Epilepsy

Question 1

Pathology?

Answer 1

abnormal neuronal activity leads to seizures

Question 2

Aetiology of seizures?

Answer 2

• idiopathic
• genetic defects
• metabolic abnormalities
  
  • alcohol withdrawal
  • hypoglycaemia
• brain tumour
• CVA
• hypoxic injury
• head trauma

Question 3

Ix?

Answer 3

• EEG
• MRI
• ECG
• Bloods
  
  • FBC
  • U&E
  • Glucose

Question 4

Types of epilepsy

Answer 4

• Generalised
  
  • tonic-clonic
  • atonic
  • myoclonic
  • absence
• Focal

Question 5

describe tonic clonic seizures and the treatment

Answer 5

• unconsciousness followed by
• muscle tensing followed by
• muslcle jerking

during the seizure there may be incontinence, tongue biting, irregular breathing & groaning

post-ictal phase after where pts are confused, drowsy, irritable and depressed

Rx:

1. sodium valproate
2. lamotrigine / carbamazepine

Question 6

describe focal seizures & the treatment

Answer 6

starts in temporal lobe. Affects speech, hearing, memory and emotions

May present with:

• hallucinations
• deja vu
• memory flashbacks
• abnormal behaviour on autopilot

Rx:

1. Lamotrigine /Carbamazepine
2. sodium valproate

Question 7

describe absence seizures and the treatment

Answer 7

• typically occurs in childhood
  
  • ​>90% of pts say that as they grow older the seizures stop
• lasts 10-20 seconds
• pt goes blank, stares into space and abruptly snaps back to normality. During seizure will not respond and be unaware of surroundings

Rx:

Sodium valproate / ethosuximide

Question 8

describe atonic seizures and the treatment

Answer 8

• sudden loss of postural muscle tone
• typically begin in childhood
• don’t last more than 3 minutes
• linked to Lennox-Gastaut syndrome

Rx:

1. Sodium Valproate
2. Lamotrigine

Question 9

describe myoclonic seizures and the treatment

Answer 9

• sudden brief muscle contractions
• pt usually remains awake
• can be seen as part of juvenile myoclonic epilepsy

Rx:

1. Sodium Valproate
2. Lamotrigine / Topiramate

Question 10

Action of Sodium Valproate and side effects? (mnemonic)

Answer 10

Action: increases levels of GABA, hence relaxing effect on brain

S/E:

• Valproate
• Alopecia
• Liver toxicity
• Pancratitis / Panyctopenia
• Retain fat (weight gain)
• Oedema
• Appetite increase
• Tremor
• Enzyme inhibitor
  
  • must avoid giving to girls / women unless absolutely necessary, and if so must make sure they are on adequate contraception

Question 11

side effects of Carbamazepine?

Answer 11

• inducer of P450 system
• agranulocytosis
• aplastic anaemia

Question 12

phenytoin side effects?

Answer 12

• vitamin D/ Folate deficiency
  
  • megaloblastic anaemia
  • osteomalacia
• peripheral neuropathy
• lymphadenopathy

Question 13

Ethosuximide side effects?

Answer 13

• rash
• night terrors

Question 14

Lamotrigine side effects?

Answer 14

• stevens johnsons syndrome
• leukopenia

Question 15

Complication of epilepsy?

Answer 15

Status epilepticus

• medical emergency
• when seizure lasts > 5 mins or > 3 seizures in 1 hour

Question 16

Rx of status epilepticus?

Answer 16

ABCDE approach

• secure airway
• high flow oxygen
• check blood glucose
• assess cardio & respiratory function
• IV access
• IV Lorazepam, repeated after 10 mins if seizure continues

If seizures persist:

• IV phenytoin/Phenobarbital

In community:

• buccal midazolam
• rectal diazepam

Question 17

DDx of seizures?

Answer 17

• hypo
• alcohol withdrawal
• electrolyte imabalance
• meningitis / encephalitis
• drugs