Epilepsy Flashcards
What is epilepsy?
Recurrent tendency of spontaneous, intermittent, abnormal electrical activity in parts of the brain manifesting as seizures
What are convulsions?
Motor signs of electrical discharges
What causes epilepsy?
2/3 idiopathic
Cortical scarring Developmental causes Space occupying lesions Stroke Hippocampal sclerosis Vascular malformations
What can patients experience before an epileptic event?
Prodrome lasting days/hours - change in mood or behaviour
What is an aura indicative of?
Focal seizure in the temporal lobe
What can aura involve?
Déjà vu
Strange feeling in gut
Strange smell
Flashing lights
What is the post-ictal phase?
Altered state of consciousness after an epileptic seizure
Typically 5-30 mins
What can patients experience in the post-ictal phase?
Headache Myalgia Confusion Temporary weakness - motor cortex Dysphagia - temporal seizures
What must happen to patients who have suffered with a seizure?
Referred for further investigation
What is important about an epileptic history? (long answer)
GET ONE FROM A WITNESS Rule out other causes - pseudoseizure Family history Previous head injury Birth problems
Ask what happened before, during and after the episode Before Illness? Medications? Triggers
During Headaches - migraines can manifest in similar ways Loss of consciousness? Lose control of bladder/bowels? Bite tongue/cheeks? Could you talk, move etc?
After
Confused, headache, myalgia?
What investigations would you ask for if you suspect epilepsy?
EEG
What are types of seizures?
Focal
Generalised - Absence, Tonic-clonic, Myoclonic, Atonic, (Tonic, Clonic)
What is the difference between focal and generalized seizures?
Focal seizures only affect one hemisphere and are usually associated with structural disease
Generalised originate at some point but spread bilaterally and rapidly distribute. They have no localising features
How are focal seizures managed?
Carbamazepine -1st line
Lamotrigine
What is used to manage generalised seizures?
Sodium valproate
What seizures can carbamazepine exacerbate?
Myoclonic and Absence
What is an absence seizure?
Brief (usually <10s) event where subject stop talking mid sentence then carry on where they left off
Often seen in childhood
What happens in a tonic-clonic seizure?
Lose consciousness
Limbs stiffen - tonic
Then jerk - clonic
Often lose continence, have aura before and severe headache after
What happens in a myoclonic seizure?
Sudden jerk of limb, face or trunk - suddenly thrown to ground
Violently disobedient limb
No loss of consciousness and continue as normal after
What happens in an atonic seizure?
Sudden loss of muscle tone –> fall
No loss of consciousness
What symptoms are indicative of temporal lobe seizures?
Complex motor phenomena Impaired awareness Oral movements - lip smacking, chewing, swallowing Deja vu Emotional disturbance Sound, smell, taste hallucination Delusional behaviour
What symptoms are indicative of frontal lobe seizures?
Motor feature - posturing or peddling movement Jacksonian march Motor arrest Subtle behavioural disturbance Speech arrest
What is a jacksonian march?
Tingling begin in periphery then spread to larger area of body
What symptoms are indicative of parietal lobe seizures?
Sensory disturbances
Tingling numbness
Pain
Motor symptoms
How do occipital lobe seizures present?
Visual phenomena - spots, lines and flashes
What things are important when giving management advice?
Pharmacological side effects
CBT can be recommended
Driving advice
What is the driving advice for a first unprovoked seizure?
Can’t drive for 6 months if no structural abnormality and no abnormality on EEG, if not 12 months off
What is the driving advice for patients with epilepsy?
Fit free for 12 months
What is the driving advice when withdrawing from anti-epileptic medication?
No driving until 6 months after last dose
Over what time period should anti-epileptic drugs be stopped?
Decreased slowly over 2-3 months
Over what time period should barbituates and benzodiazepines be stopped?
Decreased slowly over 6 months
What patients is it especially important to carefully consider management of epilepsy for?
Patients on other medication - CYP inducers/inhibitors
Women wishing to get pregnant
Women on contraception
Name some ADR’s associated with carbamazepine
Leucopenia Visual disturbance Balance issues SIADH Erythematous rash
P450 Inducer
What is important to consider about dosage with Lamotrigine?
Dose changes depending on valproate and carbamazepine use alongside
What are some ADR’s associated with Lamotrigine?
Maculopapular Rash
Steven Johnson Syndrome - warn them to see a doctor if they have flu like symptoms
Name some ADR’s associated with Sodium Valproate
Nausea Teratogenic Liver failure Pancreatitis Hair loss Obesity Ataxia Tremor Thrombocytopenia Encephalopathy
P450 inhibitor
How does carbamazepine work?
Bind to sodium channels to increase refractory period
How does lamotrigine work?
Sodium channel blocker
How does sodium valproate work?
Enhance GABA receptors
How does phenytoin work?
Bind to sodium channels to increase refractory period
Give some ADR’s of Phenytoin
Nystagmus Diplopia Tremor Dysarthria Dizzy/drowsy Peripheral neuropathy Gingival hyperplasia
CYP450 Inducer
What medication is used for pregnant women?
Lamotrigine
What is important to remember about the contraceptive pill and lamotrigine?
Lamotrigine reduce effectiveness of Contraceptive
Contraceptive reduce lamotrigine levels
What must women of child bearing age on Anti-epileptics take?
5mg Folate OD
How should patients having a fit be managed immediately?
Most resolve within 5 minutes.
If not resolving after 5-10 mins, administer benzodiazepine (4mg lorazepam)
