Epilepsy Flashcards

1
Q

What is the most common cause of SE?

A

Change in medication

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2
Q

What should be monitored continuously in patients with SE?

A

Vitals and respiratory function

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3
Q

What is SE?

A

Prolonged or repeated seizures and convulsive status epilepticus.

Also defined as an acute, prolonged epileptic crisis

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4
Q

Four types of SE?

A

Generalised Convulsive SE, Subtle SE, Non-convulsive SE (NCSE), Simple Focal SE.

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5
Q

What is generalised convulsive SE?

A

Abnormal excessive cortical electrical activity and motor activity. (most frequent and potentially dangerous.

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6
Q

What is subtle SE?

A

Consists of electrical seizure activity in the brain that endures when the associated motor responses are fragmentary or even absent.

Considered the most severe clinical stage of SE

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7
Q

What is Non-convulsive SE (NCSE)?

A

Absence SE and complex partial SE.

Further subdivisions- neonatal and infantile, only in childhood, in both childhood and adult life and in late adult life.

Also, NCSE includes electrical status epilepticus in slow wave sleep ESES

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8
Q

What is Simple Focal SE?

A

seizure that are localised to a discrete area of cerebral cortex and produce no alteration in consciousness.
Focal SE can arise from any region of the cortex.

When motor cortex is affected- epilepsy partials continua (EPC)- repetitive, often rhythmic, unilateral twitching of the limbs and/or face, usually with preservation of consciousness.

Episodes involving the primary cortex are associated with focal sensory symptoms.

Occipital focal SE= focal visual symptoms e.g. flashing spots of light, colourful visual hallucinations.

Focal SE of language cortex typically causes aphasia, termed ictal aphasia

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9
Q

What is the first line treatment for convulsive status epilepticus in community?

A

Buccal midazolam
Rectal diazepam
IV lorazepam

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10
Q

What is the first line treatment and adjunctive AED for convulsive status epilepticus in Hospital?

A

First line:
IV lorazepam
IV diazepam
Buccal midazolam

Adjunctive AEDs:
IV phenobarbital
phenytoin

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11
Q

What is the first line treatment for refractory convulsive status epilepticus?

A

IV midazolam
propofol (NOT in children)
Thiopental sodium

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12
Q

What is category 1 of AEDs?

A

Maintain specific manufactures product.
i.e. brand or generic (specified by manufacturers name/MA number) e.g. phenytoin, carbamazepine, phenobarbital, primidone.

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13
Q

What is category 2 of AEDs?

A

Need for continued supply of a particular manufacturers product- should be based on clinical judgement and consultation with patient and/or carer.

e.g. valproate, Lamotrigine, Clobazam, clonazepam, Oxcarbazepine, topiramate

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14
Q

What is category 3 AEDs?

A

Usually unnecessary to ensure that patients are maintained a specific manufacturers product.
e.g. Levetiracetam, lacosamide, tiagabine, gabapentin, prcegablin, ethosuximide, vigabatrin

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15
Q

What are 2 risks of anti-epileptic drugs in females?

A

Teratogenicity- foetal deformities
Neurodevelopmental delay

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16
Q

Points to consider before initiating anti-epilepsy medication in women and girls?

A

Contraception
folic acid supplementation
conception
pregnancy
breastfeeding
caring for children
menopause

17
Q

When a child, young person or adult has been seizure free for two years what steps need to be taken?

A

individualised assessment including risk of SUDEP and driving

18
Q

First line of treatment for Generalised tonic-clonic?

A

sodium valproate- boys, men, girls aged under 10, women who can’t have children.

Lamotrigine or levetiracetam- women, girls and young girls

19
Q

Add on therapy for generalised tonic-clonic seizures?

A

Clobazam
Lamtorigine
levetiracetam
perampanel
sodium valproate
Topiramate

20
Q

First-line treatment for Tonic or atonic seizures?

A

sodium valproate
Lamotrigine

21
Q

Add on therapy for tonic and atonic seizures?

A

clobazam
rufinamide
topiramate

22
Q

First-line treatment and add on therapies for absence seizures?

A

Ethosuximide
Lamotrigine
sodium valproate
Levetrircetam

23
Q

Drugs too avoid in absence seizures?

A

Carbemazapine
Gabapentin
Oxacarbazepine
Phenobarbital
Phenytoin
prcegablin
tiagabine
vigabatrin

24
Q

First line treatment and add on therapy for myoclonic seizures

A

Levetiracetam
sodium valproate
topiramate
brivarcetam
clobazam
clonazepam
lamotrigine
phenobarbital
piracetam
zonisamide