epilepsy Flashcards
what is the meaning seizure?
a single occurrence of sudden , uncontrollable electrical disturbances in the brain
what is the definition of epilepsy?
brain disorder charaterized by two or more unprovoked seizures
what is epilepsy syndrome?
due to unique type of epilepsy
- childhood absence epilepsy
( characterised by frequent absence seizures in children with good prognosis)
- lennox gastaut syndrome
( a severe form of epilepsy that includes multiple types of seizures and often has poor prognosis)
- juvenile myoclonic epilepsy
( features myoclonic jerks , usually in the morning with strong genetic component )
what pathophysiology of epilepsy?
excessive electrical activity due to imbalance of glutamate and GABA neurotransmitter
state classification of seizures.
- onset of seizures
- level of awareness
- whether movement when happen seizures
type of seizure depends on onset
- focal onset
- generalised onset
- unknown onset
state type of motor symptoms
- myoclonus ( muscle twitching )
- clonic ( muscle jerking )
- tonic ( muscle rigidity )
- atonic ( muscle weak )
state type of non motor symptoms
- absence ( blanking and staring )
- main symptoms do not involve muscle movements
what is the risk factor of epilepsy?
- any injury in brain
- bleeding , swelling in brain
- lack of oxygen to brain
- stroke
- brain tumors
- infection ( meningitis)
- genetic
in children
- small size of birth
- seizure in first month of life
- having seizures due to high fever
how to diagnose seizures?
- at least 2 unprovoked seizures occurring more than 24 hours apart
- assessment by neurologist include EEG , CT and MRI scan
what is the complication that can occur ?
- difficulty learning
- aspiration pneumonia
- injury from falls
- mood problems
- permanent brain damage
what is non pharmacological treatments can be used ?
- surgery to remove a small part of brain that cause seizure
- procedure to put a small electric device inside body that can help control seizures ( vagus nreve stimulator )
what is lifestyle advice can be used ?
- avoid from swimming or use dangerous things alone
- avoid triggers ( lack of sleep )
- keep diary of seizures
- don’t stop taking or change dose
- make sure don’t run out of meds
- when to call 999?
( first time seizure)
( seizure that last more than 5 min or more than 1 seizures wthin 5 min without return to normal consciousness)
( injured during seizure)
what is the moa of anti epileptic
- inhibit glutamate activity
- increase GABA activity
what is the example of antiepileptic drug ?
- phenytoin
- carbamazepine
- benzodiazepine
- lamotrigine
- barbiturate
- oxcarbazepine
- phenobarbital
- sodium valporate
what is the side effect of phenytoin?
- cleft palate
- hirsutism
- gingival hyperplasia
what is the side effect of carbamazepine and oxcarbazepine ?
- diplopia
- bruising
- jaundice
what common side effect of antiepileptic drug?
- nausea
- dizziness
- anxiety
- mood changes
what is the other side effect of carbamazepine, phenobarbital, phenytoin and sodium valporate ?
- cause thinner and brittle bones
- need to take extra vitamin and do some exercise
goal of antiepileptic treatment.
- aim to try and stop seizures happening
whats factor that need to consider of taking antiepileptic drug?
- type of seizures
- concomitant seizures
- comorbidity
- age
- sex
how to take antiepileptic drug
- taken at regular times each day , it may trigger seizures if missed it
drug interactions
- enzyme inducer ( phenytoin, carbamazepine, phenobarbital)
- enzyme inhibitors ( sodium valporate)
- oral contraceptives ( COC become less effective when combine with enzyme inducer ) need to double the dose or other method
do antiepileptic safe for pregnancy?
- valporate is teratogenic that increases risk of birth defect to newborn baby
- if seizure is not threat during pregnancy, need to withdraw drug then continue at 3rd trimester
- if take AED during pregnancy , mother must take supplementation with vitamin K injection to newborn to minimise risk of neonatal haemorrhage.
what drug that safe for pregnancy in epileptic drug ?
- lamotrigine
- levetiracetam
ok for breastfeed if monotherapy
why antiepileptic not working ?
- person not taking regularly
- person’s epilepsy itself may have changed
- person’s body may got used to antiepileptic , so it no longer works
