Is awareness impaired in:
Focal seizures?
Generalised seizures?
Focal - no impairment
Generalized - impairment
Focal seizures can go on to progress to secondary generalised seizures - T/F?
TRUE
What can the presence of aura’s help you decide?
Whether or not the pt is fit to drive
Focal aware seizures (SIMPLE focal seizure) have symptoms dependent on their anatomical localisation in the brain.
What kind of symptoms would be present in the parietal lobe?
Sensory - tingling / numbing / pain
where in the brain would a simple focal seizure be present if the symptoms they described:
changes in mood & behaviour
rising epigastric sensation
Temporal lobe
frontal lobe seizure symptoms
stiffness
twitching
spasm
spreading from distal limb to face
Complex focal seizures have impaired awareness - T/F?
TRUE
where do complex focal seizures most commonly arise?
temporal lobe
pathophysiology behind temporal lobe complex focal seizures
hippocampal sclerosis
3 key features of complex focal/’‘partial’’ seizures
aura
absence (loss of consciousness)
automatism (repetitive stereotyped movement)
what can happen after a seizure occurs
post-ictal confusion
is an absence seizure focal or generalized?
generalised
what happens during absence seizures
sudden loss of consciousness
all motor activity stopped
abrupt duration - 10 secs
pt is unaware the attack has happened and continues on as if nothing happened (no post-ictal confusion)
EEG characteristic in absence seizure
3 Hz spike wave
what are myoclonic seizures
brief contraction of one or more muscles resulting in a small twitch or severe jerk
what is juvenile myoclonic epilepsy
brief myoclonic jerks occurring 1 hour after awakening
affects mainly shoulders + arms
12-18 y/o
generalised tonic-clonic seizures also occur months/years after onset of myoclonus
Juvenile myoclonic epilepsy has a poor response to treatment - T/F?
F
complete response in 80-90% cases BUT for some lifelong therapy may be needed
what is a clonic seizure
elbows, legs and head FLEX
what group of individuals get clonic seizures
neonates & young kids
what is a tonic seizure
brief loss of consciousness pt falls to ground EXTENSION of neck upturning of eyes back arched
complications from tonic-clonic seizures
pt biting their tongue
cyanosis
incontinence
what type of imaging can be used to help determine the type of seizures?
EEG (although this may show normal results)
MRI
indications for getting an MRI for seizures
pt who develop epilepsy before 2 y/o
focal seizures
pt who continue to seizure despite 1st line medication
titration of anti-epileptic drugs should start high and titrated down - T/F?
F
other way round
Polytherapy is used when at least 2 drugs (used as monotherapy) have failed to control seizures
F
you need to use at least 3 drugs as monotherapy before you can start polytherapy
1st line tx for tonic-clonic
sodium valproate
if sodium valproate doesn’t work for tonic clonic, what can be used?
lamotrigine
2nd line for tonic-clonic seizures (name 2 options)
levetiracetam
topiramate
can sodium valproate be used for all generalised seizures?
yes - 1st line for all (tonic-clonic/absence/myoclonic)
2nd line tx for myoclonic seizure
levetiracetam
what 2 drugs can be used for focal seizures?
lamotrigine
carbamazepine
if a seizure is unclassified, what drugs can be used?
1st line - sodium valproate
2nd line - lamotrigine & topiramate
is toperimate ever used 1st line?
no - always 2nd line
what anti-epileptic drugs work on the na+ channel?
carbamazepine
phenytoin
lamotrigine
sodium valproate
S/E of carbamazepine
diplopia
ataxia
teratogenic
hyponatraemia
when is phenytoin used for seizures?
as seizure prophylaxis
S/E of phenytoin
nystagmus diplopia sedation gingival hyperplasia (gum bleeding) peripheral neuropathy
what is the mechanism of the anti-epileptic drug ethosuximide
blocks Thalamic T-type Ca2+ channels
when is ethosuximide used?
1st line in absence seizures (along with sodium valproate)
sodium valproate is teratogenic - T/F?
TRUE
what is status epilepticus
seizures which continue for a prolonged period (5+ mins)
1st line community treatment for status epilepticus
buccal/rectal midazolam
1st line hospital treatment for status epilepticus
IV lorazepam
2nd line hospital treatment for status epilepticus
IV phenobarbital or phenytoin
for cars/motorcycles:
how long do you have to stop driving if a seizure occurs when awake?
1 year
if a seizure occurs when you are asleep, you can still drive - T/F?
TRUE
BUT only if there is no awake attack for 3 years
if a seizure occurs when awake but doesn’t affect consciousness, can you drive?
you can qualify for a licence if these are the only type of attack you’ve ever had and the first one was 12 months ago
for buses/lorries:
if you have a one off seizure, you have to wait 10 years before you can drive again?
FALSE
You have to wait 5 years (you have to wait 10 if you have 2+ seizures or diagnosis of epilepsy)