Epilepsy Flashcards
Definition
Tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures
Before seizure
may me a preceding promo done
After
Post ictally- Headache, confusion, myalgia, temporary weakness
Diagnosis
History v important EEG ECG MRI CT
Things that suggest psuedoseizure
gradual onset, prolonged duration and abrupt termination. Are associated with closed eyes and resistance to eye opening, rapid breathing, fluctuating motor activity and episodes of motionless unresponsiveness
Causes
structural abnormality, genetic
types of seizure
Focal seizures- involving part of the brain
generalised seizures - involving entire brain
Types of focal seizure
Focal simple- without impairment of conciousness
Complex- with impairment of conciseness
Secondary generalised- evolving to a bilateral convulsive seizure
Types of generalised seizure
Tonic clonic- grand mal- limbs stiffen then jerk. Post octal confusion and drowsiness
Absence- brief <10s, pauses
Myoclonic- sudden jerk of a limb, face or trunk
Atonic- sudden loss of muscle tone
Frontal lobe seizures
motor- head/leg movements, posturing, post octal weakness
Parietal lobe seizures
Sensory- paresthesia
Occipital lobe seizures
visual disturbances
Temporal lobe seizures
HEAD- Hallucinations (auditory, gustatory etc), Epigastric rising/emotional, Automatisms (lip smacking/grabbing), Deja vu/dysphasia post ictal
Differential diagnosis
syncope, non epileptic attack disorder, panic attacks, TIA, etc
Epilepsy driving rules
1st seizure- can’t drive car for 6 months, HGV 5yrs
Epilepsy- 1yr/3yrs if during sleep, 10 yrs off medication for HGV
Treatment- focal seizures
1st line- carbamazepine, lamotrigine
2nd line- levetiracetam, oxcarbazepine or sodium valproate
Treatment- generalised tonic clonic seizures
1st line- sodium valproate or lamotrigine
2nd line- carbamazepine, clobazam, levetiracetam or topiramate
Absence seizures
1st line- sodium valproate or ethosuximide
2nd line- lamotrigine
Myoclonic seizures
1st line- sodium valproate
2nd line- levetiracetam, or topiramate
Which drugs should be avoided in myoclonic seizures and why
carbamazepine and oxcarbazepine- may worsen seizures
treatment- atonic
sodium, valproate or lamotrigine
Drugs that interfere with COC
carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primdone, toperamate- they induce hepatic enzymes
Shouldn’t take POP, progesterone implants not effective
Morning after pill not adequate
Side effects carbamazepine
leucopenia, diplopia, blurred vision, impaired balance, drowsiness, mild erythematous rash, SIADH rare
side effects lamotrigine
maculopapular rash, can develop Stevens Johnson syndrome, diplopia, photosensitivity, tremor, agitation, vomiting, aplastic anaemia
levetiracetam side effects
psychiatric side effects common
sodium valproate side effects
teratogenic, nausea v common. Liver failure, pancreatitis, hair loss, oedema, ataxia, tremor,
What drug should epileptics of child bearing age take
folic acid 5mg
Status epilepticus
continued seizure activity for >30mins
Management of status epilepticus
lorazepam 4mg IV or diazepam 20mg IV or rectal, midazolam 5-10mg IM
Precipitants of status epilepticus
severe metabolic disorders, hyponatraemia, infection, head trauma, sub arachnoid haemorrhage
