epilepsy Flashcards
management of generalised tonic-clonic seizures
males - sodium valporate
females - lamotrigine or levetiracetam
(girls under 10 + unlikely to need treatment when they are older may be offered sod val)
management of focal seizures
1st - lamotrigine or levetiracetam
2nd - cabamazepine, oxcarbazepine
absence seizure management
1st = ethosuximide
2nd
male - sodium valporate
female - lamotrigine or levtiracetam
(carbamazepine may exacerbate)
myoclonic seizures management
male - sodium valporate
female - levetiracetam
management of tonic or atonic seizures
male - sodium valporate
females - lamotrigine
generalised tonic-clonic seizure
loss of consciousness
tonic (muscle tensing) - comes first
clonic (muscle jerking)
may be assoc tongue biting, incontinence, groaning
after seizure - post ictal period, confused, drowsy
focal seizures
start in temporal lobes
affect hearing, speech, memory + emotions
- halluconations, memory flashbacks
- deja vu, doing strange things on autopilot
atonic seizures
drop attacks - brief lapses in muscle tone
dont usually last more than 3min
typically begin in childhood
myoclonic seizure
sudden brief muscle contractions - jump
patient usually awake
typically in kids as part of juvenile myoclonic epilepsy
general MoA of antiepileptic drugs (AEDs)
raising threshold + reducing liklihood of patient having a seizure
sodium valporate
increases activity of GABA, relaxing effect
SE -
- teratogenic
- liver damage, hepatitis
- hair loss, weight gain
- tremor
- enzyme inhibitor
carbamazepine SE
agranulocytosis
aplastic anaemia
indices P450 system so there are many drug interactions
phenytoin SE
acute management ONLY
folate + vit D deficiency
megoblastic anaemia - folate deficiency
osteomalacia - vit D deficiency
ethosuximide SE
night terrors
rashes
lamotrigine SE
stevens-johns syndrome
leukopenia
status epilepticus
seizure lasting more than 5 min or 2 or more seizures without regaining consciousness
status epilepticus management
secure airway, high conc O2, assess cardiac/resp function, check blood glucose
IV lorazepam
10mg after 10mins, wait 5 mins then another 10mg, no more than 2 doses
if continuing after 20mins with reatment -> phenytoin
if persists induce general anaesthesia (propofol, thiopentone)
status epilepticus management community
buccal midazolam
rectal diazepam
10mg after 10mins, wait 5 mins then another 10mg, no more than 2 doses
if continuing after 20mins with reatment -> phenytoin
anticonvulsants
phenytoin - acute only
sodium valporate
lamotrigine
levetiracetam
topiramate
gabapentin, pregabalin
levetiracetam
very popular
few interactions with other meds
causes mood swings - avoid in depression
topiramate
SE = weight loss, sedation, dyphasia, psychosis
very affective in those with learning difficulties
ladies and anticonvulsants
some anticonvulsants can induce hepatic enzymes
- carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate
can alter efficacy of COCP
shouldnt use POP - depot progesterone needs more frequent dosing, progesterone implants not effective
morning after pill in epilepsy
not adequate if taking enzyme inducing AEDs - dose should be increased
women + sodium valporate
If women of childbearing age – shouldn’t take sodium valproate even if on contraception
- Balance risk of uncontrolled seizures vs teratogenicity
o Sodium val taken later in pregnancy can cause autism - Folic acid + vit K
primary generalised epilepsy
Abnormal discharge across cortical network
- Most have genetic predisposition
- Often present childhood or teens
- Present in childhood + adolescence, generalized spike-wave abnormalities on EEG
tonic clonic, myoclonic, atonic, absence
management of primary generalised epilepsy
men - sodium valporate
women - lamotrigine
generalised tonic-clonic seizures
loss of consciousness + tonic (muslce tensing) + clonic (muscle jerking episodes
juvenile myoclonic epilepsy
typical onset in teenage years, commoner in girls
infrequent generalised seizures, often in morning/following sleep deprivation
daytime absences
risk factors - sleep deprivation, flashing lights
MX = sodium valporate
how can antiepileptics medications interfere with other medications?
can induce/inhibit the P450 system resulting in varied metabolism of other medications - eg warfarin
how can a focal seizure become generalised?
if focal seizure hits cortical pathways -> spread in brain + secondary generalised seizure
tonic vs clonic
Tonic = lose consciousness, body stiff, may fall.
Clonic = limb jerk, bladder/bowel control loss, tongue bite.
epilepsy and driving
1st seizure
- car = 6months
- HGV = 5yrs
epilepsy
- car = seizure free for 1yr (3if during sleep) with/without meds
- HGV = 10yrs off medication
focal seizure in temporal lobe presentation
motor -> Autonomic movements: chewing, repetitive body movement (jerking, posturing etc).
sensory -> Olfactory sensation, rising feeling in stomach, auditory
psychic -> Memories, déjà vu, jamais vue (staring blankly)
focal seizure in frontal lobe presentation
Head/eye deviation, urinary incontinence, vocalisation, bizzare behaviour
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
focal seizure in parietal lobe presentation
altered somatoensation, Paraesthesia -> sensory modalities that are associated with touch, proprioception, and interoception. These modalities include pressure, vibration, light touch, tickle, itch, temperature, pain, proprioception, and kinesthesia.
focal seizure in occipital lobe presentation
visual symptoms - flashers/floaters
risks of status epilepticus
hypoxia
rhabdomyolysis
hyperthermia (->hypotension->hypoperfusion to heart)
aspiration, brain damage
long term cerebral effects -> break down of blood brain barrier causes fluid shift -> cerebral oedema
types of status epilepticus
Generalized convulsive status epilepticus
Non convulsive status
Conscious but altered state
epilepsia partialis continua
Continual focal seizures, conscious preserved
precipitants of status epilepticus
- Abrupt withdrawal of anti-convulsant
- Treating absence seizures with CBZ
- Severe metabolic disorders – hyponatremia, pyridoxine deficiency
- Infection
- Head trauma
- Sub arachnoid haemorrhage
