Epilepsy + Seizures

Question 1

management of unprovoked generalised tonic-clonic seizures

Answer 1

1. FIRST LINE : Sodium valporate

2. SECOND LINE : Carbamazepine / Iamtrigine

Question 2

4 major types of seizures called

Answer 2

1. Partial/focal seizures
2. generalised
3. unknown onset
4. focal to bilateral seizures

Question 3

status epilepticus

Answer 3

1. patient continues to fit despite medication being administered
2. further benzos medication
3. infusions of anti epileptic medication or general anaesthetic agents

Question 4

nature of movements in epileptic seizures

Answer 4

1. Stiff/ Rigid/Shaking
2. Synchronous movements
3. No resistance to eye opening

Question 5

acute management of seizures

Answer 5

most seizures terminate spontaneously but if the seizure doesn’t terminate after 5 - 10 minutes
if not;

1. ABC
A - anaesthetist to secure the airway
B -  check sats and put patient on high flow oxygen
C - IV access + Cannula
- Check;
* Blood glucose levels
*Alcohol + Cocaine
*Electrolyte imbalances - Low levels of magnesium/calcium/sodium can cause seizures

Question 6

focal seizures

Answer 6

first line : carbamazepine or lamotrigine

second line: levetiracetam, oxcarbazepine or sodium valproate

Question 7

Absence seizures/Petit mal

Answer 7

1. sodium valproate or ethosuximide

2. sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Question 8

Acute medical management of seziures

Answer 8

-2. FIRST LINE - Benzodiazepines :

Lorazepam ( IV) / Diazepam (rectal) are used
- admin : rectally or intranasally under the tongue

-3. Admin Benzodiazepines again - further lorazepam if seizure persists

4. Iv infusion of antiepileptic
   - phenytoin
5. Status epilepticus - if patient continues to fit despite administeration of medication
6. General anaesthetic - Profolol/Modazelan to sedate patient and stop physical manifestation of the seizure

Question 9

associated symptoms with epileptic seizures

Answer 9

1. Postictal period - tired and drowsy ( may not remember ambulance coming or period straight after )
2. Todd’s Paresis - seziure in the motor cortex causes temporary muscle weakness and paralysis
3. Bowel incontinence is more likely in epilepsy
4. Tongue biting - specific areas of the tongue bitten such as side of tongue or inside of cheek indicate epileptic seizure
5. Auras

Question 10

myoclonic seizures

Answer 10

1. short muscle twitches

Question 11

nature of movements in non epileptic seizures

Answer 11

1. contorted movements
2. backarching
3. pelvic thrusting movements
4. resistance to eye opening

Question 12

Psychogenic non-epileptic seizures

Answer 12

1. previously termed pseudoseizures, this term describes patients who present with epileptic-like seizures but do not have characteristic electrical discharges
2. patients may have a history of mental health problems or a personality disorder

Question 13

focal to bilateral seziure

Answer 13

1. starts on one side of the brain in a specific area before spreading to both lobes
2. previously termed secondary generalized seizures

Question 14

tonic seizures

Answer 14

1. a type of generalised seizure

2. all muscles become stiff and flexed

Question 15

pathophysiology of epilepsy

Answer 15

1. Excess excitation
   - Excess levels of glutamate released to bind onto NMDA receptor channels resulting in long term activation
2. Too little inhibition
   - too little of GABA neurotransmitter binds to GABA receptor and causes opening of CL- ion channels

Question 16

Temporal lobe seizure symptoms

Answer 16

1. Hallucinations (auditory/gustatory/olfactory),
   - Epigastric rising/Emotional - refers to stomach sensation that starts in the stomach and rises in waves up the chest to throat or head
2. Automatisms (lip smacking/grabbing),
3. Deja vu/Dysphasia post-ictal)

Question 17

duration of epileptic seizure

Answer 17

1. shorter

2. less than 5 minutes

Question 18

definition of epilepsy

Answer 18

a common neurological condition characterised by recurrent seizures.

Question 19

Febrile convulsions

Answer 19

1. typically occur in children between the ages of 6 months and 5 years
2. around 3% of children will have at least one febrile convulsion
3. usually occur early in a viral infection as the temperature rises rapidly
   seizures are typically brief and generalised tonic/tonic-clonic in nature

Question 20

conditions associated with epilepsy

Answer 20

1. cerebral palsy: around 30% have epilepsy
2. tuberous sclerosis - rare genetic condition that causes non cancerous, benign tumors to develop in different parts of the boody
3. mitochondrial diseases

Question 21

atonic seizures

Answer 21

1. all muscles suddenly relax and become floppy

Question 22

myoclonic seizures

Answer 22

FIRST LINE - sodium valproate

SECOND LINE: clonazepam, lamotrigine

Question 23

management

Answer 23

following the patients first seizure, patients have an;

• EEG
• Neuroimaging - MRI

2. Most neurologists start anti epileptics following a second epileptic seizure

Question 24

other common causes of recurrent seizures apart from epilepsy;

Answer 24

1. febrile convulsions
2. alcohol withdrawl seizures
3. psychogenic non epileptic seizures

Question 25

tonic - clonic seizures

Answer 25

1. tonic phase is when muscles tense up followed by clonic phase where muscles contract and relax

Question 26

basic classification of seizures

Answer 26

. Where seizures begin in the brain 2. Level of awareness during a seizure (important as can affect safety during seizure) 3. Other features of seizures

Question 27

colour changes in non epileptic seizures

Answer 27

1. flushed

Question 28

colour changes in epileptic seizures

Answer 28

1. Cyanosed

Question 29

Generalised sezuires

Answer 29

1. engage both sides of the brain on onset 2. can be further divided into - motor : * tonic/clonic * atonic * clonic * myoclonic - non motor : absence sezuire

Question 30

clonic seziures

Answer 30

1. violent muscle contractions known as convulsions

Question 31

focal/ partial seizures

Answer 31

1. start in a specific site of the brain 2. level of awareness can vary; - focal awareness/simple partial - no lack of awareness - focal impaired awareness/complex partial - complete lack of awareness - awareness unknown 3. Can be further classified into motor/non motor - motor : Jacksonian march - non motor : deja vu, jamais vu, or aura

Question 32

signs and symptoms

Answer 32

patients who have had a generalised seizure also - 1. bite their tongue - 2. experience incontinenece of urine - 3. following a seizure have 'postictal phase' where they feel tired and drowsy for 15 mins

Question 33

frontal lobe seizure symptoms

Answer 33

1. head and leg movements 2. posturing 3 post

Question 34

duration of non epileptic seizure

Answer 34

1. longer | 2. waxes and wanes

Question 35

Alcohol withdrawl seizures

Answer 35

1. occur in patients with a history of alcohol excess who suddenly stop drinking, for example following admission to hospital 2. chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors. 3. Alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission) 4. the peak incidence of seizures is at around 36 hours following cessation of drinking 5. patients are often given benzodiazepines following cessation of drinking to reduce the risk