Epilepsy Flashcards
How prevalent is epilepsy?
What % of epileptics are well controlled with medication?
1% of population
70% well controlled
What is an epileptic seizure?
Spontaneous uncontrolled abnormal brain activity
What % of epileptics have a 1st degree relative with epilepsy?
30%
What conditions are associated with epilepsy?
Tuberous sclerosis
SLE
Sarcoidosis
A history of what in childhood increases risk of epilepsy?
Atypical febrile seizures
What are common precipitators of an epileptic seizure?
Lack of sleep
Alcohol
Flashing lights
TCA use
What is a simple partial seizure?
No LOC
Focal motor/sensory/ psychic symptoms
What are the 2 main groups of seizures?
Where do they originate?
Partial - Originate in one hemisphere
Generalised - Both hemispheres, LOC immediately
What is meant by tonic?
Stiff sustained contractions
What it meant by clonic?
Rhythmic jerking of one limb, side of body or whole body
What is meant by Atonic?
Myoclonic jerks followed by atony and sudden fall to the floor - no LOC
What is an absence seizure (petit mal)? What seizure category does it fall in to?
Abrupt psychomotor arrest & blank staring in to space/upward deviation of eyes
It is a generalised seizure
What is a complex partial seizure?
Partial seizure + LOC
When is an EEG performed if suspecting epilepsy?
After 2nd seizure
What can be done to elicit a seizure?
flashing lights
hyperventilation - can bring on absence seizure
Adults being investigated for epilepsy must have which additional investigations?
ECG - determine arrhythmia or long QT
MRI/CT - exclude infective or vascular causes
What is first line management of generalised seizures in females?
Lamotrigine
What is a grand mal seizure?
Tonic-clonic
repeated contraction & relaxation of muscles
What is the first line treatment for generalised seizures?
Who is this contraindicated in and what is used instead?
Sodium valproate - increases GABA
- absence, tonic clonic, atonic etc
Females of reproductive age - lamotrigine
What is first line treatment for partial/focal seizure?
Carbemazepine - increases GABA
Lamotrigine
Following a seizure, what are the rules on driving?
What rules of driving apply to those with epilepsy?
Cannot drive for 6 months after a seizure
Those with epilepsy must be seizure free for 12 months
What type of diet is advised for epileptics?
Ketogenic diet - high fat low carb
When can stopping anti epileptic drugs be considered?
Seizure free for 2 years
Wean down over 3 months
What is SUDEP?
sudden unexplained death in epilepsy
commonly occurs with uncontrolled epilepsy
associated with night time seizure + apnea/asystole
What are the rules of breastfeeding and anti-epileptics?
Safe to use, especially lamotrigine
What is defined as status epilepticus?
Seizure lasting > 30 minutes or repeated seizures lasting > 30 minutes with no regaining of consciousness inbetween
For a tonic-clonic seizure lasting > 5 minutes, what is the preferred treatment in the community?
Rectal diazepam - 10mg in adults
Paeds - 0.5mg/kg
Buccal midazolam - 10mg in adults
Paeds - 0.5mg/kg
For a tonic-clonic seizure lasting > 5 minutes, what is the preferred treatment in hospital?
IV lorazepam - 4mg in adults
Paeds - 0.1mg/kg
After administration of 1 drug to terminate a seizure has failed, what is the next step?
repeat after 10 minutes
After 2 doses of drug have been trailed to terminate a seizure, what is the next step?
IV phenytoin
If a patient is already on phenytoin, what can be used instead to terminate a persistent seizure?
Phenobarbitone
What is the end stage attempt at terminating a seizure?
RSI with thiopentone - anaesthetist
