Epilepsy Flashcards
Generalised tonic-clonic seizures
LOC and tonic (muscle tensing) and clonic (jerking) episodes
Prolonged post-ictal period
Management:
- first-line: sodium valproate
- second line: lamotrigine or carbamazepine
Focal seizures
Start in temporal lobes
Hallucinations, memory flashbacks, deja vu, doing strange things on autopilot
Management
- first-line: lamotrigine or carbamazepine
- second line: sodium valproate
Absence seizures
Blank, stare into space then abruptly return to normal
Typically last 10-20seconds
First line: sodium valproate or ethosuximide
Atonic seizures
Drop attacks
Brief lapses in muscle tone, don’t usually last more than 3 minutes
Management
- first line: sodium valproate
- second line: lamotrigine
Myoclonic seizures
Sudden brief muscle contracts
Management
- first line: sodium valproate
- second line: lamotrigine, levetiracetam, toprimate
Infantile spasms
West syndrome
Cluster of full body spasms
1/3 die by 25, 1/3 seizure free
First line: prednisolone, vigabatrin
Febrile convulsions
Typically age 6m to 5y
Usually occur early in viral infections
Typically brief and generalised tonic/ tonic-clonic
Alcohol withdrawal seizures
Chronic alcohol enhances GABA and inhibits NMDA type glutamate receptors
Alcohol withdrawal does the opposite
Peak incidence is 36 hours after cessation
Often given benzos to reduce risk
Psychogenic non-epileptic seizures
Epileptic-like siezures with no characteristic electrical discharges
May have history of mental health problems or personality disorder
Sodium valproate side effects
Increased appetite and weight gain
Alopecia
P450 enzyme inhibitor
Ataxia
Tremor
Hepatitis
Pancreatitis
Thrombocytopeania
Teratogenic
Carbamazepine side effects
P450 enzyme inducer
Dizziness and ataxia
Drowsiness
Leucopenia and agranulocytosis
SIADH
Visual disturbances
Lamotrigine side effects
Steven-Johnson syndrome
Phenytoin side effects
P450 enzyme inducer
DIzziness and ataxia
Gingival hyperplasia, hirsutism, coarsening of facial features
Megaloblastic anaemia
Peripheral neuropathy
Enhanced vitamin D metabolism causing osteomalacia
Lymphadenopathy
Status epilepticus management
ABCDE
Secure airway
Give high-conc oxygen
Check blood glucose
Gain IV access
IV lorazepam 4mg, repeated after 10 minutes of seizure continues
If seizure persists IV phenobarbitural or phenytoin
Status epilepticus medical management in the community
Buccal midazolam
Rectal diazepam