Epilepsy Flashcards
Which investigation is mandatory in a fallen patient?
ECG
What patients get a CT scan acutely?
skull fracture deteriorating GCS Focal signs head injury with seizure failure of GCS to improve suggested other pathology
Post 1st seizure, how long should a car driver wait before driving again?
6 months
Post 1st seizure, how long should a HGV driver wait before driving again?
5 years
In epilepsy diagnosis, how long should a person driving a car wait to drive again?
1 year - 3 years if during sleep
In epilepsy diagnosis, how long should a truck driver wait before driving again?
10 years off medication
What is generalised epilepsy?
genetic predisposition in most
spike-wave abnormalities in EEG
childhood and adolescence
tonic clinic, absence, myoclonic, clonic, tonic, atonic
What is the first line treatment for primary generalised epilepsy?
sodium valproate
What is the problem with sodium valproate?
it is teratogenic
What can be used as an alternative to sodium valproate?
lamotrigine
what is focal onset epilepsy?
focal onset seizures with an underlying structural cause
What is the first choice treatment in focal onset epilepsy?
carbamazepine
What is a common form of focal onset epilepsy?
complex partial seizures with hippocampal sclerosis
What are side-effects of sodium valproate?
weight gain
teratogenic
hair loss
fatigue
What is a main side-effect of phenytoin?
enzyme induction
When is phenytoin used?
acute seizure management
name some new anticonvulsants
lamotrigine
levetiracetam
topiramate
gabapentin, pregabalin
What is a problem with lamotrigine?
longtime to titrate to treatment dose
What is the main problem with levotriacetam?
mood swings
but well tolerated generally
What side-effects can be caused by topiramate?
sedation
dysphasia
weight loss
not very well tolerated
What are gabapentin and pregabalin used for?
neuropathic pain
Which type of contraceptive pill should not be used with anti-convulsant medication?
progesterone only
what happens to the efficacy of the COCP with anticonvulsant use?
altered
Which anti-convulsants can induce hepatic enzymes?
carbamazepine phenobarbital phenytoin topiramate oxcarbazepine
What is status epileptics?
recurrent epileptic seizures without full recovery of consciousness with continuous seizure activity lasting more than 30 minutes
what kinds of conditions can precipitate status?
severe metabolic disorders infection head trauma SAH withdrawal of AEDs treating absence seizures with CBZ
What is convulsive status?
generalised convulsions without cessation using excess cerebra energy and poor substrate delivery causing lasting damage
What is the immediate management of a seizure patient?
stabilise - ABC
identify cause
anti-convulsants
