Epilepsy Flashcards
definition of seizure and epilepsy
Seizure: abnormal paroxysmal neuronal discharge of the brain
epilepsy: tendency to have seizures
most common cause of epilepsy?
idiopathic (no clear cause)
genetics contribute to aetiology of epilepsy
different types of epilepsy
Generalised: seizures start in and affect both sides of brain at once, happen w no warning
Focal: “” affect one part of brain
focal onset may spread to involve whole brain -> bilateral tonic clonic seizure (secondary generalisation)
3 subtypes of generalised seizures?
tonic-clonic
Myoclonic
Absence seizure
whats a tonic clonic seizure
tonic phase then
clonic phase: shaking of arm and legs
then post ictal period of sleepiness/drowsiness
whats a myoclonic seizure?
jerky movements affecting both upper limbs w/out loss of consciousness
usually happens in morning
whats an absence seixure?
childhood type of seizure, brief loss of contact with surroundings
2 types of focal seizure?
focal aware seizure: consciousness not impaired
focal impaired awareness seizure: consciousness is impaired
principle of management of epilepsy
main drug treatment?
anticonvulsants
e.g. carbamazepine, lamotrigine…
how long is drug treatment required for?
2-3 years, sometimes lifelong
how can compliance of drug treatment be increased?
patients must understand nature of treatment
most clinicians dont treat patients with a single seizure
how will chosen drug treatment be introduced?
introduce at low dose, gradually increase to standard dose
how to change drug treatment if seizures not controlled?
slowly inc to maximum tolerated before changing to another drug
what type of therapy desired?
monotherapy.
combined only req in 10-15% patients w epilepsy
surgical treatment for epilepsy
for drug-resistant patients
- temporal lobe resection (most common)
- extratemporal resection
- hemispherectomy
- corpus callosotomy
- vagus nerve stimulation
implication of diagnosis of epilepsy on driving
not allowed unless seizure free for 1 years or had attacks during sleep for 3 years
large lorries and passenger vehicles: 10 years seizure free w/out taking AEDs
single seizure: wait 6 months
implication of diagnosis of epilepsy on pregnancy and AED?
whats the main concern for any women taking AEDs?
baby with major congenital malformation such as neural tube defect
whys sodium valproate contraindicated in preg?
can cause foetal valproate syndrome- dysmorphic features
AEDs stop in planning stages of preg if possible
supplements: any woman on AEDs should take…?
5mg folic acid daily
babies born to patients taking enzyme inducing AEDs (e.g. carbamazepine) should receive..?
1mg of Vit K IM at birth to reduce risk of haemorrhagic disease of newborn
why should breatfeeding be encouraged (AEDs)?
amouont of AEDs excreted in breast milk too small to have significant problems to baby
women on enzyme-inducing AEDs should avoid using what?
POP/COC containing less than 50mcg od oestrogen as Drug ineractions-> failure of the oral contraceptive
whats (tonic clonic) status epilepticus?
Unremitting seizure: lasts >5 mins/
Recurrent seizures w/out regaining consciousness: >1 seizure within a 5 min period,
medical emergency that req prompt treatment to prevent any permanent/ long term cerebral damage
20% mortality rate
how is status epilepticus managed?
emergency:
maintain airway, access breathing, give oxygen, maintain circulation, establish IV access
take blood for emerg. investigation (full blood count, gluc, renal, liver func tests, Ca level, AEDs level)
drug management of status epilepticus?
dextrose (hyperglycaemia): thiamine (alcohol abuse)
drug management of status epilepticus?
to stop seizures….
- Lorazepam as IV bolus (or diazepam IV/rectally)
- IV phenytoin infusion (valproate),(ECG, BP monitoring, pulse oximetry needed)
- transfer to ICU if still …
(propofol, thiopental, midazolam)
