Epilepsy Flashcards
What are the 3 types of seizures and where do they affect the brain?
- Focal - seizure starts in one side of the brain
- Generalized – affects both sides of brain
- Status epilepticus Uninterrupted seizure activity (life threatening condition)
What are the seizure characteristics?
Tonic-Clonic – increased muscle tone and jerking (Most common)
Absence – suddenly stop (appear to be daydreaming)
Myoclonic- single repetitive jerking 1 or more muscle group
Atonic – drop attack loss of muscle tone
Tonic – immediate increase of muscle tone
Clonic – repetitive jerks
Which antiepileptics will need specific brands ?
Category 1: Carbamazepine, phenobarbital, phenytoin, primidone –
GP ensure pt is maintained on a specific manufacturer’s product.
Which antiepileptics may need specific brands?
Category 2: Clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, topiramate, valproate, zonisamide,
need for continued same brand depends on clinical judgement and pt preference
Which antiepileptics dont need speicific brands
Category 3: Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin -usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product.
What seizures is carbamazepine used for?
Tonic-clonic, focal seizures and complex focal seizures
responds poorly to absence, atonic and tonic seizures
What are the SE of carbamazepine?
Sedation, Dizziness, drowsiness
Mental disturbances
headache
Water retention, weight increased
Nausea, vomiting, hyponatraemia
What form of carbamazepine should be given?
controlled- release
How should the dose of carbamazepine be increased?
Increases in dose at a rate of 200 mg every 1-2 weeks may be required to achieve a stable seizure threshold
Stable carbamazepine concentrations occur usually within 2-3 weeks after commencement of treatment
What are common interactions of carbamazepine?
> Phenytoin/phenobarbital – increases carbamazepine clearance
Warfarin levels are decreased
Erythromycin, cimetidine, propoxyphene, and CCB decrease the metabolism of carbamazepine
!!! Carbamazepine can reduce effectiveness birth control, could lead to unexpected pregnancies !!!
it accelerates elimination of many benzodiazepines and decreases their action
What are the common SE of valproate?
- Nausea
- gastric irritation
- diarrhoea
- weight gain
- hyperammonaemia
- thrombocytopenia
- transient hair loss.
What seizures is valproate used for?
- First-line treatment to children, young people, and adults with newly diagnosed generalised tonic-clonic seizures and used in absence seizures.
- Often used in infantile epilepsy due to low toxicity and lack of sedative action.
Is valproate suitable for childbearing or potential women?
- Hepatotoxicity
- Pancreatitis
- Risk of teratogenesis - spina bifida, organ and limb malformation
what types of seizures is lamotrigine used for?
o Partial seizures
o Primary and secondary tonic-clonic seizures
o Seizures associated with Lennox-Gastaut syndrome (childhood epileptic encephalopathy)
what are the SE of lamotrigine?
- Aggression, agitation, irritability
- Arthralgia – (pains in a joint)
- Diarrhoea
- Dizziness, drowsiness
- dry mouth
- fatigue
- headache