Epilepsy Flashcards
Pathology?
abnormal neuronal activity leads to seizures
Aetiology of seizures?
- idiopathic
- genetic defects
- metabolic abnormalities
- alcohol withdrawal
- hypoglycaemia
- brain tumour
- CVA
- hypoxic injury
- head trauma
Ix?
- EEG
- MRI
- ECG
- Bloods
- FBC
- U&E
- Glucose
Types of epilepsy
- Generalised
- tonic-clonic
- atonic
- myoclonic
- absence
- Focal
describe tonic clonic seizures and the treatment
- unconsciousness followed by
- muscle tensing followed by
- muslcle jerking
during the seizure there may be incontinence, tongue biting, irregular breathing & groaning
post-ictal phase after where pts are confused, drowsy, irritable and depressed
Rx:
- sodium valproate
- lamotrigine / carbamazepine
describe focal seizures & the treatment
starts in temporal lobe. Affects speech, hearing, memory and emotions
May present with:
- hallucinations
- deja vu
- memory flashbacks
- abnormal behaviour on autopilot
Rx:
- Lamotrigine /Carbamazepine
- sodium valproate
describe absence seizures and the treatment
- typically occurs in childhood
- >90% of pts say that as they grow older the seizures stop
- lasts 10-20 seconds
- pt goes blank, stares into space and abruptly snaps back to normality. During seizure will not respond and be unaware of surroundings
Rx:
Sodium valproate / ethosuximide
describe atonic seizures and the treatment
- sudden loss of postural muscle tone
- typically begin in childhood
- don’t last more than 3 minutes
- linked to Lennox-Gastaut syndrome
Rx:
- Sodium Valproate
- Lamotrigine
describe myoclonic seizures and the treatment
- sudden brief muscle contractions
- pt usually remains awake
- can be seen as part of juvenile myoclonic epilepsy
Rx:
- Sodium Valproate
- Lamotrigine / Topiramate
Action of Sodium Valproate and side effects? (mnemonic)
Action: increases levels of GABA, hence relaxing effect on brain
S/E:
- Valproate
- Alopecia
- Liver toxicity
- Pancratitis / Panyctopenia
- Retain fat (weight gain)
- Oedema
- Appetite increase
- Tremor
- Enzyme inhibitor
- must avoid giving to girls / women unless absolutely necessary, and if so must make sure they are on adequate contraception
side effects of Carbamazepine?
- inducer of P450 system
- agranulocytosis
- aplastic anaemia
phenytoin side effects?
- vitamin D/ Folate deficiency
- megaloblastic anaemia
- osteomalacia
- peripheral neuropathy
- lymphadenopathy
Ethosuximide side effects?
- rash
- night terrors
Lamotrigine side effects?
- stevens johnsons syndrome
- leukopenia
Complication of epilepsy?
Status epilepticus
- medical emergency
- when seizure lasts > 5 mins or > 3 seizures in 1 hour
