Epilepsy

Question 1

What are the two main subtypes of epilepsy? and then their subclassifications?

Answer 1

Defined as 2 or more seizures as child or adult

2 types- Partial and generalised

focused/partial–in one area
can be with impaired awareness or not (eg or complex partial )
can develop to generalised seizures (Jacksonian march)

Generalised–
tonic-clonic
Absence
Myoclonic
atonic
other

Question 2

Sx of Tonic clinc, absence, myoclonic, atonic seizures

Answer 2

Tonic-clonic-classic jerking
can feel it coming- visual, sensory, mental aura
Lose awareness, tongue bite, lip smack, drool and wetself- ANS dyf
afterwards feel drowsy for a while-15mins ish

> 30mins- status epilepticus

Absence- classically 3-10y/o-grow out of it-
short, seconds long episodes, recover fast
not aware
(SIMiLAR TO COMPLEX PARTIAL-but there last longer, classic lipsmack, rub hands)

Myoclonic -very brief sudden jerks- often syndromes-
Juvenile Myoclonic Epilepsty or Lennox Gastaut syndrome (disable kids)

Atonic-whole body becomes limp

Question 3

Seizures drug management

Answer 3

usually start after 2nd attack

For generalised- Sodium Valporate first line,but not used if pregnant/or age of being able too– Inhibits p450

Carbamezipine- First line for Focal seizures-induced p450

Lamotrigine- 2nd line for both-can cause NecFac

+cant drive 6m after seizure (1st). Established epilepsy-12m fit Free
+Care with p450- SodiumVAl inhbits, Carbam Induces
+ care with Pregnancy

Question 4

Status epilepticus Management

Answer 4

At home for parents- oral diazepam

ambulance- oral midazolam, rectal diazepam

Hospital- IV acess, IO acess- 5mg Lorazepam, –can give another 5mg

then consider Phenytoin/ITU/Barbituates