Epilepsy Flashcards
Give some risk factors for epilepsy
Birth problems Developmental delay Past seizures Head injury Family history
Give examples of drugs that can precipitate epileptic seizures
Theophylline Tramadol Penicllins/cephalosporins Anti-emetics Opioids
What investigation must a patient receive if they have presented with seizure?
ECG
When do patients with seizures get a CT scan?
Skull fracture
Deteriorating GCS
Focal signs
Head injury
What are the only indications for EEG?
Classify epilepsy
Confirm non-epileptic attacks
Surgical evaluation
Confirm non-convulsive status
A patient presents with a one-off seizure. For how long are they not allowed to drive cars?
6 months
A patient presents with a one-off seizure. For how long are they not allowed to drive HGVs?
5 years
A patient has a number of epileptic attacks while awake and has lost consciousness. For how long are they not allowed to drive cars?
1 year
An epileptic patient had a single awake seizure, but has since been only having asleep seizures. For how long (from the last awake seizure) is a patient not allowed to drive cars?
3 years
For how long must an epilepsy patient have been off medication and not had a seizure before being able to drive HGVs?
10 years
What is the cause of epilepsy?
Unprovoked discharges of electrical activity in the brain
Epileptic seizures tend to be caused by high frequency excitatory/inhibitory action potentials
Excitatory
Epilepsy is commonest at what age?
Over 50
What is SUDEP?
Sudden unexplained death in epilepsy patients
Give some causes of SUDEP
Aspiration during seizure
Sudden cardiac event
Brain waves stop working
What can increase the risk of SUDEP?
Nocturnal seizures
Drugs
Alcohol
What occurs in focal epilepsy?
A single part of the brain is abnormal leading to a specific seizure
What happens if the focal lesion impacts the cortical network?
Generalised seizures can occur
What occurs in generalised epilepsy?
There is an abnormality in the pathways around the brain
Give examples of generalised seizures
Absence Myoclonic Atonic Tonic Tonic clonic
Give examples of focal seizures
Motor
Sensory
Psychic
Focal epilepsy is commoner in which age group? Why?
Over 50s - more likely to have structural brain abnormality
What test can be done in under 30s to determine the type of epilepsy?
EEG
What symptoms may be seen in juvenile myoclonic epilepsy?
Early morning jerks
Generalised seizures
What treatment is generally given for primary generalised epilepsy?
Sodium valproate
Which patients will not normally get sodium valproate? Why?
Young women - teratogenic
What drug is given as an alternative to sodium valproate?
Lamotrigine
What drugs are given to treat focal onset epilepsy?
Carbamazepine
Lamotrigine
What drugs are used to treat absence seizures?
Sodium valproate
Ethosuximide
What drugs can be used in myoclonic seizures?
Sodium valproate
Levetiracetam
Clonazepam
What is the main drug used in atonic, tonic and tonic clonic seizures?
Sodium valproate
What medications are affected and should not be used in women taking carbamazepine?
Progesterone only pill
Progesterone implants
Why must a woman requiring the morning after pill see her doctor if she is taking carbamazepine?
As she will require a higher dose
What is status epilepticus?
Recurrent epileptic seizures without full recovery of consciousness
What are the types of status epilepticus?
Generalised convulsive
Non convulsive status
Epilepsia partialis continua
Give some precipitants of status epilepticus
Severe metabolic disorders Infection Head trauma SA haemorrhage Withdrawal of anti-convulsants
What is the effect of status epilepticus on the metabolic state?
It is massively increased to maintain convulsion
What can occur due to an increased metabolic state?
Hypoxia
Hypotension
Hyperthermia
Rhabdomyolysis
What is the first-line drug given in status epilepticus?
Benzodiazepines
What other anti-convulsants are used in status epilepticus?
Phenytoin
Levetiracetam
Sodium valproate
