Disorders Of Neuronal Transmission Flashcards
What is a Jacksonian march
Focal motor seizure aspect
Unilateral, distal to proximal seizure
Frontal lobe seizure
What is seen in a temporal lobe seizure
Hallucinations, lip smacking, grabbing and plucking (automatism)
What is seen in frontal lobe seizure
Head and leg movement, posturing with post ictal weakness.
Jacksonian march
What is seen in an occipital lobe seizure
Flashers and floaters
Typical absence seizures
What type of epilepsy is it and what happens
Generalised seizure which have a loss of awareness for ,pre than 10 seconds before returning to normal
Features of genaralised tonic clinic seizures
Initial tonic stiffening, followed by a clonic phase (synchronous jerking of limbs)
Eyes open
May have tongue biting, incontinence and cyanosis.
Has a post ictal phase (gradual return of awareness with confusion and maybe headache.
Managment of first seizure
Baseline bloods
BM, ketones, ECG
MRI and EEG if epilepsy likely
Should urgently be referred to be seen by a neurologist within 14 days.
Driving and epilepsy
Cannot drive after 1 st seizure for six months
If epileptic must be seizure free for one year.
Treatment of generalised tonic clonic and a tonic seizures
Valproate for men
Lamotrigine or levetiracetam for women
Treatment of focal seizures
Lamotrigine or carbamazepine is 1st line
Levetiracetam is second line
Treatment of myoclonus seizures
Valproate or levetiracetam
DO NOT GIVE carbamazepine
Lamotrigine and carbamazepine
MOA and side effects
Both block sodium channels
Both can cause SJS
Carbamazepine is an enzyme inducer, decrease warfarin and COCP effect.
Sodium valproate
MOA and side effects
Increases GABA activity
Extremely teratogenic , CHD, cleft palate and developmental delay. Foetal valproate syndrome.
What aed are category one and cannot be switched over
Carbamazepine, phenytoin and barbituates
What category is lamotrigine
2
Epilepsy drugs and pregnancy
What if they need valproate
If they are taking, what else do they need
Pregnancy prevention programme
5mg folic acid until week 12
How is phenytoin given
Give a loading dose of 20mg/kg, followed by 100mg every 6-8 hours
Give in a large vein, at no more than 50mg a min
Monitor patients breathing, pulse and bp. Do an ECG, and take serum levels after 24 hours
What congenital conditions predispose you to epilepsy
C palsy
Tuberous sclerosis
