Epilepsy And Pseudo Seizures 2 Flashcards
Epilepsy is
Disease of brain defined by any of the following
- At least 2 unprovoked seizures occurring >24 hours apart
- One unprovoked seizure and probability of further seizures , occurring in the next 10 years
- diagnosis of epilepsy syndrome
Epilepsy is considered to be resolved when
Individuals who had an age dependant epilepsy syndrome but now are past the applicable age
Or those who have remained seizure free for last 10 years, with no medication for the last 5 years
Provoked seizure is
Acutecsymptomatic
= within 7 days of brain insult
Acute brain insult= stroke, haemorrhage, TBI, Encephalitis
Treat seizures when
1) seizures are provoked by metabolic disturbances or drugs -> correct or withdraw provocative factor
2) short term benzodiazepine - reduce risk of seizures in alcohol and DT
3) following an acute brain insult or neurosurgery
4) following an acute brain insult, AESs used to treat the provoked seizure should be withdraw After 7 days
5) AED treatment is not indicated for concussive convulsions
AED is
Anti epileptic drug
Risk of reoccurrence in low risk group
6 months= 26%
2 years= 39%
5 years= 51%
8 years= 52%
Are AEDs given after a seizure
Immediate AED reduces the occurrence of seizures in next 1-2 years
Does not affect long term remission in individuals with single or infrequent seizures
EEG is abnormal in what %
In 50% in epileptics
Best drug for generalised seizures
Valproate
Which is the best drug?
50% seizure free after any first treatment
No significant differences in 6-12 months measure of seizure freedom
Drug metabolism responsiveness and toxicity depends on
Genetic predisposition and ethnicity
Risk of hypersensitivity reactions
More frequent with aromatic AEDs
Cross reactivity
Severe skin reactions
AED hypersensitivity syndrome
- > multiorgan symdrome (liver)
- > followed by skin rash
Stop drug
DVLA?
If you have a seizure stop driving for a year
If scans + EEG go well then 6 months
Get a 3 year licences then reassess
Epileptic drugs and pregnancy
AED reduce effectiveness of oral contraceptives
Preg an Andy /pregnancy supplements
Folic acid
Anticonvulsants - risks
Don’t stop drugs suddenly
Major fetal malformation is
Life threatening or require surgery
Risk of MFM on pregnant women taking AEDs
Doubled to 4.5%
But still low chance so must take drugs as the seizures could kill mother
Valproate risk
Is dose related 6-9%
6-10 points lower verbal IQ
Sodium valproate must no longer be prescribed to
Women of child bearing age
Cognitive teratogeneisis is
Minor fetal malformations
(Valproate)
Preventable to some extent on folate supplements
Effect of maternal seizures
Foetus- small for gestational age, decreased verbal IQ
Fetal heart rate decelerations
Vitamin k whilst pregnant
Enzyme inducing AEDs effect vitamin K
Give oral vitamin K in last 4 weeks of preg
Give Vit K to new born
Which AEDs are safe in breastfeeding
Phenytoin, Carlazepine and valproate
Types of epileptic surgery
Respective - remove area generating seizures
E.g lesionectomy, lobectomy, hemispherectomy
Functional neurosurgery - change brain function to improve epilepsy
GCSE
NCSE is
Generalized convulsive status epilepticus
Non convulsive status epilepticus
Status epilepticus is
Failure of mechanisms responsible for seizure termination
Initiation of mechanisms which lead to abnormallly prolonged seizures
Can have long term consequences like neuronal death and neuronal injury and alteration of neuronal networks
Status epilepticus
Resistant to bento,s
Phenobarbitone
Propofol
One scale with epilepsy
Treatment more likely to work earlier on
Seizure activity may cause neuronal loss and atrophy
Accumulation of toxic metabolites may cause further damage
Stages of status epilepticus
Early SE
Established status
Refractory status
Step 1 early convulsive SE
First choice - IV lorazepam: 2-4 mg if needdd repeat
If IV not possible then Buccal midazolam 10 mg
If not then IM midazolam 10mg
If not rectal diazepam 10 mg
If seizures stop
Recurrence rate is high ; the majority of patients need IV stage 2 anti epileptic drugs
Epileptic seizure then take what action
ABCDE
Step 2 established SE
Phenytoin 18mg/kg
Or
Levetiracetam 30mg/kg
Or sodium valproate 30/kg
Hazards of IV phenytoin
Precipitation of crystals
Hypotension and arrhythmia
Step 3 refractory convulsive SE
Anaesthesia and ventilation
