Epilepsy and seizures Flashcards
EEG features of absence seizures
3Hz spike-and-wave
Lasting around 10 secs
Absent seizures can be triggered by…
Hyperventilation
Adverse effects of carbamazepine
SIADH
Teratogenic (NTD)
Diplopia
P450 inducer
Serious/ rare
- Steven Johnson syndrome
- DRESS syndrome
- Agranulocytosis
- Folate deficiency
- Hepatitis
Adverse effects of phenytoin
Hirsutisim
Gingival hyperplasia
Agranulocytosis
P450 inducer
Osteoporosis
Rash
Serious/ rare
- Steven Johnson syndrome
- DRESS syndrome
Adverse effects of Valproate
Teratogenic (NTD)
Thrombocytopenia
Weight gain
Alopecia
Serious/ rare
- Pancreatitis
- Hepatitis
What anti-epleptic is most likely to cause psyhcosis
Levetiracetam
What anti-epileptic is associated with hirsuitism, osteoporosis and a rash
Phenytoin
What anti-epileptic is associated with hepatotoxicity, SIADH and agranulocytosis
Carbamazepine
What anti-epileptic is associated with thrombocytopenia, pancreatitis and alopecia
Valproate
What type of epilepsy is characterised by B/L polyspike and slow wave on EEG?
Myoclonic epilepsy
First line treatment for narrow focal seizures
1st- lamotrigine
Carbamazepine
Phenobarbital (kids)
Phenytoin
Keppra
Oxcarbazepine
2nd line-
Gabapentin
Pregabalin
Valproate
Topiramte
Acute complications of seizures
- Hyperthermia causing CNS damage
- Cardioresp deficity
Acute management of seizures
1st line- IV/ IM benzo
- Lorazepam
- Diazepam
- IM midazolam
Intranasal/ buccal midazolam
Rectal Diazepam
2nd line/ status epilepticus
- Fosphenytoin
- Valproate
- Keppra
3rd line
- Phenobarbital
Long-term complications of seizures
Psychiatric- depression, anxiety, psychosis
Sleep disorders
Sudden unexpected death in epilepsy
Causes of provoked/ acute symptomatic seizure
Intracranial lesion
- SDH
- CNS infection
- Stroke
Intracranial surgery
Anoxic encephalopathy
TBI
Metabolic disturbance
Drug/ alcohol withdrawal
MS/ autoimmune
Catamenial epilepsy
Type of reflex epilepsy triggered by phases of the menstrual cycle
Genetic causes of epilepsy
Ion channel/ receptor mutation
- KCNQ2
- SCN1A
Chromosomla
- Angelmann
- Prader-Willi
- Rett
Metabolic disorders
- Polyketonuria
- Lysosomal storage disease
- Peroxisomal disorder
- MELAS
Ictal features of focal seizures
Neuropsychiatric aura
- Deja vu
- anxiety/ fear
Automatism (impaired awareness)
Motor
- Contralateral clonus/ myoclonus
- Jacksonian march
- Large amplitude movements: jumping, pelvic thrusting
Sensory
- Paraesethesia
- Hallucinations
- Vertigo
- Tinnitus
- Gustatory/ olfactory
Hyperarrhythmia on EEG is associated with what epilepsy syndrome?
West syndrome
Burst suppression on EEG is associated with ______ and ______
Anoxic encephalopathy
Barbituates use
Lab investigations for acute seizures
Routine bloods
Electrolytes- calcium, magnesium
Blood gas
Toxicology
Blood culture
Pregnancy test
Antiepileptic drug level
Management of refractory status epilepticus (40-60 mins)
Induced coma
- Propofol
- Thiopental
- Pentobarbital
- IV midazolam
Intubation/ ICU
Management of eclampsia
1st line- magnesium sulphate
Antihypertensives
Features associated with increased risk of seizure recurrence
CNS lesion
Abdominal EEG
Nocturnal seizure
Treatment of typical absence seizures
1st line
- ethosuximide
Valproate
2nd line
- lamotrigine
- Clonazepam
Treatment of atypical absence seizures
1st line
- Valproate
- Lamotrigine
- Topiramate
2nd line
- Clonazepam
- Felbamate
Long-term tx of tonic clonic seziures
1st line
- lamotrigine
- valproate
- phenobarbital (kids)
2nd line
- Carbamazepine
- Zonisamide
Surgical management of temporal lobe epilepsy
Resection of anteriomedial temporal lobe/ amygdala + hippocampus
Surgical management of epilepsy
Resection of lesion
Hemispherectomy
Callostomy/ Hemispherotomy
Non-surgical treatments of epilepsy
Surgical resection/ deconnection
Vagus nerve/ deep brain stimulation
What type of medications should be avoided in hepatic enzyme inducing AEDs
Progestin implants
COCP
Progestin-only pills
AEDs with low teratogenic risk
Lamotrigine
Levetiracetam
