Epilepsy Flashcards
Brief spasms beginning in first few months of life
1. Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times
2. Progressive mental handicap
3. EEG: hypsarrhythmia
usually 2nd to serious neurological abnormality (e.g. TS, encephalitis, birth asphyxia) or may be cryptogenic
poor prognosis
Infantile spasms (West’s syndrome)
May be extension of infantile spasms (50% have hx)
onset 1-5 yrs
atypical absences, falls, jerks
90% moderate-severe mental handicap
EEG: slow spike
ketogenic diet may help
Lennox-Gastaut syndrome
paraesthesia (e.g. unilateral face), seizures characteristically occur at night
Benign rolandic epilepsy
Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Daytime absences
3. Sudden, shock-like myoclonic seizure
usually good response to sodium valproate
Juvenile myoclonic epilepsy (Janz syndrome)
Other features to ask
Tonge-biting
Incontinence
Post-ictal
Investigations of epilepsy
EEG
MRI
How long can patients not drive for after seizure
6 months fit free
If established epilepsy, 12 months
Important cosiderations in seizures
Driving
Other medication e.g. warfarin
Pregnancy
Oral contraceptives
Sodium valproate
1. How does it work
2. What used for
3. Adverse effects
- Increases GABA activity
- generalised seizures in males
- increased appetite and weight gain, alopecia, P450 enzyme inhibitor, teratogenic
Carbamazepine
1. How does it work
2. What used for
3. Adverse effects
- Binds to sodium channels increasing their refractory period
- second-line for focal seizures
- P450 enzyme inducer, dizziness and ataxia, drowsiness, SIADH
Lamotrigine
1. How does it work
2. What used for
3. Adverse effects
- Sodium channel blocker
- Different types
- Stevens-Johnson syndrome
Phenytoin
1. How does it work
2. What used for
3. Adverse effects
- Binds to sodium channels increasing their refractory period
- No longer 1st line
- P450 enzyme inducer, gingival hyperplasia, hirsutism, coarsening of facial features, megaloblastic anaemia, osteomalacia
UKMEC for lamotrigine and COCP
3
Pseudoseizures vs seizures
Pseudoseizures pelvic thrusting and gradual onset
Prolactin is raised in seizures + tonge biting and incontinece (not in psudoseizures)
Use video telemetry
Management of absence seizures
sodium valproate, ethosuximide
Valproate and pregancny
Teratogenic - neural tube defects
phenytoin and pregnancy
cleft palate
Is breastfeeding safe on antiepileptics?
Yes
rising epigastric sensation
psychic or experiential phenomena, such as déjà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)
Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are commo
Temporal lobe seizure
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Frontal lobe (motor)
Paraesthesia
Parietal (sensory)
Floaters/flashes
Occipital (visual)
When are antiepileptics started
What is the exception
After 2nd seizure
If
neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable
Generalised tonic-clonic seizures Mx
males: sodium valproate
females: lamotrigine or levetiracetam
Women with generalised tonic-clonic seizures who are unable to have children mx
Sodium valproate
Focal seizures mx
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Absence seizures (Petit mal) mx
Ethosuximide
2nd line same as generalised tonic clonic
What antiepileptic will make absence seizures worse
Carbamazepine
Myoclonic seizures mx
males: sodium valproate
females: levetiracetam
Tonic or atonic seizures
males: sodium valproate
females: lamotrigine
