Epilepsy Flashcards
Etiology of Seizures
Criteria of Dx of Epilepsy
Classification of Seizures
Types of Focal Seizures
Types of Generalized Seizures
- Generalized Tonic-Clonic Seizures
- Absence Seizures
- Myoclonic Seizures
- Tonic Seizures
- Atonic Seizures
CP of Focal Aware Motor Seizures (Simple Partial)
CP of Focal Impaired Awareness Seizures (Comple Partial)
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- No preceding Aura or warning
- Ictal Stages
- Post-Ictal Stages
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- Aura
No preceding Aura or warning
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- Ictal Stage
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- Tonic Phase of Ictal Stage
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- Clonic Phase of Ictal Stage
CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”
- Post-Ictal Stage
CP of Generalized Non-Motor (Absence) Seizures
DDx of Seizures
Characters of (Pseudo-seizures)
Dx of Seizures
Dx of Seizures
- Hx & Ex
Dx of Seizures
- Labs
Dx of Seizures
- Neuroimaging
Dx of Seizures
- EEG
Significance of EEG
- Differentiate epileptic seizures from conditions that mimic them.
- Classify seizure types
- Tailor therapy.
The yield of EEG increases with ……
- Sleep deprivation
- Performing multiple studies
- Performing the study in close proximity to the seizure.
TTT of Seizures
TTT of Seizures
- TTT of Provoked Seizures
TTT of Seizures
- TTT of Unprovoked Seizures & Epilepsy
ASMs may be prescribed for patients after a first unprovoked seizure if there is:
TTT of Seizures
- General Principles in drug therapy
The choice of ASM is usually based on:
Examples of ASM
Drug of Choice
- Focal seizures and secondarily Generalized seizures
Phenytoin, Carbamazepine, Oxcarbazepine, Levetiracetam,
Lamotrigine
Drug of Choice
- Primary generalized tonic-clonic seizures
Valproate, Lamotrigine
Drug of Choice
- Abxence Seizures
Valproate, Ethosuximide
Drug of Choice
- Juvenile myoclonic epilepsy
Valproate, Levetiracetam
Drug of Choice
- Patient taking multiple medications
Levetiracetam, Lacosamide
Drug of Choice
- Medication expense is a concern
Phenytoin, Carbamazepine, Valproate
Drug of Choice
- Pregnancy
Lamotrigine, Levetiracetam (avoid valproate)
Drug of Choice
- Hepatic Failure
Levetiracetam, Topiramate, Gabapentin
Drug of Choice
- Renal Failure
Carbamazipine, Oxcarbazepine, Lamorigine
Withdrawing ASMs
Ideal candidates for medication withdrawal have:
TTT of Status Epilepticus
TTT of Status Epilepticus
- Life Support
TTT of Status Epilepticus
- Abort Seizures
TTT of Status Epilepticus
- Abort Seizures (Phase I)
Intravenous lorazepam (0.1 mg/kg) or diazepam (0.15 mg/kg)
TTT of Status Epilepticus
- Abort Seizures (Phase II)
- Intravenous phenytoin (15-20 mg/kg)
- Valproate (25-40 mg/kg) or Levetiracetam (1000- 3000 mg)
TTT of Status Epilepticus
- Abort Seizures (Phase III)
TTT of Status Epilepticus
- Abort Seizures (Phase IV)
- Pentobarbital is loaded at a dose of 5 mg/ kg followed by IV infusion of 1-10 mg/kg/hr, titrated gradually upwards to a burst- suppression pattern on EEG
TTT of Status Epilepticus
- Determine the etiology
- Once seizure control is established, focus on determining the etiology
- History, examination, Laboratory studies, Neuroimaging and sometimes CSF examination.
TTT of Status Epilepticus
- Prevent Further Episodes
- Correct the proximate cause of status epilepticus if detected.
- Patients with known epilepsy need ASM regimen modification to prevent seizure recurrence.
