Epilepsy

Question 1

What is epilepsy?

Answer 1

Chronic disorder of recurrent seizures which affects 1% population.
It is a neuronal hyper-excitability disorder arising from excess excitability or disinhibition.
There can be impairment of motor activity, consciousness and perception

Question 2

What are the 4 principal seizure types?

Answer 2

Generalised - whole brain. Can be tonic clonic (jerks/motor/convulsions and consciousness affected, rigidity, micturition, defacation, respiration stops, they wake up confused for ~2-4 mins, or absence (lack of attention). Myoclonic is a brief jerk of muscles.

Partial - one specific area of the brain (focal). Can be tonic clonic too.

Secondary generalisation - partial seizures spread to affect whole brain

Simple/complex- whether consciousness impaired, complex it is impaired

Question 3

What is the principle treatment of epilepsy?

Answer 3

Sodium channel blockers

Question 4

What are the 2 mechanisms of action of sodium valproate?

Answer 4

1. block voltage gated sodium channels to reduce AP driven excitability
2. Inhibit GABA degradative enzymes to increase levels of inhibitory NT GABA

Question 5

Why does SV need additional monitoring?

Answer 5

Narrow TI

Question 6

Name 4 co-morbidities common with epilepsy

Answer 6

Depression
anxiety
agitation
anger 
suicide
ADHD
reproductive problems
insomnia
migraines 
potential cognitive decline

Question 7

What differentiates a seizure from epilepsy

Answer 7

Epilepsy is characterised by chronic recurrence of seizures. Isolated seizures can occur alone and not be epilepsy, but having a seizure increases risk of epilepsy

Question 8

When do you start treatment of epilepsy?

Answer 8

Decision to treat is complex as there are legal ramifications and current drugs have significant side effects. Could do an EEG to measure electrical activity of the brain to see severity/hypersynchronus/abnormal activity in the brain

Question 9

Name treatment for absence seizures?

Answer 9

Lamotrigine
Sodium vaproate
Ethosuxamide (only for absence really)

Question 10

Generalised tonic clonic

Answer 10

Sodium vaproate
carbemazepine
lamotrigine

Question 11

Myoclonic

Answer 11

levetiracetam
valproate
topirmate

Question 12

Focal /partial seizure

Answer 12

carbemazepine
lamotrigine
levetiracetam
valproate

Question 13

What is the therapeutic range of sodium valproate?

Answer 13

50-100 mg/L

Question 14

Is it important to maintain brands of phenytoin / sodium valproate

Answer 14

Yes - different bioavailabilities and release profiles. Could affect seizure control, and the fact they are narrow TI so could cause either toxic s/e or seizures