Epilepsy Flashcards
What is epilepsy
A chronic disorder characterised by recurrent seizures
What is epilepsy characterised by
Impairment of motor activity (convulsions), consciousness, perception and/or behaviour
What is a seizure
Principle symptom of epilepsy
What is a convulsion
- Sudden, violent, irregular movement of a limb or of the body, caused by involuntary contraction of muscle
DOES NOT HAVE TO BE EPILEPTIC IN ORIGIN (serotonin syndrome)
How does serotonin syndrome occur
High dose of SSRIs- convulsions, brain activity is not seizure like
What is a complex seizure
- Consciousness is impaired although not loss
- Preceded by aura
- Automatisms- lip smacking and grimacing, may occur
- Amnesia of varying duration and degree is common
What is a simple seizure
Those that no not cause impaired consciousness, duration is less than one minute
What is a absence seizure type (generalised)
- Abrupt, short (10-30 seconds) cessations of physical movement and loss of attention
- Characterised in childhood
What is a clonic seizure type
- Characterised by loss of consciousness
2. Rapidly alternating muscle contraction and relaxation
What is a tonic seizure type
- Occurs predominantly during sleep and in childhood
2. Cause sustained contraction of the skeletal muscles in the head and trunk then spreading to the limb
What is tonic clonic seizure type (generalised)
- Patients experiencing a loss of consciousness with a sudden contraction of muscles
- Respiratory Muscles are involved: stridor or loud cry can be heard
- Clonic convulsion: grunting noise present and saliva froth from the mouth
- Duration: 2-3 minutes and ends with gurgling sound
- Cyanosis resolves and patient wakes with confusion
What is atomic seizure type
- Usually occur in children and manifest as brief total loss of muscle tone
- Loss of consciousness followed by fall
What is a myoclonic seizure type
- Brief sudden, involuntary shock like muscle contractions (involves whole body- generalised)
- Just a few muscles (focal) or more than two contiguous regions (regional)
What is an isolated seizure type exposure? (3)
Not considered epilepsy
Considered when a trigger is introduced such as a CNS infection, stroboscopic lighting, head injury, fever, drug related
Can increase risk of developing epilepsy
What are the disease burdens of epilepsy (5)
Premature mortality is 2-3 times higher in epilepsy patients due to
- SUDEP: patients spontaneously dying
- Status Epilepticus
- Accidents: consequence of seizure
- Aspiration pneumonia
- Drug toxicity, ADRs and suicides
What are the co-morbidities of epilepsy (8)
- Cognitive decline
- Anxiety
- Depression
- Agitation, anger and emotional out bursts
- ADHD
- Reproductive problems
- Insomnia
- Migraine
What area in the brain affects motor function
Frontal Lobe
What area in the brain affects sensory function
temporal lobe - deja vu, psychiatric symptoms
parietal lobe- sensory function, tingling symptoms
What are the treatment options for generalised tonic clonic seizures (1st, 2nd and adjunctive)
1st Line: Carbamazepine, Lamotrigine, Topiramate, Valproate
2nd Line: Oxcarbazepine, Phenytoin
Adjunctive: Clobazam, Levetriacetam
What are the treatment options for generalised tonic absence seizures (1st, 2nd and adjunctive)
1st Line: Ethosuximide, Lamotrigine, Valporate
2nd Line: Topiramate
Adjunctive: Benzodiazepine
What is a partial seizure and give examples
Seizure discharge in one area of brain
Symptoms: Involuntary movement, abnormal sensory experiences, consciousness loss
Examples: Jacksonian Epilepsy and Psychomotor epilepsy
What are the treatment options for partial seizures (1st, 2nd and adjunctive)
1st Line: Carbamazepine, Lamotrigine, Oxcarbazepine, Topiramade, Valporate
2nd Line: Gabapentin, Phenytoin
Adjunctive: dual therapy: Clobazam, Levetiracetam, Ticagabine
How do you diagnose epilepsy? (5)
- Obtaining an accurate and detailed history from the patient of the evens before, during and after a seizure
- A specialist in epilepsy must do this
- Identify the primary cause: stroke, arrhythmia, TIA
- EEG or MRI (can detect lesions in brain that may cause epilepsy)
- IF results show epilepsy, see which type and consider rectifiable surgery or recurrent drug therapy
What are the aims of pharmacotherapy
- Ensure patients are seizure free or minimise number of break through seizures
- Maximise quality of life
- Balance with drug use as some have major side effects that reduce quality of life
How do you treat the first seizure
No drug therapy (unlikely to occur again)
How do you treat the second seizure with 1st choice mono therapy?
1st choice mono therapy: Achieve control, monitors continue: withdraw after seizure free amount of time:
Carbamazepine (300mg effective dose, not 500mg), Lamotrigine, Oxcarbazepine, Topiramate, valporate
How do you treat the second seizure with 2nd choice mono therapy or adjunctive dual therapy?
2nd choice mono therapy: GABA: Gabapentin, Phenytoin
Adjunctive dual therapy:
Clobazam, Levetiracetam, Tigabine
What if all mono therapy and dual therapy treatments fail?
Vagal nerve stimulation or surgery
How do sodium channel blockers work in epilepsy and give drug examples
Seizures rely on dependent action potential voltage gated sodium channels, inhibitor leads to prevention
Examples: Phenytoin, Carbamazepine (also GABA inhibitor) and carisbamate
How do GABA drugs work in epilepsy and give drug examples
Enhancement of GABA mediated Cl- channels to increase inhibition and attenuate seizures
Examples: Phenobarbitone, Diazepam
What are the first generation anti epileptic drugs (3)
Phenobarbital
Phenytoin
Corticosteroids/ACTH
What are the second generation anti epileptic drugs (4)
Diazepam
Carbamazepine
Valproate
Clobazam
What are the third generation anti epileptic drugs (4)
Lamotrigene
Oxcarbmazepine
GABApentin
PREGbalin
