Epilepsy Flashcards
What are the seizure types?
focal, generalised, unknown
What are the epilepsy types?
focal, generalised, combined generalised and focal, unknown
Someone has had a single episode of seizure. Should you treat with antiepileptic drug therapy?
not immediately, recommended after second unprovoked seizure
In which circumstances should antiepileptic drugs be considered after first unprovoked seizure?
- EEG demonstrates epileptic activity
- Brain imaging shows structural abnormality
- Ongoing neurological deficit or abnormality
- Patient/family considers the risk of further seizures unacceptable
Which antiepileptic drug is contraindicated in pregnancy/child bearing potential?
sodium valproate
What are the categories of adverse effects associated with antiepileptic drugs?
- Acute, related to MOA
- Idiosyncratic
- Chronic
- Delayed
- Secondary to drug interactions
What is the driving advice for first unprovoked seizure? (group 1 car and motorcycles)
no driving for 6 months
Driving advice for cars after multiple unprovoked seizures?
no driving for 12 months
Group 2 bus and lorry for first unprovoked seizure? what about multiple?
one- no driving for 5 years
multiple- no driving for 10 years
General tips for safety for someone with epilepsy?
avoid using locks on doors, shower instead of a bath, don’t go swimming or do water sports on your own, avoid busy roads + roads by rivers, be careful of heights
What is convulsive status epilepticus?
continuous seizure activity for a prolonged period of time or repetitive seizures that occur without regaining consciousness
Which benzodiazepines would you administer in status epilepticus?
4mg lorazepam IV
or up to 10mg IV diazepam
If you can’t get IV access, how can you administer benzodiazepines?
rectal diazepam
buccal midazolam
If the seizure persists after benzodiazepine administration, which second line treatment should be used?
IV phenytoin
Why might someone not respond to anti-epileptic medication?
seizure classification, diagnosis of epilepsy, dose, compliance, lifestyle e.g. drugs and alcohol
What are the non pharmacological management options for epilepsy?
surgery, vagal nerve stimulation, ketogenic diet
Which is an appropriate antiepileptic in pregnancy/ women of child bearing age?
Lamotrigine (2nd line in non pregnant)
What are three causes of epilepsy?
2/3 idiopathic
Congenital
Acquired: CVA, Space OL, trauma
Differentials for provoked/non-epileptic seizures?
Withdrawal: EtOH, opiates, benzos
Metabolic: glucose, Na, Ca, urea, NH 3
↑ICP: trauma, haemorrhage, cortical venous
thrombosis
Infection: meningitis, encephalitis, cycticerosis,
HIV
Eclampsia
Pseudoseizures
List three presenting features of complex partial seizure
5 A’s
Aura
Autonomic: change in skin colour, temperature, palps
Awareness lost: motor arrest, motionless stare
Automatisms: lip-smacking, fumbling, chewing,
swallowing
Amnesia
What is the first line drug for tonic-clonic and absent seizure?
valproate
Side effects of valproate?
ALPROATE appetite incr pancreatitis reversible hair loss oedema ataxia teratogenicity encephalopathy
List two reversible causes of status epilepticus?
alcohol excess (therefore treat with thiamine) and hypoglycaemia
List three investigations for status epilepticus?
antiepileptic drug levels
tox screen
U+E, LFT, FBC, glucose, calcium
Which drugs are used in the slow IV bolus phase and IV infusion phase?
slow bolus: lorazepam
IV infusion: phenytoin or diazepam
What are risk factors for seizure reoccurence in first time seizures
cerebral palsy, brain abscess, trauma, abnormal EEG, abnormal brain scan
What are the differences between syncope and seizure?
syncope: always prodrome, onset is gradual, duration 1-30sec, incontinence is uncommon. Seizure- sometimes prodrome, sudden onset, longer duration, convulsions prolonged, incontinence, slow recovery, confusion
What is Todd’s paresis?
limb weakness following seizure
Which disease that results in neurological symptoms is caused by tick bites?
Lyme’s disease
