Epilepsy 3 Flashcards
Why does the presentation of generalised epilepsy usually occur in childhood & adolescence ?
Because it is usually due to a genetic predisposition
What are the 5 main types of generalised epilepsy ?
Think juan MATTA
- Absence seizures
- Tonic-clonic seizures
- Myoclonic seizures
- Atonic seizures
- Tonic seizures
Describe the typical presentation of a absence seizure
- Person becomes blank & unresponsive for a few seconds (<10secs)
- May appear to be day dreaming, they usually stop what they are doing & look blank, they will not respond to what is happening around them
- May carry on walking etc but will not be aware they are.
- This has a characteristic 2.5-3.5 Hz spike & wave pattern
May be associated with mild clonic jerking of the eyelids & extremities
Describe the typical presentation of tonic-clonic seizures (grand-mal)
This is the seizure that most people think of as epilepsy
There is major convulsions with rigidity (tonic) & jerking (clonic) which slows over 60-120 seconds followed by a stuporous state (post-ictal depression) e.g. confusion, headache, sleepiness
2 main phases:
- Tonic phase - muscles suddenly tense up, causing the person to fall to the ground if they are standing
- Clonic phase - muscles will start to contract & relax rapidly, causing convulsions
What are the 2 non-convulsive generalised epilepsies ?
Atonic and absence seizures
Describe the typical presentation of myoclonic seizures
- Sudden jerk of a limb, face or trunk
- Person may be thrown to the ground by the jerk, or have a violently disobedient limb
- They are brief but can happen in clusters (many happening close together)
- Often happen shortly after waking
- Risks for causing them include - flashing lights, alcohol, sleep deprivation (often can happenin freshers week) would be known as juvenile myoclonic epilepsy at a young age
Describe the typical presentation of atonic seizures
- Sudden loss of muscle tone causing a fall, no loss of consciousness
- Tend to be brief and recover quickly
Describe the typical presentation of tonic seizures
- Muscles suddenly become stiff, if standing often fall
- Tend to be brief without warning & recover quickly
What is the 1st line treatment of focal seizures ?
1st line = Carbamazepine or lamotrigine (go with lamotrigine due to less side effects)
2nd line = Levetriacetum, oxycarbazepine or sodium valproate
What is the 1st & 2nd line treatment of atonic, tonic and generalised tonic-clonic seizures and state the problem with the 1st line treatment?
(just think that all the ones with the word tonic in them have the same treatment)
- 1st line = sodium valproate
- 2nd line = lamotrigine
The problem with sodium valproate is that it is teratogenic so cannot be given to women of childbearing age
What is the treatment of absence seizures ?
- 1st line = sodium valproate, then if this doesn’t work then ethosuximide
- 2nd line = lamotrigine
What is the treatment of myoclonic seizures ?
- 1st line = sodium valproate
- 2nd line = Levetiracetum
- 3rd line = topiramate
What are the 4 main targets which different AED’s act on ?
- Increase inhibitory neurotransmitter system - GABA
- Decreased excitatory neurotransmitter system - Glutamate
- Block voltage-gated inward positive currents - Na+ or Ca2+
- Increase outward positive current K+
What is the mechanism of action of sodium valproate ?
Works by enhancing GABA synthesis
What are the main side effects of sodium valproate ?
- Weight gain
- Teratogenic
- Hair loss
- Fatigue
Think - what the hell fiona
