Epilepsy Flashcards
What is the DVLA advice for patients who have had their 1st fit?
Stay off driving for 6 months after 1st fit
must show seizure free for 12 months if underlying epileptogenic activity/SOL
How do you manage 1st fit in secondary care?
Can discharge home if safe
To be seen in epilepsy clinic within 2 weeks
–> Do not start AED if 1st fit/without prior discussion with neurology
You are looking after a 20-year old who had her first fit, and she is now in AMU. What Ix would you like to do?
Bloods: Glucose, FBC, U + E, LFTs, lactate (if severe)
ECG
CT head (need TRO SOL/bleed)
Urinary pregnancy test
In outpatient:
EEG (later on, especially if suspect genetic generalised epilepsy)
MRI head
What anti-epileptics are safe in pregnancy? Which one is contraindicated?
None really, although the best ones are lamotrigine and levetiracetam
Sodium valproate is contraindicated in pregnancy because it is highly teratogenic.
What are the side effects of sodium valproate?
V omiting A lopecia L iver toxicity P ancreatitis R etention of fat O edema A ppetite increase T remor/Teratogenic E nzyme inducer
What are the side effects of carbamazepine?
Enzyme inducer SIADH Agranulocytosis Erythematous rash Stevens-Johnson syndrome
What are the side effects of phenytoin?
P 450 interactions H irsutism E nlarged gums (gum hypertrophy) N ystagmus Y ellow-browning of skin T eratogenic O steomalacia I nterferes with folate metabolism N europathies: vertigo, ataxia, headaches
What are the side effects of lamotrigine?
Stevens-Johnson syndrome (toxic epidermal necrolysis) Visual disturbances (diplopia) Blurred vision Photosensitivity Tremor Agitation Vomiting Aplastic anaemia
What are the side effects of Keppra (levetiracetam)?
Depression (low mood)/suicide Agitation D & V Dyspepsia Drowsiness Diplopia Blood dyscrasias (abnormal blood)
