epilepsy Flashcards
seizure vs epilepsy
seizure = single episode
epilepsy = >2 unprovoked seizures
not all people with seizures have epilepsy.
all people with epilepsy have seizures
idiopathic generalised epilepsy characteristics
- appears in childhood/adolescence
- can be: absence, generalised, myoclonic
idiopathic partial epilepsy characteristics
- begins in childhood, outgrown by puberty
- never diagnosed in adulthood
- seizures occur during sleep
- partial motor- seizure involving face
evidence of high risk for recurrence
[3]
- previous seizure
- epileptiform EEG
- abnormal brain scan
evidence of low risk for recurrence [3]`
- single seizure
- normal EEG
- normal brain scan
types of generalised seizures [5]
- generalised tonic clonic (grand mal)
- absence (petit mal)
- myoclonic
- clonic
- tonic
- atonic
Generalised tonic-clonic seizure (grand mal) characteristics
- unconsciousness
- body stiffening (tonic)
- violent jerking (clonic)
- deep sleep (postictal)
- shrill cry, apnoea, incontinence, dilated pupils
absence (petit mal) characteristics
- sudden behavioural arrest
- 1-15 sec
- brief LOC
- interrupts activity, may occur several times a day
myoclonic characteristics
- bilateral sporadic jerks
clonic characteristics
bilateral rhythmic jerks
tonic characteristics
muscle stiffness, rigidity
atonic characteristics
- loss of muscle tone in 4 limbs
types of partial seizures [3]
- simple
- complex
- partial with 2ndary generalisation
phenytoin MOA
block Na channels –> decrease membrane excitability
phenytoin considerations [3]
- narrow therapeutic range
- non-linear r/s btw dose & serum conc. > req frequent monitoring
- teratogenetic –> contraindicated for pregnancy
carbamazepine MOA
block Na channels –> reduce membrane excitability
carbamazepine considerations
- accelerates elimination of other drugs (hepatic enzyme CYP450 inducer, half-life shortens with repeated doses)
- aplastic anemia: rare but severe S/E
which drugs block Na channels to reduce membrane excitability
phenytoin and carbamazepine
valporate MOA [2]
- block Na & Ca channels
- increase GABA (inhibitory neurotransmitter)
can valporate be used for all seizures
yes
can phenytoin be used for all seizures
no, not for absence seizures
can carbamazepine be used for all seizures
no, not for absence seizures
general antiepileptic dose-related side effects
- drowsiness, confusion, mental changes
- nystagmus
- ataxia
- slurred spech
- nausea
valporate considerations
strongly binds to plasma proteins and DISPLACES OTHER ANTIEPILEPTICS
general antiepileptic non dose related side effects
[6]
- hirsutism (abnormal hair growth_
- acne
- gingival hyperplasia
- folate deficiency
- osteomalacia (bone tissue softening)
- hypersensitivity (steven-johnson)
benzodiazepine MOA
enhance GABA
benzodiazepines onset of action
short: hours
intermediate: up to 24h
long: >24h
which type of benzodiazepines are used for seizures?
intermediate & long acting
- used for refractory seizures (not controlled w first line) and status epilepticus
simple seizures characteristics
- no LOC
- motor: jerking, muscle rigidity, spasm, head turning
- sensory
complex seizures characteristics
- automatism, involuntary but coordinated movement
- no awareness of what they are doing but no LOC
partial seizure with secondary generalisation characteristics
initially associated with preservation of consciousness & evolves into LOC & convulsions
nursing management for seizure [5]
- maintain airway > turn to side, monitor SpO2
- oral suctioning
- establish IV access (med adm)
- mark serizure start time, observe duration & characteristics
- protect from hitting hard surfaces
which drug can be used for absence seizures
sodium valporate
when to test antiepileptic drug levels
- assess compliance
- possible antiepileptic drug toxicity
- titration of dose
- routine testing is not required
