Epilepsy and Safety Flashcards
Define SUDEP
Deaths in people with epilepsy with or without evidence of seizures, that are not caused by injury or drowning or other known causes [excluding status epilepticus or postmortem evidence of toxicological or anatomical cause of the death].
When does SUDEP most commonly occur?
SUDEP most often occurs Postictally in aftermath of generalized tonic clonic seizure, rarely partial seizure, but can occur without preceding seizure
What physiological phenomena characterize SUDEP?
Progressive cardiorespiratory compromise with diffuse EEG suppression
List some features that make patients high risk for SUDEP? (8)
- Uncontrolled/ frequent
- Generalized/ convulsive
- **YOUNG age of onset
- **Developmental disability
- 31-40 yoa
- ETOH
- Channelopathies
- Failed surgery, poor supervision, nocturnal seizures
What are some actions one can take to avoid SUDEP? (3)
- Compliance w meds and seizure control
- Sleep well and avoid PRONE POSITION
- Postictal O2 + astute observation
How long should patients be advised not to drive?
3x longest seizure free period
How do we treat depression in epileptic patients?
- SSRI + CBT
- Change SSRI, TCA, venlafaxine, mirtazapine
- Combo SSRI/TCA, TCA + venlafaxine/mirtazapine (combo or choose one)
- PolyRx
- ECT
Special concerns for AEDs in patients with HIV/AIDS: (3)
- Phenytoin = ^ protease inhibitor dose 50%
- Valproic acid: Decrease zidovudine; no change w efaverenz
- Lamotrigine is safe
4 drugs that lower seizure threshold?
- Bupropion
- Tramadol
- Psudoephedrine
- Levaquine
How does incidence of postpartum depression change in women with seizures?
What is one additional concern in postpartum women with seizures?
Increased
Sleep deprivation ^ seizure occurrence
What is the recommended approach to contraception in women with epilepsy?
Two methods–IUD is preferred method
What causes catamenial pattern epilepsy?
Change in E:P ratio throughout menstrual cycle
Define Catamenial pattern epilepsy:
- Perimenstrual
- Periovulatory
- Luteal
Two fold increase in seizure occurrence on one of 3 vulnerable periods:
C1= Perimenstrual pattern: Seizures [Sz] predominant between -3 to +3 of Menstrual cycle {MC}
C2 = Periovulatory pattern: Sz between +10 to – 13
C3 = Luteal phase: Sz during day +10 to day +3 of next cycle especially seen in anovulatory cycles
Common feature of all these patterns is decrease in Sz during follicular phase Day 4 to 9
What causes NTDs in patients with epilepsy?
AED exposure within first 28 days
How do we prevent NTDs and which drug is worst?
0.4-4mg folic acid prior to conception
Valproic Acid is the worst
