1(E): Epilepsy Flashcards
Define epilepsy
- Two or more unprovoked seizures occurring more than 24-hours apart
- One seizure with probability of second-seizure more than general recurrence risk (60%) after two unprovoked seizures
- Epilepsy syndrome
What is epilepsy
- Recurrent tendency to spontaneous, intermittent. abnormal electrical activity in part of the brain manifesting as seizures
What are convulsions
Motor signs of electrical discharge
What is the main cause of epilepsy
Idiopathic
What are other causes of epilepsy
Genetic TBI Infection Alcohol-related SOL
What are seizure-triggers
Sleep deprivation
Alcohol
Stress
Flashing-lights
What are 4 risk factor for epilepsy
- FH
- Hypoxic-Ischemic
- Meningitis or Encephalitis
- TBI
What investigations should those with epilepsy first receive
EEG
MRI
If someone is having a seizure in public what should be done
ACTION first-aid
Assess danger Cushion head Time Identity bracelet Over - recovery position Never put object in their mouth
What are criteria for calling an ambulance
- First seizure
- Persists beyond 5 minutes
- Two episodes without regaining consciousness
- Difficultly breathing
When are seizures treated medically
Persist beyond 5-minutes.
3 or more seizures in 24-hours
What is first-line for seizure management in the community
Buccal midazolam
If buccal midazolam is unavailable, what is given
Rectal diazepam
What benzodiazepine is preferred where possible
IV lorazepam
When are anti-epileptic medications started
After second-seizure
What is first-line for generalised tonic-clonic seizures
Sodium valproate
What is first-line for absence seizures
Ethosuximide, Sodium Valproate
What is first line for myoclonic seizures
Lamotrigine, Valproate, Clonazepam
What is first line for focal seizures
Carbamazepine
When is surgery for epilepsy indicated
Hippocampal resection - if tubero sclerosis (associated with infantile spasms)
What other surgical procedures can be ordered for epilepsy
DBS
Vagal nerve stimulation
Describe interaction between anti-epileptics and contraception
Anti-Epileptics affect CYP450 and may alter efficacy of contraceptives. Lamotrigine does not affect CYP450 - but does reduce effectiveness of oestrogen-containing contraceptives
What medication should women of child-bearing age not be on
Sodium Valproate
What is least teratogenic medication
Carbamezapine
What are pregnant women often put on and why
Lamotrigine - little teratogenic effects. More effective and tolerable than carbamazepine.
What does valproate cause in-utero
NTD
What does phenytoin cause in-utero
Cleft-Palate
Describe epilepsy and driving
Individual should not drive for 12-months following their last seizure
Explain driving following a seizure
6-months off driving, unless 20% recurrence risk of another seizure then 12-months
Explain when epilepsy is resolved
- Out of age-range for epilepsy syndrome
- Seizure free 10-years, 5 of which are medication free
What is a complication of epilepsy
SUDEP
When is SUDEP more common
Uncontrolled epilepsy
What causes SUDEP
Nocturnal hypoxia or systole
What orthopaedic complication are those with seizures at increased risk of
Fracture
What psychiatric complication are those with epilepsy at risk of
Neurpsych assessment
What contraceptives should be given in epilepsy
IUD
Depo provea injection
What is problem with depo provea injections and epilepsy
Depo provea does not protect against bone health - and these individuals are at increased risk of fractures.
