Epilepsy Flashcards
What is a seizure?
Seizures are transient episodes of abnormal electrical activity in the brain.
What is a generalised tonic clonic seizure?
Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes. associated tongue biting, incontinence, groaning and irregular breathing.
What is a post-ictal period?
After the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed.
Management of generalised tonic clonic seizures
First line: sodium valproate
Second line: lamotrigine or carbamazepine
What is a focal seizure?
Focal seizures start in temporal lobes. They affect hearing, speech, memory and emotions. There are various ways that focal seizures can present:
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
What is the management of focal seizures?
First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam
What is an absence seizure?
Absence seizures typically happen in children. The patient becomes blank, stares into space and then abruptly returns to normal. During the episode they are unaware of their surroundings and won’t respond. These typically only lasts 10-20 seconds. Most patients (> 90%) stop having absence seizures as they get older.
Management for absence seizures
First line: sodium valproate or ethosuximide
What is an atonic seizure?
Atonic seizures are also known as “drop attacks”. They are characterised by brief lapses in muscle tone. These don’t usually last more than 3 minutes.
They typically begin in childhood.
They may be indicative of Lennox-Gastaut syndrome.
Management of atonic seizures
First line: sodium valproate
Second line: lamotrigine
What is a myoclonic seizure?
Myoclonic seizures present as sudden brief muscle contractions, like a sudden “jump”. The patient usually remains awake during the episode.
They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.
Management of myoclonic seizures
First line: sodium valproate
Other options: lamotrigine, levetiracetam or topiramate
Infantile spasms (West syndrome)
a rare (1 in 4000) disorder starting in infancy at around 6 months of age. It is characterised by clusters of full body spasms. There is a poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.
Management of infantile spasms
Prednisolone
Vigabatrin
Mechanism of sodium valproate
It works by increasing the activity of GABA, which has a relaxing effect on the brain.
This is a first line option for most forms of epilepsy (except focal seizures).
Side effects of sodium valproate
Teratogenic so patients need careful advice about contraception
Liver damage and hepatitis
Hair loss
Tremor
Side effects of carbamazepine
Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions
*first line for focal seizures
Side effects of phenytoin
Folate and vitamin D deficiency Megaloblastic anaemia (folate deficiency) Osteomalacia (vitamin D deficiency)
Side effects of ethosuximide
Night terrors
Rashes
Side effects of lamotrigine
Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
Leukopenia
*DRESS - drug rash with eosinophilia and systemic symptoms - is a hypersensitivity reaction
What is status epilepticus
- MEDICAL EMERGENCY
- seizures lasting more than five minutes or more than 3 seizures in one hour
Management of status epilepticus in a hospital
Take an ABCDE approach:
Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
If seizures persist: IV phenobarbital or phenytoin
Management of status epilepticus in the community
Buccal midazolam
Rectal diazepam
