Epilepsy Flashcards
what is epilepsy?
Epilepsy is an umbrella term for a condition where there is a tendency to have seizures.
what are seizures?
Seizures are transient episodes of abnormal electrical activity in the brain. There are many different types of seizures.
A diagnosis of epilepsy is made by a specialist based on ..
A diagnosis of epilepsy is made by a specialist based on the characteristics of the seizure episodes.
give some investigations we can do for epilepsy?
EEG
ECG
MRI Brain
why might we do an EEG to investigate epilepsy?
An electroencephalogram (EEG) can show typical patterns in different forms of epilepsy and support the diagnosis.
why might we do an MRI Brain to investigate Epilepsy
An MRI brain can be used to visualise the structure of the brain. It is used to diagnose structural problems that may be associated with seizures and other pathology such as tumours.
what is the aim of treatment for seizures?
The aim of treatment is to be seizure free on the minimum anti-epileptic medications. Ideally they should be on monotherapy with a single anti-epileptic drug. Treatment is initiated and guided by a specialist.
give 6 types of seizures
Generalised Tonic-Clonic Seizures
Focal Seizures
Absence Seizures
Atonic Seizures
Myoclonic Seizures
Infantile spasms
describe Generalised Tonic-Clonic Seizures
loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.
Tonic phase comes before the clonic phase.
associated Tongue biting, incontinence, groaning, irregular breathing
After the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed.
how do we manage generalised tonic-clonic seizures?
Management of tonic-clonic seizures is with:
First line: sodium valproate
Second line: lamotrigine or carbamazepine
describe focal seizures
Focal seizures start in temporal lobes. They affect hearing, speech, memory and emotions. There are various ways that focal seizures can present:
Hallucinations
Memory flashbacks
Déjà vu
Doing strange things on autopilot
ocal seizures affect which area of the brain?
Temporal lobes
focal seizures affect what ?
hearing, speech, memory, and emotions
4 ways focal seizures can present?
Hallucinations
Memory flashbacks
Déjà vu
Doing strange things on autopilot
how do we treat focal seizures?
One way to remember the treatment is that they are the reverse of tonic-clonic seizures:
First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam
describe absence seizures
typically in children
patient becomes blank, stares into space and then abruptly returns to normal.
During the episode they are unaware of their surroundings and won’t respond.
These typically only lasts 10-20 seconds.
Most patients (> 90%) stop having absence seizures as they get older.
treatment for absence seizures
Management is:
First line: sodium valproate or ethosuximide
describe atonic seizures
Atonic seizures are also known as “drop attacks”.
They are characterised by brief lapses in muscle tone.
These don’t usually last more than 3 minutes.
They typically begin in childhood.
They may be indicative of Lennox-Gastaut syndrome
atonic seizures may be indicative of what syndrome?
They may be indicative of Lennox-Gastaut syndrome.
management of atonic seizures is?
Management is:
First line: sodium valproate
Second line: lamotrigine
describe myoclonc seizures
sudden brief muscle contractions - like a sudden jump.
patient remains awake during episodes
They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.
myoclonic seizures occur in various forms of epilepsy but typically happen in children as part of …
They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.
management for myoclonic seizures
Management is:
First line: sodium valproate
Other options: lamotrigine, levetiracetam or topiramate
describe infantile spasm seizures
This is also known as West syndrome.
It is a rare (1 in 4000) disorder starting in infancy at around 6 months of age.
It is characterised by clusters of full body spasms. There is a poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.
prognosis of infantile spasms>
There is a poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.
infantile spasms is also known as?
west syndrome
how do we treat infantile spasms?
It can be difficult to treat but first line treatments are:
Prednisolone
Vigabatrin
give some first line epilsepsy maintenance medications?
Sodium Valproate
Carbomazepine
Phenytoin
Ethosuximide
Lamotrigine
describe sodium valproate
1st line for most forms of epilepsy (except focal seizures).
increases GABA activity - relaxing effect on brain.
side effects of sodium valproate?
Teratogenic so patients need careful advice about contraception
Liver damage and hepatitis
Hair loss
Tremor
who must avoid sodium valproate?
It must be avoided in girls or women unless there are no suitable alternatives and strict criteria are met to ensure they do not get pregnant.
as is tetrogenic
describe carbamazepine - what’s it used for?
This is first line for focal seizures.
side effects of carbamazepine
Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions
side effects of phenytoin?
Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
side effects of ethosuximide?
Night terrors
Rashes
side effects of ethosuximide?
Night terrors
Rashes
Side effects of Lamotrigine
Notable side effects:
Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
Leukopenia
what is Status Epilepticus
Status epilepticus is an important condition you need to be aware of and how to treat. It is a medical emergency. It is defined as seizures lasting more than 5 minutes or more than 3 seizures in one hour.
how do you manage status epileptics in hospitals?
Take an ABCDE approach:
Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
If seizures persist: IV phenobarbital or phenytoin
what are the medical options in the community for status epileptics?
Medical options in the community:
Buccal midazolam
Rectal diazepam
