Epilepsy and Seizures Flashcards
Focal seizure (frontal lobe) - symptoms
Motor signs - stiffness, twitching, spasms
Focal seizure (parietal lobe) - symptoms
Sensory manifestations - tingling, numbness, pain
Focal seizure (occipital lobe) - symptoms
Visual phenomena - flashing lights, colours, hallucinations
Focal seizure (temporal lobe) - symptoms
Changes in mood/behaviour
Rising epigastric sensation is also a common feature
What is the difference between ‘seizure’ and ‘epilepsy’?
Seizure - short episode of symptoms caused by discharging electrical activity in the brain
Epilepsy - ongoing liability for recurrent seizures
What is the difference between focal and generalised seizures regarding awareness?
In generalised seizures, awareness is always impaired
What is a complex focal seizure?
Focal seizure in which the patient is not aware of their surroundings or what they are doing
Typically arise from the temporal lobe
3 distinct components - aura, absence (loss of consciousness) and automatism (repetitive, stereotyped movements - lip smacking, chewing, fiddling etc.)
Name some types of generalised seizure
Absence seizure
Myoclonic seizure
Clonic seizure
Tonic seizure
Tonic-clonic seizure
What’s the seizure type?
- abrupt, sudden loss of consciousness lasting <10 seconds
- tone is usually preserved and falls are absent
- normal activity is resumed as if nothing had happened, and there is no pos-ictal confusion
- EEG shows characteristic 3 Hz spike-wave
Absence seizure
What’s the seizure type?
- brief contraction of muscles, shock-like jerks, usually occurring in the first hour or so of waking
- jerks mainly affect the shoulders and arms
- develops between 12 and 18 years
Juvenile myoclonic epilepsy
What’s the seizure type?
- Muscles spasm and jerk
- Elbows, head and legs will rapidly flex and relax
- Most frequently seen in neonates and young children
Clonic seizure
What’s the seizure type?
- two phases: one in which the skeletal muscles become stiff and the individual loses consciousness, and the other in which muscles start to contract and relax rapidly
Tonic-clonic seizure
Tonic phase - loss of consciousness and stiffness
Clonic phase - rapid contraction and relaxation
When is polytherapy considered for the management of epilepsy?
Intiially, monotherapy should be opted for
Polytherapy is generally only considered if an individual’s seizures cannot be controlled by 3 first choice drugs
Tonic-clonic seizures (type of generalised seizure) - first and second line treatments
First line
- Sodium valproate (or Lamotrigine if unsuitable)
Second line
- Levetiracetam
- Topiramate
- Clobazam
Absence seizures (type of generalised seizure) - first line treatments
First line
- Ethosuximide
- Sodium Valproate
Myoclonic seizures (type of generalised seizure) - first and second line treatments
First line
- Sodium Valproate
Second line
- Levetiracetam
Focal seizures - first line treatments
Lamotrigine
Carbamazepine
Carbamazepine - how does it work, what are some of the adverse effects, and when might it be used?
How does it work - (anticonvulsant) Na+ channel inactivation
Adverse effects - diplopia, ataxia, blood dyscrasias, teratogenic, hyponatraemia
When used - first line in managing focal seizures. Also useful in managing neuropathic pain due to trigeminal neuralgia
Phenytoin - how does it work, what are some of the adverse effects, and when might it be used
How does it work - (anti-epileptic) Na+ channel inactivation
Adverse effects - narrow therapeutic index. nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anaemia, teratogenic (causes cleft palate and cardiac defects)
When to use - seizure prophylaxis (both tonic-clonic and focal seizures, but doesn’t work for absence seizures. Also used IV to treat status epilepticus that cannot be managed with BZDs
Lamotrigine - how does it work, what are some of the adverse effects, and when might it be used
How does it work - (anticonvulsant) blocks voltage-gated Na+ channels
Adverse effects - may cause rash and Steven Johnson Syndrome
Uses - safe in pregnancy, used to treat focal and tonic-clonic seizures, as well as BPD
Ethosuximide - how does it work, what are some of the adverse effects, and when might it be used
How does it work - block thalamic T-type Ca2+ channels
Adverse effects - GI upset, fatigue, headache, urticaria, Steven Johnson syndrome
Used - treats absence seizures
Sodium Valproate - how does it work, what are some of the adverse effects, and when might it be used
How does it work - Na+ channel inactivation and increase in GABA concentration
Adverse effects - GI upset, liver failure, neural tube defects e.g. spina bifida so avoid in pregnancy/women of childbearing age, tremor, weight gain
Uses - first line in tonic-clonic and myoclonic seizures, second line in absence seizures. Can also be used to treat BPD and migraines
What is Status Epilepticus?
How is it managed?
Life-threatening convulsive seizures which continues for at least 5 minutes (either one continuous seizure or repeated seizures in which the individual does not regain consciousness)
Buccal or rectal midazolam (BZD) if in the community
IV lorazepam if in hospital and IV access is already established
If seizures continue, administer IV phenytoin or phenobarbitol
What are the DVLA rulings regarding epilepsy and driving?
Group 1 vehicles
- if a seizure occurs while awake = stop driving for 1 year
- if a seizure occurs while asleep = can drive, but only if no awake attack for 3 years
- if a seizure occurs when awake but doesn’t affect consciousness = may still qualify for a license if this is the only type of attack the patient has and the first one was at least 12 months ago
Group 2 vehicles
- one-off seizure = stop driving for 5 years
- more than one seizure/epilepsy diagnosis = must be seizure and medication free for 10 years
