Epilepsy Flashcards
What causes epilepsy?
Increased excitatory neurotransmission via glutamate, and decreased inhibitory neurotransmission via GABA - this causes hyper-excitability
What are the types of generalised seizures?
Tonic-clonic
Tonic
Myoclonic
Atonic
Absence
What are the types of partial (focal) seizures?
Simple and complex
What is the difference between an enzyme inducing and an enzyme inhibiting drug?
Enzyme inducing: a drug which promotes enzymes to metabolise another drug quicker, so a higher dose of the affected drug is needed
Enzyme inhibiting: inhibits enzymes, so a lower dose of the affected drug is needed
What are some examples of enzyme-inducing anti epileptics?
Carbamazepine
Phenytoin
Phenobarbital
Topiramate
What are some examples of enzyme-inhibiting anti epileptics?
Lamotrigine
Sodium valproate
Levetiracetam
Acetazolamide
Why should you avoid sudden withdrawal of any anti-epileptic drug?
Because it can cause rebound seizures
What certain tests are done to diagnose epilepsy?
EEG
CT scan
MRI scan
How long should the seizure-free period be in an epileptic patient who wants to drive again?
1 year
How long can a patient not drive for after they’ve had an epileptic episode?
6 months
What emergency contraception can be given for a female who is taking any anti-epileptic drug?
Double dose levonorgestrel
Alternatively offer a C-IUD
Why should valproate never be used in females of child-bearing age?
Because there is a risk of teratogenicity
What is the 1st and 2nd line treatment of tonic-clonic seizures?
1st - sodium valproate
2nd - lamotrigine or carbamazepine
What is the 1st and 2nd line treatment of absence seizures?
1st - sodium valproate
2nd - lamotrigine
Which drugs should NOT be given with absence, myoclonic and tonic/atonic seizures?
Gabapentin
Pregabalin
Phenytoin
Carbamazapine
What is the 1st and 2nd line treatment for tonic and atonic seizures?
1st - valproate
2nd - lamotrigine
What is the 1st and 2nd line treatment for focal seizures?
1st - carbamazepine or lamotrigine
2nd - sodium valproate, or levetiracetam
Which 2 anti-epileptic drugs are used for TDM?
Phenytoin
Phenobarbital
What are the serious side effects of sodium valproate?
Hepatotoxicity
Blood disorders
What are the serious side effects of phenytoin?
Ataxia - loss of body movement
Sore throat/fever/mouth ulcers
Rash
Aggravation of acne
Blood disorders - bruising/bleeding
What are the serious side effects of carbamazepine?
Hyponatraemia
Neutropenia
Bone marrow suppression
Hepatotoxicity
What are some side effects of lamotrigine?
Skin reactions, e.g. rash
Blood disorders
What is status epilepticus?
Having >2 seizures occur with no recovery
What do you give in status epilepticus?
IV lorazepam, or diazepam
