Falls & epilepsy

Question 1

Fall & seizure Hx?

• actual fall (8)
• other parts (4)
• what should be discussed post hx?

Answer 1

Onset
what were they doing?
Light headed/other syncopal symptoms 
What did they look like?
(pallor, breathing, posturing of limbs, head turning)
Event
Type of movement (tonic phase, clonic movements)
(Corpopedal spasms, rigor)
Responsiveness and awareness throughout 
After
speed of recovery
Sleepiness/disorientation, deficits 

Epilepsy risk factors 
(birth, development, seizures in the past, head injury, fam Hx, drugs & alcohol)
Social Hx 
DRIVING & OCCUPATION
PMHx and Drug Hx

-explain diagnosis
risk of recurrence
Driving and safety

Question 2

Examination?

Answer 2

only do in syncope Hx- CV exam and L+S BP

Question 3

Investigations?

Answer 3

ECG
imaging- MRI Vs CTb
??EEG??

Question 4

Epilepsies 
-types of epilepsy?
-for 1st type:
onset?
EEG?
types of seizure?

Answer 4

Generalised
(genetic predisposition, in childhood and adolescence
See Spike wave abnormalities on an EEG
Tonic clonic, absence, myoclonic, tonic and atonic

Partial/focal epilepsy

Question 5

Primary generalised epilepsy

• present when?
• give an example?
• treatment?
• inv?

Answer 5

-childhood or teens

-juvenile myoclonic epilepsy
(early morning jerks, generalised seizures, risk factors: sleep deprivations, flashing lights)

• sodium valproate OR Lamotrigine
• EEG to determine type

Question 6

Focal onset epilepsy

• cause?
• onset?
• type of seizure?
• treatment?

Answer 6

• underlying structural cause
• Focal onset then generalise, can occur at any age
• complex partial seizures with hippocampal sclerosis
• Carbamazepine or lamotrigine

Question 7

Anticonvulsants 
-give 3 older ones?
-Give 4 new generation?
what should be given in the following types of seizure?
Absence
Myoclonic
Atonic/tonic/tonic clonic
-when should they be prescribed?
-What drugs alter the efficacy of the pill? (6)

Answer 7

-Phenytoin
(for acute management only, enzyme inducer)
Sodium valproate
(effective but lots of SE: weight gain, teratogenic, hair loss, fatigue)
Carbamazepine
(only for focal onset, can make generalised worse)

-Lamotrigine
(well tolerated in both generalised and focal but takes a long time to titre up)
Levetiracetam
(popular, few interactions, well tolerated but can cause mood swings)
Topiramate
(SE: dysphasia, sedation, weight loss)
Gabapentin, Pregabalin
more in neuropathic pain, huge drug abuse)

-Na valproate

Na valproate
Levetiracetam

Na valproate

• not after first seizure, only if there is a risk that another will occur
• Carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate

Question 8

Status epilepticus

• what is this?
• types? (3)
• precipitants? (6)

Answer 8

-recurrent epileptic seizures without full recovery of consciousness
Continuous seizure activity lasting more than 30 mins

-generalised convulsive status epilepticus
non-convulsive states (conscious but in altered state)
Epilepsia partialis continua
(continual focal seizures, consciousness preserved)

-Severe metabolic disorder (hyponatraemia, pyridine def)
Infection
head trauma
Subarachnoid Haemorrhage 
abrupt withdrawal of anti convulsants 
treating absence seizures with CBZ

Question 9

Convulsive status

• what is it?
• why does it occur?
• Can cause what? (4)
• Management? (3)

Answer 9

• generalised convulsions without cessation
• excess cerebral energy demand and poor substrate delivery causes lasting damage

-Resp insufficiency & hypoxia
Hypotension
hyperthermia
rhabdomyolysis

-Stabalise with ABCDE
identify cause: bloods +/- CT
Anti convulsants
(phenytoin, Keppra, Valproate, Benzodiazepines)