demand and POOR substrate delivery > DAMAGE ! ----respiratory insufficiency and hypoxia ---hypotension -- hyperthermia ---rhabdomyolysis

Question 40

Steven-Johnson $ may occur following exposure to which AED?

Answer 40

- Phenytoin | - Lamotigrine

Question 41

What are the long term effects of Phenytoin?

Answer 41

- hirsutism - megaloblastic anemia - gingival hyperplasia