Epilepsy Flashcards
Two main types of seizures
Focal or generalised
Types of focal seizures
With impairment of consciousness (complex), without impairment of consciousness (Simple), and evolving to bilateral convulsive seizure (secondary generalised)
Types of generalised seizures
Absent seizures, tonic-clonic, myoclonic, atonic seizures
Triggers of seizures
Poor sleep, alcohol, drugs, withdrawal, stroke, intracranial haemorrhage, SOLs, metabolic disturbances
Features of absent seizures
Often children, pause briefly, <10 secondarys, and then carry on where they left off
Features of tonic-clonic seizures
Patients lose consciousness, limbs stiffen and start jerking. Post ictal common
Features of myoclonic seizures
Sudden jerk of limb, trunk or face
Features of atonic seizures
Sudden loss of muscle tone, causing fall, whilst consciousness
Which seizures does carbamazepine worsen
Absent and myoclonic seizures
Features of complex focal seizures
Patients lose consciousness after aura or onset. Post-ictal symptoms common
Most common origin site for complex focal seizures
Temporal lobe, with post ictal confusion
Features of simple focal seizures
Do not lose consciousness, only experience focal symptoms. Post-ictal symptoms do not occur
Features of secondary generalised focal seizures
Experience of focal seizure, which evolves to generalised seizure, typically tonic clonic. 2/3 of patients with focal seizures
Post ictal featurs of seizures
Lasts 5-30 minutes after seizure, confusion, drowsiness, nausea, HTN and headache
Features of temporal lobe focal seizure
Automatisms (lip-smacking), deja vu/jamais vu, emotional disturbance (sudden terror), olfactory gustatory or auditory hallucination
Features of frontal lobe focal seizure
Motor features such as Jaksonian march, dysphasia or Todd’s palsy
Features of parietal lobe focal seizures
Sensory symptoms such as tingling, numbness, motor symptoms due to spread of electricity to pre-central gyrus in frontal lobe
Features of occipital lobe focal seizure
Visual symptoms such as spots and lines in visual field
First line treatment for focal seizure
Carbamazepine or lamotrigine in first line
First line treatment for absent seizures
Sodium valproate or ethosuximide
First line treatment for tonic clonic seizures
Sodium valproate or lamotrigine
First line treatment for myoclonic seizures
Sodium valproate, Levetiracetam or Topiramte
First line treatment for atonic seizures
Sodium valproate or lamotrigine
Cautions of sodium valproate
Women of childbearing age due to high risk of neural tube defects
Alternative for sodium valproate
Lamotrigine
Drugs more effective in focal seizures
Carbamazepine, gabapentin and phenytoin
Drugs effective in all types of seizures
Lamotrigine, levetiracetam and valproate
Side effects of phenytoin
Acne, anorexia, constipation, dizziness, gingival hypertrophy and tenderness, hirsutism, insomnia, paresthesia, rash, tremor
Side effects of sodium valproate
Anaemia, confusion, convulsion, deafness, extrapyramidal disorders, gastric irritation, haemorrhage, headache, hyponatraemia, stupor, somnolence, thrombocytopenia, transient hair loss, tremor, weight gain, teratogen
Side effects of carbamazepine
Ataxia, blood disorders, blurred vision, fatigue, hyponatraemia, oedema, skin problems, SIADH, drowsiness, diplopia
Side effects of lamotrigine
Blurred vision, aggression/agitation, arthralgia, ataxia, back pain, diarrhoea, diplopia, dizziness, headache, insomnia, N+D, rash, tremor
Side effects of topiramate
Abdominal pain, aggession, agitation, alopecia, anxiety, confusion, constipation, DNV, dyspepsia, movement disorders, mood changes, myalgia, parasthesia, tremor, weight loss
