Epilepsy Flashcards
What is the most common cause of SE?
Change in medication
What should be monitored continuously in patients with SE?
Vitals and respiratory function
What is SE?
Prolonged or repeated seizures and convulsive status epilepticus.
Also defined as an acute, prolonged epileptic crisis
Four types of SE?
Generalised Convulsive SE, Subtle SE, Non-convulsive SE (NCSE), Simple Focal SE.
What is generalised convulsive SE?
Abnormal excessive cortical electrical activity and motor activity. (most frequent and potentially dangerous.
What is subtle SE?
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
What is Non-convulsive SE (NCSE)?
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
What is Simple Focal SE?
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
What is the first line treatment for convulsive status epilepticus in community?
Buccal midazolam
Rectal diazepam
IV lorazepam
What is the first line treatment and adjunctive AED for convulsive status epilepticus in Hospital?
First line:
IV lorazepam
IV diazepam
Buccal midazolam
Adjunctive AEDs:
IV phenobarbital
phenytoin
What is the first line treatment for refractory convulsive status epilepticus?
IV midazolam
propofol (NOT in children)
Thiopental sodium
What is category 1 of AEDs?
Maintain specific manufactures product.
i.e. brand or generic (specified by manufacturers name/MA number) e.g. phenytoin, carbamazepine, phenobarbital, primidone.
What is category 2 of AEDs?
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
What is category 3 AEDs?
Usually unnecessary to ensure that patients are maintained a specific manufacturers product.
e.g. Levetiracetam, lacosamide, tiagabine, gabapentin, prcegablin, ethosuximide, vigabatrin
What are 2 risks of anti-epileptic drugs in females?
Teratogenicity- foetal deformities
Neurodevelopmental delay
Points to consider before initiating anti-epilepsy medication in women and girls?
Contraception
folic acid supplementation
conception
pregnancy
breastfeeding
caring for children
menopause
When a child, young person or adult has been seizure free for two years what steps need to be taken?
individualised assessment including risk of SUDEP and driving
First line of treatment for Generalised tonic-clonic?
sodium valproate- boys, men, girls aged under 10, women who can’t have children.
Lamotrigine or levetiracetam- women, girls and young girls
Add on therapy for generalised tonic-clonic seizures?
Clobazam
Lamtorigine
levetiracetam
perampanel
sodium valproate
Topiramate
First-line treatment for Tonic or atonic seizures?
sodium valproate
Lamotrigine
Add on therapy for tonic and atonic seizures?
clobazam
rufinamide
topiramate
First-line treatment and add on therapies for absence seizures?
Ethosuximide
Lamotrigine
sodium valproate
Levetrircetam
Drugs too avoid in absence seizures?
Carbemazapine
Gabapentin
Oxacarbazepine
Phenobarbital
Phenytoin
prcegablin
tiagabine
vigabatrin
First line treatment and add on therapy for myoclonic seizures
Levetiracetam
sodium valproate
topiramate
brivarcetam
clobazam
clonazepam
lamotrigine
phenobarbital
piracetam
zonisamide
