Epilepsy Flashcards
define epilepsy
tendency for recurrent, usually spontaneous epileptic seizures. There is an abnormal electrical discharge from the brain that can be excitatory or inhibitory
classification of epilepsy
- generalised
2. focal
associations with generalised epilepsy
childhood/teens
EEG
sodium valporate
example of a generalised epilepsy
juvenile myoclonic epilepsy
risk factors in juvenile myoclonic epilepsy
low sleep
flashing lights
what causes focal epilepsy?
underlying structural cause e.g. stroke in adults
management of focal epilepsy?
carbamazepine
presentation of epilepsy
tonic-clonic seizure= all muscles contract causing rigidity before refractory relaxation period
aura
what brain lobe is activated in tonic-clonic seizures?
frontal
diagnosis of epilepsy
history= onset (environment, photosensitivity versus hyperventilation), syncopal symptoms, movements, recovery
drugs (avoid tramadol in epileptics)
ECG
EEG
speed of recovery of epilepsy
syncope is fast
seizure is slow
why do those with a seizure get an ECG?
prolonged QT can present with collapse and jerks caused by hypotension
what can EEG distinguish in seizure?
epileptic versus non-epileptic attacks
localisation
management of epilepsy
safety e.g. driving, swimming, bathing, climbing ladders
pharmacology
old anticonvulsants
phenytoin
sodium valporate
carbamazepine
use of phenytoin
acute only as high dose can be given very quickly
side effects of sodium valporate
teratogenic
weight gain
hair loss
fatigue
when should carbamazepine be used?
focal only as makes generalised worse
new anticonvulsants
lamotrigine
levetiracetam
topiramate
gabapentin and pregabalin
adverse of lamotrigine
long time to titrate
SJS risk
adverse of levetiracetam
mood swings
adverse of topiramate
weight loss
sedation
dysphasia
when is pregabalin and gabapentin used?
neuropathic pain
which anticonvulsants induce hepatic enzymes and can alter efficacy of the OCP?
carbamazepine
phenytoin
what is status epilepticus?
acute emergency of a recurrent epileptic seizure lasting >30 minutes without full recovery of consciousness
types of seizure in status epilepticus
generalised
non-convulsive state (conscious but altered state)
epilepsia partialis continua
what are the risks in status epilepticus?
excess cerebral damage to contract muscles leading to respiratory insufficiency, hypotension, hyperthermia and rhabdomyolysis
management of status epilepticus
stabilise, ABCDE
anticonvulsants= first line is BZDs, second line is phenytoin
what is non-epileptic attack disorder?
functional attack that tends to have prolonged duration of 10-20 minutes
often associated with previous trauma, need CBT
