Epilepsy Flashcards
Drugs that can precipitate epileptic seizures
Tramadol - can induce in previously stable patients
Driving and Epilepsy
1st seizure - 6 months car, 6 years for HGV / PCV
Epilepsy - 1 year car, or 3 years if seizure during sleep.
10 years off medication for HGV / PCV
Generalised Seizures
Generalised seizures involving the corticothalamic circuitry. Can start from focal point.
Epilepsy Classification
Epileptic Seizures
Epileptic Syndromes
Epileptic Seizures
Generalised
Partial (focal site of origin)
Epilepsy Syndromes
Type of seizure
Age
Aetiology
Partial Seizures
Simple - without impaired consciousness
Complex - with impaired consciousness
Generalised Seizures
Abscence Myoclonic Atonic - rare, seen in kids Tonic Tonic clonic (primary generalised)
Generalised Epilepsy
Most have genetic predisposition
Present in childhood and adolescence
Spike-wave abnormality on EEG
Tonic clonic, absence, myoclonic, clonic, tonic and atonic
Primary Generalised Epilepsy
Often present in childhood or teens
Sodium Valproate treatment of choice
Lamotrigine alternative
e.g. Juvenile Myoclonic Epilepsy
Juvenile Myoclonic Epilepsy
Early morning jerks
Generalised seizure
RF: Sleep deprivation, flashing lights
Focal Onset Epilepsy
Underlying structural problem Focal onset - can then generalise Any age Frequent: complex partial seizures with hippocampal sclerosis Carbamazepine or lamotrigine
Focal Onset Epilepsy
Underlying structural problem Focal onset - can then generalise Any age Frequent: complex partial seizures with hippocampal sclerosis Carbamazepine or lamotrigine
Partial Seizure treatment
Carbamazepine
Lamotrigine - takes three months to work
Levetiracetam
Generalised Seizure - Absence treatment
Sodium Valproate
Ethosuximide
Generalised Seizure - Myoclonic treatment
Sodium Valproate
Levetiracetam
Clonazepam
Generalised Seizure - Atonic, tonic, generalised tonic clonic treatment
Sodium Valproate
Levetiracetam
Phenytoin
Acute management only - Status epilepticus
SE: Gum hypertrophy
Sodium Valproate
‘domestos’ of anticonvulsants
SE: Weight gain, teratogenic, hair loss, fatigue
Carbamazepine
Focal onset seizure treatment
Can make primary generalised seizures worse - do not use.
Lamotrigine
Well tolerated in generalised and focal seizures
Takes long time to titrate up - 3 months
Topiramate
SE: weight loss, sedation, fatigue
Reasonably effective but not well tolerated
When to prescribe drugs?
Patient has epilepsy
Single seizure but has high risk of recurrence
Only if patient wants drugs - SE and benefit weighing
Ladies and Anti-convulsants
Alter efficacy of COC
Lamotrigine efficacy is reduced by COC.
Folic acid for conception (high dose 3 months) + vit K.
