epilepsy Flashcards
causes epilepsy
primary generalised epilepsy (JME), developmental (neuronal migration), hippocampal sclerosis, trauma and surgery, tumour, vascular (stroke, CVA), encephalitis/inflammatory, metabolic (low calcium, sodium), Alzheimers, drugs, alcohol
what drugs are implicated in epilepsy as a cause
ciclosporin, lidocains, quinolones, TCAs, antipsychotics
what can hippocampal sclerosis be due to
childhood febrile convulsions
what is JME
myoclonic starts in teenager can go unrecognised and later have a generalised tonic clonic. life long treatment neded. occur in the morning after waking
when does loss of consciousness occur
in complex partial and all generalised seizures
what are the generalised seizures
absence, tonic clonic, myoclonic, atonic
signs of temporal partial seizure
automaticisms- lip smacking, singing, kissing, chewing; dysphasia; memory- deja vu; emotional disturbance; abdominal rising sensation; delusional; emotional disturbance
signs of occipital partial seizure
visual- flashes, spots, lines
signs of parietal partial seizure
sensory disturbance- tingling, numbness
signs frontal partial seizure
behavioural; dysphasia; motor- peddling movement of the legs, post ictal Todds palsy
what is Todds palsy
focal weakness in a part of the body after a seizure
investigations
FBC, ESR, renal, LFT, calcium, glucose, ECG, MRI, EEG
management - DVLA
must not drive 12 months after last seizure. If it is the first seizure then 6 months off driving
management of a single seizure
no treatment unless high risk of recurrence
first line generalised tonic clonic
sodium valproate, lamotrigine
first line absence
sodium valproate, lamotrigine
what drug should you not use in absence of myoclonic
carbamazepine
first line myoclonic
levetiracetam, valproate, topiramate
first line partial with or without 2ary generalisation
carbamazepine, lamotrigine
side effects sodium valproate
Valproate; Appetite incr- weight gain; Liver failure; Pancreatitis; Reversible hair loss; Oedema; Ataxia; Teratogenecity, tremor, thrombocytopenia; Encephalopathy
side effects carbamazepine
leucopenia, diplopia, rash, blurred vision
side effects lamotrigine
maculopapular rash (stevens jonhson), diplopia, photosensitivity, blurred vision, tremor, anaemia
side effects levetiracetam
psych side effects- depression, agitation; D&V, dyspepsia, drowsy, diplopia, blood dyscrasia
side effects phenytoin
decr intellect, depression, coarse facial features, acne, gum hypertrophy
which drugs interfere with contraception
hepatic enzyme inducing AEDs- carbamazepine, phenytoin, phenobarbital
what is status epilepticus
continuous seizures lasting >30mins.
why could status happen in a patient with pre existing epilepsy
recent medication reduction or withdrawal, progressive disease, metabolic, intercurrent illness
why could status happen in someone with no Hx epilepsy
metabolic- decr glucose, Na, incr Ca; alcohol; toxicity; CVS; SAH; SOL; cerebral infection;; febrile illness
complications of status- cerebral
oedema, incr ICP, haemorrhage, infarction, damage 2ary to hypoxia, seizure, metabolic
complications of status- systemic
DIC, severe dehydration, metabolic acidosis, hypothermia, pancreatitis, renal and hepatic failure
complications of status- cardioresp
arrhythmias, resp failure, shock, cardiac arrest, hyper/hypotension, pulmonary oedema, PE, aspiration pneumonia
management of status- early treatment
IV lorazepam 2-4mg, rectal diazepam
management of status- when seizure duration >10mins
IV phenytoin (phenobarbital if already on phenytoin)
if doesn’t respond to phenytoin (status)
general anaesthetic, transfer to ITU, midazolam, thiopental
how can you differentiate a real seizure and a pseudoseizure
real seizure- increase in prolactin. do EEG
