Epilepsy Flashcards
what is the most important tool to investigating a possible case of epilepsy
the history
what are the 2 classification of epilepsy seizures
generalised seizures
partial/focal seizures
what drugs may precipitate epileptic seizures
- aminophylline
- theophylline
- antibiotics e.g. penicillins, cephalosporins, quinolones
- anti-emetics e.g. prochlorperazine
- opioids e.g. diamorphine
when is an EEG useful
Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical evaluation
Confirmation of non-convulsive status
what is the proposed cause of epileptic seizures
abnormal excessive or synchronous neuronal activity
imbalance between excitation and inhibition
what does symptoms in a focal seizure depend on
on which cortical area is affected
i.e. if temporal lobe affected then awareness of the environment becomes impaired
what is partial seizures further spilt into
simple - without impaired consciousness
complex - with impaired consciousness
what are the types of generalised seizures
Absence Myoclonic Atonic Tonic Tonic clonic (primary generalised)
what type of epilepsy has the most genetic predisposition
generalised epilepsy
what is seen on an EEG in generalised epilepsy
generalised spike-wave abnormalities
what is the first line treatment for generalised epilepsy
Sodium valproate
how does treatment for generalised epilepsy differ
the first line is the same i.e. Sodium valproate
the second line options depend on the type of seizure i.e. tonic-clonic, absence, myoclonic
what is the second line treatment for tonic-clonic seizures
Lamotrigine or Carbamazepine
what is second line for absent seizures
Lamotrigine or Ethosuximide
what is second line for myoclonic seizures
Lamotrigine or Clonazepam
what is the first line treatment for PARTIAL seizures
Carbamazepine
what is 2nd line for PARTIAL seizures
Lamotrigine or Sodium valproate
what is 3rd line for PARTIAL seizures
gabapentin
if a > 30y/o presents with epilepsy what is the most likely type
focal/partial seizure
what is frequently seen in complex partial seizures
hippocampal sclerosis
what are features of a tonic-clonic seizure
- LOC
- falling heavily if standing
- breathing stop
- central cyanosis
- limbs stiffen (tonic) the jerk (clonic)
- afterwards, coma like state for some minutes
- patient may be disorientated, confused upon awakening
what can occur during tonic-clonic seizures
tongue bitting
urinary incontinence
myalgia
headache
severely bitten tongue + LOC»_space; think tonic-clonic
what are features of an absence seizures
brief pause e.g. stop talking mid sentence then continue
present in childhood
provoked by stress or hyperventilating
what are features of a myoclonic seizure
sudden jerk of a limb, face or trunk but predominating in the arm
in epilepsy, more marked in the morning, or on awakening
trigger by fatigue, alcohol and sleep deprivation
what are atonic seizures
sudden, brief loss of muscle tone
causes a heavy fall but no LOC
what are tonic seizures
generalised increase in tone and an associated loss of awareness
what are features of a simple partial seizure
- no disturbance of consciousness or awareness
- focal motor, sensory, autonomic or psychic symptoms
- no post-ictal symptoms
what are features of a complex partial seizure
- awareness is impaired and consciousness disturbed
- post-ictal confusion common with seizures from temporal lobe
what area of the brain is most commonly affected in complex focal seizures
temporal
get faster recovery with frontal lobe seizures
what are Sx related to a focal seizures (temporal lobe)
lip smacking, chewing, fumbling, fiddling, singing, kissing, abdo pain, deja vu, sudden terror/anger, aura
what are Sx related to a focal seizures (frontal lobe)
peddling movement with legs, jacksonian march, speech arrest
what are Sx related to a focal seizures (parietal lobe)
tinging, numbness, pain
what are Sx related to a focal seizures (occipital lobe)
spots, lines, flashes in vision
EEG features of Childhood absence epilepsy
3/sec spike and wave
EEG features of Juvenile absence epilepsy
poly-spike and wave
EEG features of Juvenile myoclonic epilepsy
poly-spike and wave
photosensitivity
EEG features of GTCS on awakening
spike and wave on waking and sleep onset
what needs to be considered in ladies taking anti-convulsants
some induce hepatic enzymes and can alter efficacy of COCP
morning after pill also not adequate - dose needs to be increased
what contraception should not be used in epileptic female patients
progesterone only pill
what anti-convulsants induce hepatic enzymes
Carbamazepine
Phenytoin
why is sodium valproate not given to young women
teratogenic
- give lamotrigine instead
what is status epilepticus
medical emergency
- seizure lasting >5 mins or 3 seizures in one hour
drug given for status epilepticus in hospital
IV lorazepam 4mg
- repeat after 10 mins if seizure still continues
If seizure persists – IV phenytoin / phenobarbital
drug given for status epilepticus in the community
buccal midazolam
rectal diazepam
side effects of sodium valproate
teratogenic
hepatitis
hair loss
tremor
side effects of carbamazepine
agranulocytosis
aplastic anaemia
drug-drug interactions as it induces P450
Steven Johnston syndrome
side effects of lamotrigine
Steven johnston syndrome
leukopenia
side effects of phenytoin
folate + vit D deficiency
- megaloblastic anaemia
- osteomalacia
what is required when starting a phenytoin infusion
cardiac monitoring due to pro arrythmogenic affects
