Epilepsy

A seizure whereby there is rapid contraction and relaxation of muscles causing an uncontrollable shaking of the body is called a [blank_start]convulsive[blank_end] seizure.

[blank_start]Generalised seizures[blank_end] affect both brain hemispheres [blank_start]Focal seizures[blank_end] affect only one brain hemisphere

Types of Generalised Seizure: [blank_start]Tonic-clonic[blank_end] - Contraction of limbs followed by their extension & arching of back lasting 10-30s, followed by a shaking of the limbs. [blank_start]Tonic[blank_end] - Constant contraction of the muscles. Person often turns blue as breathing is stopped. [blank_start]Clonic[blank_end] - Shaking of the limbs in unison. [blank_start]Myoclonic[blank_end] - Brief, shock-like jerks of a muscle or a group of muscles.

During tonic-clonic seizures, bites to which part of the tongue are more common?

If a patient presents after a fall/seizure, it is mandatory to rule out a cardiovascular cause via which investigation?

DVLA Rules Regarding Seizures - car: You’ve had a one-off seizure while awake and lost consciousness:

DVLA Rules Regarding Seizures - HGV: You’ve had a one-off seizure while awake and lost consciousness:

DVLA Rules Regarding Seizures - car: Diagnosed with epilepsy:

DVLA Rules Regarding Seizures - HGV: Diagnosed with epilepsy:

Primary Generalised Epilepsy often presents ...

The treatment of choice for primary generalised epilepsy is [blank_start]Sodium Valproate[blank_end]

If a primary generalised epilepsy patient is unresponsive to Sodium Valproate, which of the following second line treatments is most common?

Due to the adverse side effects, sodium valproate is not recommended for focal onset epilepsy. Instead, what is the first line treatment for this condition?

Sodium Valproate is teratogenic and should not be prescribed to pregnant women

A 17 year old girl is taken to A&E after having had a generalized seizure. She had been out partying the night before. No past Hx of note, although her mother reported that she had been a bit clumsy and jerky in the mornings recently, e.g. dropping her hairbrush or coffee cup. Which of the following statements is correct?

What is status epilepticus?

Status Epilepticus is a clinical emergency. Whilst they tend to stop by themselves, to prevent further damage anticonvulsants should be given. Which of the following anticonvulsants should be given in an acute situation such as this?

A patient in status epilepticus is considered an emergency case. Therefore, urgent blood tests and CT to identify the cause are required.

What means of investigation is used to differentiate generalised from focal epilepsy?

Women on anti-convulsants seeking the contraceptive pill should not use the [blank_start]progesterone only pill[blank_end] and should instead be switched to the [blank_start]combined pill (estrogen + progesterone)[blank_end]

The morning after pill is more effective in women taking anti-convulsants and the dose should be titred down accordingly.

Which anti-convulsant can be given to patients who are obese/have sleep problems due to its weight reducing and sedative effects? [blank_start]Topiramate[blank_end]

Carbamazepine typically makes Primary Generalised Epilepsy worse

In the case of Status Epilepticus, patients are generally given benzodiazepines first line to attempt to halt the seizures. Such medications include IV [blank_start]Lorazepam[blank_end], Buccal [blank_start]Midazolam[blank_end] and Rectal [blank_start]Diazepam[blank_end]. If benzodiazepines fail to halt the seizures, then the anti-convulsant called [blank_start]Phenytoin[blank_end] should be given IV.

Which type of seizure typically causes the patient to experience odd smells? e.g. every time they drive they experience a "metallic smell"

Is an absence feature focal or generalised?

Following a seizure patients typically enter what is known as a [blank_start]postictal[blank_end] state where they feel drowsy and tired for around 15 minutes before they are back to feeling normal again.

Which of the following anticonvulsants is known to induce alopecia?

Which anticonvulsant medication is known to cause Stevens-Johnson Syndrome in some rare cases? [blank_start]Lamotrigine[blank_end]