Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Epilepsy / seizure

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Emergency Medicine
Progress Test Topic(s)
A 20 year old Tongan rural community lifeguard is brought to the Emergency Department after having an apparent convulsive episode at the life saving club. She has a past medical history of depression for which she takes antidepressant medications. She drinks alcohol frequently. She has a contusion on her right temple after hitting her head when she collapsed.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy and pathophysiology of neural pathways involved in seizure
   - Pathology of intracerebral tumours, bleeds and traumatic brain injuries
   - Seizure patterns and localisation (simple, complex, partial, generalisation, absence, daytime/nocturnal)
   - Mechanism of action, pharmacokinetics, and pharmacodynamics of anticonvulsant drugs and drug interactions
   - Toxicology of alcohol and pathophysiology of alcohol withdrawal
   - Psychiatric and psychological sequelae of seizure-activity and use of anticonvulsants; cognitive dysfunction, mood disturbance, personality changes, anxiety disorder, psychosis
Clinical and Communication Skills 
   - Emergency management of seizures and status epilepticus
   - History from a patient with a seizure; discuss alcohol intake
   - Gaining collateral history from witnesses as there is often impaired consciousness/awareness in those with seizures
   - Perform full neurological and cardiovascular examinations
   - Indications for basic biochemical blood test, echocardiogram, Holter monitoring, CT, MRI and electroencephalography (EEG) for investigating 'funny turns'
   - Classification of seizures
   - Differential diagnosis of seizures in different age groups
   - Longterm management of epilepsy; indication for initiating medical therapy; role of therapeutic drug monitoring; titration of anticonvulsant drugs
   - Management of epilepsy during pregnancy and peripartum period
   - Role of psychotherapy in the treatment of psychogenic non-epileptic seizures
   - Outline the management of certain types of epilepsy with neurosurgery
Personal and Professional Skills 
   - Safety issues related to seizures/epilepsy: fitness to drive, swimming, and operating heavy machineries
   - Address patient concerns regarding function, employment and insurance
   - Confidentiality
   - Understand patient's anxiety regarding the possiblity of an underlying cause
   - Stigma of diagnosis
   - Recognising and advising on any potential triggers; e.g. TV, lighting, sleep-deprivation
Hauora Māori 
   - Lower anti-epileptic medication prescribed to Maori despite need
   - Higher rates of hospitalization for epilepsy in Māori compared with non-Māori
   - Ability to cater for differential health literacy needs of Māori patients and whānau
Population Health 
   - Epidemiology of epilepsy
   - Effectiveness and cost-effectiveness of new treatments for epilepsy
   - Delivering sustainable comprehensive health services to rural communities
Conditions to be considered relating to this scenario
idiopathic, absence seizures, tonic-clonic seizures, juvenile myoclonic epilepsy, focal seizures with retained awareness (focal motor seizures, focal sensory seizures, benign rolandic epilepsy), focal seizures with loss of awareness (temporal lobe epilepsy, frontal lobe epilepsy, parietal lobe epilepsy and occipital lobe epilepsy), febrile convulsion, vasovagal syncope, Stokes-Adams attack, cardiac arrhythmias, psychogenic non-epileptic seizures
Less common but 'important not to miss'
encephalitis, intracranial haemorrhage, space occupying lesion, alcohol withdrawal, substance abuse
tuberous sclerosis, systemic lupus erythematosus (SLE), polyarteritis nodosa, sarcoidosis, vascular malformation