Epilepsy Flashcards
What are the risk factors for epilepsy?
prematurity; global developmental delay; seizures in the past (incl. febrile fits); head injury; family history; drugs; alcohol
What investigation is mandatory in all those who have fallen/had fit?
ECG
When is a CT scan done acutley?
clinical/radiological skull #; decreasing GCS; focal neuro signs; head injury with seizure; GCS 12; auggestion of other pathology- eg SAH
What is the ban of driving length after a first seizure for a car?
6 months
What is the ban on driving an HGV/ PCV after the first seizure?
5 years
What is the driving rules for epilptics and HGV/PCV?
been 10 years off medication
What is generalised epilepsy?
most genetically prediposed which present in childhood and adolescence, affect both hemispheres and lose consciousness
What is seen on EEG with generalised epilepsy?
generalised spike-wave abnormalities on EEG
What is the treatment of choice generally for primary generalised epilpsy?
sodium valproate
What is an example of a type of priamry generalised epilepsy?
juvenile myoclonic epilepsy
What are the problems with sodium valproate?
teratogenic- not suitable for women of child-bearing age; lots of side effects
What are the SE with sodium valproate?
weight gain; pancreatitis; hepatitis; oedema; hair loss; ataxia; fatiue; nausea; encephalopathy
What are the risk factors for juvenile myoclonic epilepsy?
sleep deprivation and flashing lights
What causes focal onset epilepsy?
underlying structural cause- commonly hippocampal sclerosis
What typically causes hippocampal sclerosis?
hx of febrile convulsions
What is teh treatmetn for focal epilepsy?
carbamazepine or lamotrigine
What is phenytoin used for?
acute managment only
What is a main problem with carbamazepine?
can make primary generalised epilepsies worse
What is the problem with carbamazepine with females?
alters the efficacy of the OCP adn morning after pill
What is status epilepticus?
recurrent epilpetic seizures without full recovery of consiousness; lasting more than 30 mins
What are the types of status epilepticus?
generalised convulsive status epilepticus; non convulsive status (consiouc but in altered state); epilepsiea partialis continua- continual focal seizures- consioucenss preserved
What are the causes of status?
severe metabolic disorders- hyponatraemia; hypoglycaemia; infection; head trauma; SAH; abrupt withdrawal of anti-convulsants; treating absence seizures with CBZ
What can convulsive status result in?
respiratory insufficiency and hypoxia; hypotension; hyperthermia and rhabdomyolysis
What drugs can precipitate epileptic seizures?
theophylline; tramadol; anti-emetics; opioids; antibiotics eg penicillins; cephalosproins and quinolones
What is the MOA of carbamazepine and lamotrigine?
inhibit the actiivity of voltage-gated sodium channels; reducing pre-synaptic excitability and abilityo f APS to spread
What is MOA of pregabalin and gabapentin?
inhibt voltage-gated calcium cannels with drives neurotrasmitter release
