Epilepsy Flashcards
What specific aspects are important in a patient who has fallen?
Before, during and after events
Eye witness account- phone if necessary
Risk factors for epilepsy?
Birth Developmental Previous seizure (inc. febrile) Head injury (incl LOC) FH Drugs Alcohol
What role does examination play in 1st seizure clinics?
Little to no role, history most important
What should be performed in a diagnosis of syncope?
Full cardio exam including L + S Blood pressure
Which investigations are useful in the fallen patient?
ECG compulsary
CT or MRI brain
Which patients get a CT scan acutely?
Clin or radiological skull fracture Deteriorating GCS Focal signs Head injury w/ seizure Not GCS 15 after 4 hrs Suggestion of other pathology eg SAH
What are the rules of driving after a seizure
1st seizure - 6 months car, 5 years HGV
Epilepsy - 1 year or 3 years during sleep, 10 years off meds for HGV
Features of primary generalised seizure?
Often childhood or teens
Early morning jerks
Generalised sizure
Often sleep depiravtion or flashing lights
Treatment for primary generalised seizure
Sodium Valproate (Teratogenic)
Lamotrigine as alternative
Features of focal onset epilepsy
Underlying structural cause
Focal onset at any age
Frequent complex partial seizures with hippocampal sclerosis
Treatment of focal onset epilepsy
Carbamazepine or lamotrigine (Not sodium valproate because S/E)
Side effects of sodium valproate?
Weight gain
Teratogenic
Hair loss
Fatigue
What effect does carbamazepine have on generalised epilepsy?
It makes primary generalised epilepsies worse
Disadvantage of Lamotrigine
Takes a long time to titrate dose up
Side effect of Levetiracetam
Can cause mood swings
Side effects of Topiramate?
Sedation
Dysphagia
Weight loss
What is the method of interaction between anti convulsants and the contraceptive pill?
They can induce hepatic enzymes which alter the efficacy of the OCP
What is status epilepticus
Recurrent epileptic seizures without full recovery of conciousness, can last more than 30 mins
What are the 3 types of status epilepticus?
Generalised convulsive status epilepticus
Non convulsive (Concious but in altered state)
Epilepsia partialis continua (Continual focal seizures, conciousness preserved)
Precipitants of status epilepticus
Hyponatraemia, pyridoxine deficiency
Infection
Head trauma
SAH
Abrupt withdrawal of anti convulsants
Treating absence seizures with CBZ
What is a convulsive status?
Generalised convulsions without cessation
Excess cerebral energy demand and poor substrate delivery causes lasting damage
Complications of convulsive status?
Resp insufficiency and hypoxia
Hypotension
Hyperthermia
Rhabdomyolysis
Which Anti convulsants in acute setting
Phenytoin
Keppra
Valproate
Benzodiazepenes
