epilepsy Flashcards
What is epilepsy
Epilepsy is a neurological disorder characterized by recurring seizures, which are sudden, abnormal electrical activity in the brain.
At what age does epilepsy occur most frequently
childhood to adolescence
What are the risk factors that can predispose a patient to getting epilepsy
Young patients may develop epilepsy either due to genetics or a premature birth
older patients may develop epilepsy because of dementia
All people can develop epilepsy when there is a change in structure to the brain
What are the three phases of a seizure
pre ictal
ictal
post ictal
what is the pre ictal phase of a seizure
when a patient begins to feel “off” some people may get dejavu or begin to smell strange smells etc
What is the ictal phase of a seizure
the start to the end of a seizure where there is intense electriccal activity in the brain
what is the post ictal phase of a seizure
the afterward and recovery stage where a patient has had a seizure
What are the 4 different types of seizures
absence
myoclonic
tonic + atonic
tonic clonic
what is an absence seizure
an absence seizure is most common in children and presents as them being blank and unresponsive for a couple of seconds with a high frequency
what is a myoclonic seizure
myoclonic seizures most commonly occur after waking up and present with muscle jerks but the patient is conscious
what is a tonic seizure
where the patients muscles are stiff during the seizure
what is an atonic seizure
where the patients muscles are floppy during the seizure
what is a tonic clonic seizure
a seizure in which the patient is not conscious and has stiff muscles while jerking and shaking
in the post ictal phase they will feel fatigued and confused.
Seizures can have different onsets in addition to different types name the four different types of onset
Focal onset
Generalized onset
Unknown onset
Unclassified onset
what is a focal onset
focal onset is when the seizure stays in one part of the brain and stays there and can either be an aware focal onset or unaware focal onset relating to if they are conscious or not
what can a focal onset develop into
tonic clonic seizure
what is generalized onset
when the seizurre affects both sides of the brain without warning and the patient losing conscious except in one type of seizure
what type of seizure has a generalized onset but the patient is aware of it
myoclonic seizures
what is unknown onset
after looking at the information we cant determine whether something has a focal onset or a generalized onset
what is unclassified onset
we havent got enough information to determinee if the seizure has a generalized or focal onset
What are the two types of epilepsy syndrome
dravet
lennox - gastaut
what is dravet syndrome
A syndrome that develops from birth and is resistant to anti-epilepsy medication
what can trigger dravet syndrome
hyperthermia
infection
flashing lights
emotional stress
excitement
what is lennox gastaut syndrome
when a young patient <10 presents with delayed intellectual development with regular syndrome they are said to haave this
what are the two things we need to look out for as a medical emergency when it comes to epilepsy
high frequency (cluster seizures)
long duration (prolonged convulsive seizure or status epilepticus)
what are cluster seizures
cluster seizures are when a patient experiences more than 3 seizures in 24 hours
what is a prolonged convulsive seizure
when a seizure lasts for longer than 2 minutes from regular seizure
how do we treat a prolonged convulsive seizure
clobazam or midazolam
what is status epilepticus
a seizure that lasts for longer than 5 minutes
how do we treat status epilepticus
buccal midazolam
rectal diazepam
if no response call 999
repeat dose after 10 mins if still no response give
- levetiracetem
- phenytoin
- sodium valporate
or
phenobarbital
generalized anasthesia
how does epilepsy actually occur
over firing of excitatory symptoms and failure of inhibitory action potentials
what ions are associated with excitatory signals
na+ ca2+
what ions are associated with inhibitory signals
cl -
k +
what are the channels associated with excitatory signals
NMDA
what are the substances associated with excitatory signals
Glutamate
Acetylcholine
what is the substance associated with inhibitory signals
GABA
what are the four drugs that we need to use brand specific prescribing and dispensing called
carbamazepine
phenobarbital
phenytoin
primidone
are all classed as catagory 1 epileptic drugs
What is first line in focal seizures for treatment
levitiracetem
lamotrigine
what is first line in patients with generalized tonic clonic seizures
sodium valporate (not pregnant women however)
what is the first line in patients able to give birth
lamotrigine
levetiracetem
what is the first line in absence seizures
ethosuximide
what medications can absence seizures be exacerbated by
carbamazepine
gabapentin
oxcarbazepine
phenobarbital
phenytoin
pregabalin
what is the first line in myoclonic seizures
sodium valporate (not in pregnant patients)
what is the first line in myoclonic seizures for patinets that can give birth
levetiracetem
what is the first line in tonic / atonic seizures
sodium valporate
what is the first line in tonic / atonic seizures for patients that can give birth
lamotrigine
what medications are NOT associated with antiepileptic hypersensitivity syndrome
sodium valporate
levetiracetem
ethosuximide
how long should patients watch out for symptoms of antiepileptic hypersensitivity syndrome
2 months
what symptomss of antiepileptic hypersensitivity syndrome are most common
rash
swollen lymph nodes
fever
how long must a patient be seizure free to stop taking anti-epileptic medications
2 years min
How long is the duration over which we wean down aa paitent on anti-epileptics
3 months min
what two drugs lengthens the wean down period
benzodiazapines
barbituates
If someone who drives undergoes a seizure what must they do
stop driving and inform the DVLA
when someone has their first unprovoked seizure how long must pass before they are allowed to drive
6 months
If a patient has epilepsy but wants to drive what criteria must they meet
medication adherence
follow up adherence
be seizure free for 1 year minimum
not have a history of unprovoked seizures
Case:
a patient has had a seizure during their sleep but wants to know what the criteria is for being allowed to drive
a year must pass from the date of the seizure unless
The patients seizures only occur while they are asleep (3 year process)
Case:
a patient is currently in the process of changing their medication how long must they wait before they can drive again
6 months
Case:
a patient is going through the process of withdrawing from their medication how long must they wait before they can drive again
6 months from last dose
Case:
a patient is going through a change in their medication but has a seizure how long must they wait before they can drive again
1 year
what is the min dose of carbamazepine that is clinically appropriate
100mg OD
what is the max dose of carbamazepine that is clinically appropriate
400mg od
aside from epilepsy what can carbamazepine be used for
trigeminal neuralgia
bipolar disorder
diabetic neuropathy
what is carbamazepine contraindicated in
acute porphyria
atrioventricular conduction problems
bone marrow depression
acute liver disease
severe leukopenia
Much like valporate what patient groups is vit d reccomended in
patients who are immobile
patients who dont get enough sun
patients who dont get enough ca2+ in diet
what are the common side effects of carbamazepine
dizzy
drowzy
luekopenia
thrombocytopenia
GI
Weight gain
What are the notable side effects of carbamazepine
agranulocytosis
alopecia
bone marrow disorders
photosensitivity
what enzyme does carbamazepine induce
cyp3a4
what does caramazepine interact with
cyp3a4 inhibitors such as
clarithromycin
ketoconazole
biologics ending in ir
amiodarone
ticragrelor
