Epilepsy

Question 1

What are the two main categories of epilepsy and their subtypes?

Answer 1

1. Generalised seizures - involve the whole brain
   
   1. Tonic-clonic
      
      • Rarer
        
        • Myoclonic
        • Abscence (Petit Mal)
        • Atonic - drop attack.
        • Tonic Seizures
2. Focal/Partial seizures - involve a certain part of the brain.

Question 2

Which seizures are seen more commonly in childhood?

Answer 2

The rarer causes (myoclonic, atypical abscence, atonic and tonic)

Question 3

Describe the main feature (conciousness or no consciousness) of Generalised seizures and then describe there subtypes..

Answer 3

• Generalised - no focal features, consciousness lost immediately
  
  1. Grand mal (tonic-clonic)
  2. Petit mal (absence seizures)
  3. Myoclonic: brief, rapid muscle jerks
  4. Partial seizures progressing to generalised seizures

Question 4

What is the difference between simple partial and complex partial seizures?

Answer 4

• Complex Partial (consciousness is disturbed)
• Simple partial (consciousness is preserved)

Question 5

Describe the subtypes of partial seizures

Answer 5

• Partial - focal features depending on location

1. Simple (no disturbance of consciousness or awareness)
2. Complex (consciousness is disturbed)
3. Temporal lobe - simple partial seizures in temporal lobe epilepsy will usually only cause abnormal sensations.
   
   1. Sensations include aura, deja vu, jamais vu; motor → Jacksonian march.

Question 6

In Temporal Lobe seizures, what do, aura, deja vu, jamais vu and Jacksonian march mean?

Answer 6

• Aura
  
  • Auditory, olfactory, gustatory, visual or sensory (skin or organs)
• Deja Uv - a feeling of familiarity
• Jamais vu - a feeling of unfamiliarity
• Amnesia
• Jacksonian march - unilateral motor cortex activity that advances to affect different parts of the motor cortex and thus different parts of the contralateral body seize at different times.

Question 7

Roughly speaking what are the first line drug for generalised seizures vs partial seizures?

Answer 7

Generalized seizures = sodium valproate

Partial seizures = Carbamazepine.

Question 8

What anti-epileptic is used to treat absence seizures?

Answer 8

Sodium valproate

Question 9

What anti-epileptics are used to treat Generalised seizures?

Answer 9

1st line = sodium valproate

2nd line = lamotrigine or carbamazepine

Question 10

What drugs are used to treat Partial Seizures?

Answer 10

1st line Carbamazepine

2nd line - lamotrigine or sodium valproate

Question 11

What anti-epileptics are used to treat myoclonic seizures?

Answer 11

1st line - sodium valproate

2nd line - clonazepam or lamotrigine.

Question 12

What are some side effects of sodium valproate?

Answer 12

• Gastrointestinal: nausea
• Increased appetite and weight gain
• Alopecia: regrowth may be curly
• Ataxia
• Tremor
• Hepatitis
• Pancreatitis
• Thromobcytopaenia
• Teratogenic
• Hyponatraemia

Question 13

What are some side effects of carbamazepine?

Answer 13

• P450 enzyme inducer
• Dizziness and ataxia
• Drowsiness
• Headache
• Visual disturbances (especially diplopia)
• Steven-Johnson syndrome
• Leucopenia and agranulocytosis
• Syndrome of inappropriate ADH secretion