[epilepsy] Flashcards
T
Temporal Lobe
sore tongue due to severe tongue bite
cortex
cortical scarring
1 year
“you must contact the DVLA”
idiopathic
Partial
Primary generalised
Partial
The attack ONSET is key for Dx
A seizure with features referable to one part of one hemisphere
Simultaneous onset of electrical discharge throughout the cortex i.e. no localising features (at onset)
simple partial
complex partial
Partial with secondary generalisation
absence tonic-clonic myoclonic atonic (akinetic) infantile
temporal
awareness unimpaired
focal symptoms
post ictal symptoms usually absent
Awareness impaired
focal symptoms
post-ictal symptoms common
headache confusion sore tongue myalgia temporary weakness (can get in partial)
temporary weakness due to focal cortical seizure
temporal
Frontal
temporal
focal start (either simple/complex)
spreads to generalised
usually convulsive
generalised -absence
Loss of consciousness
limbs stiffen (tonic)
limbs jerk (clonic)
post-ictal confusion
sudden jerk of face/limb/trunk
sudden loss of tone (fall?)
occipital
frontal
motor
spreading motor seizure from a distal part of a limb to the ipsilateral face.
retained awareness
frontal
Temporal
brief unconscious behaviours
motor behaviours with no recollection
jamais vu (strangely unfamiliar)
temporal lobe
temporal
frontal retains awareness
temporal
temporal
2
Sodium valproate
Lamotrigine
Sodium valproate
lamotrigine
ethosuximide
Carbemazepine
oxcarbazepine
*worsen seizures)
Carbamazepine
100mg/12hr intitial
increase by 200mg every 2weeks
max 1000mg
Sodium valproate
lamotrigine
Concurrently administer 1st and 2nd line and only withdraw 1st once established on 2nd line
risk of recurrence following a 1st time unprovoked seizure
MRI
neurosurgical resection (70% seizure free)
neurosurgical resection
Vagus nerve stimulation
nocturnal seizure apnoea
T
100mg/12hr intitial
increase by 200mg every 2weeks
up to a max 1000mg
IF MONOTHERAPY:
initial 25mg/d
increase by 50mg every 2 weeks
Max 250mg
Sodium valproate
Carbamazepine
phenytoin
initial 300mg/12hrs
increase by 100mg/12hrs every 3 days
carbamazepine
phenytoin
barbituates
VALPROATE appetite increase Liver failure Pancreatitis reversible hair loss Oedema Ataxia Teratogenic, thrombocytopenia, Tremor Encephalopathy Nausea
Leucopenic
vision problems (diplopia/blurred)
Impaired balance
Maculopapular rash
Stevens-johnsons syndrome (0.1%)
visual problems
reduced IQ depression coarse facial features visual problems dysarthria
lamotrigine for general
Carbamazepine for partial
folic acid
seizure free for > 2years
normal EEG
normal CNS exam
other (e.g. the need to drive)
alcohol
benzodiazapines
hippocampus
sensory loss
motor (spread to precentral gyrus)
