Epilepsy Flashcards
What is focal epilepsy caused by?
Give a common example
Focal structural abnormality
Hippocampal sclerosis
Give examples of symptoms you might be in a frontal lobe seizure.
Repetitive muscle/muscle group clonus
Posturing
Personality change
Give examples of symptoms you might be in a parietal lobe seizure.
Pain
Indescribable sensory phenomena
Give examples of symptoms you might be in a temporal lobe seizure.
Automatism
Deja vu
Dysphoria/euphoria
Unusual speech
Focal epilepsy tends to present in childhood.
T/F?
False
Focal epilepsy tends to affect older people as it is caused by structural abnormalities
What causes generalised seizures?
Abnormal brain activity in a connecting pathway in the brain
Describe tonic-clonic seizure.
Patients stiffen (tonic), jerk (clonic) and are confused/drowsy afterwards
Describe atonic seizure
Patient loses tone of muscles without loss of consciousness
Describe absence seizure
Brief lapse in awareness where patients stop speaking and stare (seen in children)
Describe myoclonic seizure
Sudden jerk of limb, trunk or face
Generalised epilepsy tends to present in childhood.
T/F?
True
What is functional attack disorder and how can you clinically differentiate it from epilepsy?
Condition caused by past traumas which presents with seizures related to trauma, stress or anxiety
Traumatic event in childhood
Co-ordinated movement during seizure
Describe familiar aura (e.g. sweet smell/taste, not indescribable)
How do you manage functional attack disorder?
Exclude epilepsy (EEG)
Counselling (when patient is ready to confront trauma)
What investigations would you order in newly presenting epilepsy?
ECG
Essential investigation to look for prolonged QR syndrome which is fatal if missed
EEG
Classifies epilepsy
Management of an acute seizure?
IV/rectall benzodiazepine
IV phenytoin
First line management of focal epilepsy
Carbamazepine or lamotrigine
First line management of generalised epilepsy
Sodium valproate
Second line management of focal epilepsy
Levetiracetam or sodium valproate or topiramate
Second line management of generalised epilepsy
Lamotrigine or levetiracetam
Third line management of generalised epilepsy
Dual therapy
sodium valproate, lamotrigine, levetiracetam
Third line management of focal epilepsy
Dual therapy
(carbamazepine, lamotrigine, levetiracetam, topiramate)
Unless they are over 60
Last line management of focal epilepsy
Excisional sugery (if one epileptogenic focus)
Vagus nerve stimulation (if more than one epileptogenic focus)
Patient given new diagnosis of epilepsy.
How long does she lose her driving license for?
Until 1 year seizure free
Patient has first seizure.
How long do they lose their license for?
6 months seizure free
Patient who works in HGV has a seizure
How long until she can drive her HGV?
5 years
Patient who works in HGV is given new diagnosis of epilepsy
How long under she can drive her HGV?
10 years seizure free off medication
Patient with known epilepsy is acting strangely on the ward.
What should this raise suspicion of?
Non-convulsive status epilepticus
What is status epilepticus?
Why is it an emergency?
Seizure without spontaneous recovery
Brain can’t sustain high metabolic demands of a seizure
What is the management of status epilepticus?
Benzodiazepines IV/IM (maximum of 2 doses)
What increases the chances of sudden death in epilepsy?
Sudden Unexpected Death in Epilepsy (SUDEP) risk increased with
- nocturnal seizure
- drug use
- poor medication compliance
Mechanism of action of carbamazepine
Na channel blocker which decreases neuronal activity
Mechanism of action of lamotrigine
Na channel blocker which decreases neuronal activity
Mechanism of action of topiramate
Na channel blocker which decreases neuronal activity
Mechanism of action of sodium valproate
Increases GABA synthesis
Mechanism of action of levetiracetam
Inhibits SV2A which inhibits neurotransmitter release
Which anticonvulsant is useful for focal seizures but can worsen generalised seizures?
Carbamazepine
What anticonvulsant should be avoided in young women?
Sodium valproate (teratogenic)
What is first line management of generalised epilepsy in a pregnant women?
Lamotrigine, levetiracetam
Which anticonvulsant can cause mood swings?
Levetiracetam
Which anticonvulsant should be avoided in obesity?
Sodium valproate
Causes weight gain
Which anticonvulsant can cause weight loss?
Topiramate
17 year old girl started on carbamazepine.
What should you ask about before sending her away?
Contraception
Carbamazepine is hepatic enzyme induced and reduces effectiveness of COCP
Women with epilepsy wants to get pregnant.
What do you give her?
5mg folic acid daily
