Epilepsy Flashcards
What are the risk factors for epilepsy?
Trauma at birth Past seizures (inc. febrile) Head injury Family history Drugs & Alcohol
What is the first line investigation in a patient with syncopal/seizure presentation?
ECG
What presentations would provoke an urgent CT of the head?
Clinical or radiological skull fracture
Deteriorating GCS
Foca lsignhttps://www.facebook.com/?ref=tn_tnmns
Head injury with seizure
Failure to be GCS 15 4 hours after arrival
How long after your 1st seizure can you not drive a car or HGV/PCV?
Car = 6 months HGV/PCV = 5 years
How long do you have to be off epilepsy medication to drive a HGV/PCV?
10 years
What are the potential triggers for a seizure?
Sleep deprivation Stress/Anxiety Alcohol Recreational drugs Cough/cold UTI/infections
What factors lead to an increased risk of death in epileptics?
Learning disabilities
Nocturnal seizures
No bed partner
Non compliance with medication
What are the types of epilepsy?
Focal
Generalised
Unclassified
What are the 2 types of seizure in focal epilepsy?
Simple
Complex
Describe a simple focal seizure
Aware - not unconscious
Causes of simple focal seizures
Single site of injury (scar, tumour, stroke, encephaitis)
Treatment of focal epilepsy
Carbemazepine
Lamotrigine
Describe a complex focal seizure
Spreads to further part of hemisphere (mostly temporal)
Secondary generalised
Unconscious (unclear history)
What is the first line treatment for generalised epilepsy in men?
Sodium valproate
What is the first line treatment for generalised epilepsy in women?
Lamotrigine
But if lots of seizures levetiracetam as lamotrigine takes 10-12 weeks to work
How is epilepsy diagnosed?
Eye witness account
MRI if focal tumour
EEG - classification ornon-convulsive status
Do ECG for long QT
What is the biggest cause of death in epilepsy?
Suicide
What is the first line management of status epilepticus?
Medazelam (buccal)
Lorazepa,
Why should carbamazepine, phenobarbitol, phenytoin & primidone be prescribed carefully in women?
Induce hepatic enzymes - can alter efficacy of OCP & shouldn’t use progesterone only pill
Side effects of sodium valproate
Weight gain
Teratogenic
Hair loss
Fatigue
Side effects of topiramate
Sedation
Dysphagia
Weight loss
What can precipitate status epilepticus?
Severe metabolic disorders Infection Head trauma Sub-arachnoid haemorrhage Abrupt withdrawal of anti-convulsants Treating absent seizures with CBZ
Treatment of status lasting> 5 mins
Benzodiazepine
if continues for a further 10 mins - second dose of benzo
Within 30 mins of seizure started give sodium valporate - if continues should be sedated in ITU with CG monitoring
What is a myotonic seizure?
Shock like jerks usually seen on both sides of the body at the same time
