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year three exam 2 > epilepsy clinical > Flashcards

epilepsy clinical Flashcards

1
Q

what is epilepsy

A

a neurological condition - defined by
- At least 2 unprovoked or reflex seizures occurring more than 24 hours apart
- One unprovoked or reflex seizure and probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures over the next 10 years (at least 60%)
- Diagnosis of epilepsy syndrome

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2
Q

what is a seizure

A

transient occurrence of signs or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain

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3
Q

epilepsy incidence

A

70 mill worldwide
5-10 per 1000 in UK

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4
Q

what is the mortality risk with epilepsy

A

increased risk - tonic clonic, night time seizures, no treatment

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5
Q

aetiology of epilepsy

A

structural abnormalities
genetic mutations
infections
metabolic disorder
immune disorder

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6
Q

what are the risk factors for epilepsy

A

premature birth
complicated febrile seizures
brain development malformation
family history
head trauma
infections
tumours
cerebrovascular disease
dementia
drug/alcohol withdrawal

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7
Q

what are focal seizures

A

increased neuronal activity originating from and staying on one hemisphere of the brain
- simple - no loss of consciousness
- complex - impaired awareness

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8
Q

what are the signs and symptoms of focal seizures

A

depends on the area of the brain affected
- motor symptoms or non-motor symptoms

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9
Q

what are the motor symptoms of focal seizures

A

clonic, atonic, automatisms, epileptic spasms, irregular big movements

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10
Q

what are the non-motor symptoms of focal seizures

A

changes in HR, behaviour arrest, cognitive symptoms, emotional symptoms, confusion

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11
Q

what are generalised seizures

A

increased neuronal activity that is widespread across both hemispheres of the brain
- can have motor or non-motor symptoms

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12
Q

what is status epilepticus

A

prolonged seizure lasting for 5 minutes or more OR recurrent seizures one after another without recovery in between

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13
Q

what can trigger status epilepticus

A

head injury
metabolic disturbances - hypo
cerebrovascular events
alcohol withdrawal

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14
Q

how is status epilepticus treated in community

A
  • note time
  • first aid to protect from injury (if/when stops - recovery position)
  • if >5 mins - buccal midazolam or rectal diazepam
  • if >5 mins since meds, history of status epilepticus or 1st emergency treatment call 999
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15
Q

how is status epilepticus treated in hospital

A

high potency thiamine/glucose if withdrawal/hypo
- IV loraz/diaz or buccal midaz (max 2 doses)
- if still happening after 40 mins - IV AEDs
- at 60mins - ICU for propofol, midazolam and thiopental sodium
- EEG monitoring

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16
Q

what are the general management strategies for treating epilepsy

A

individualised treatment
monotherapy is the aim

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17
Q

sodium valproate indications

A

in males and women not of childbearing age
- tonic clonic
- myoclonic
- tonic
- atonic
- absence - others c/i

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18
Q

sodium valproate side effects

A

nausea
weight gain
PCOS
transient LFT elevation
blood dyscrasias
alopecia
liver toxicity
pancreatitis

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19
Q

sodium valproate pharmacokinetics

A

CYP inhibitor
present in placenta

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20
Q

monitoring requirements for sodium valproate

A

LFTs 6m
blood dyscrasias
liver disorders
pancreatitis

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21
Q

carbamazepine indications

A

focal seizures

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22
Q

carbamazepine s/e

A

dry mouth
drowsiness
nausea
vision disorders
blood disorders
hyponatraemia
skin disorders

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23
Q

carbamazepine pharmacokinetics

A

CYP inducer

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24
Q

carbamazepine monitoring

A

pre-treatment screening in patients of Thai or Chinese origin for HLAB 1520 - stevens Johnson’s

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25
indications for ethosuximide
absence seizures or myoclonic-atonic seizures
26
ethosuximide side effects
- GI discomfort - Anxiety - Sleep disturbances - Ataxia - Drowsiness - Blood disorders - Rash - Stevens Johnson's syndrome
27
monitoring with ethosuximide
blood dyscrasias suicidal behaviours
28
indications for lamotrigine
monotherapy in - focal - generalised tonic clonic - absence - tonic - atonic - idiopathic
29
lamotrigine side effects
- Dizziness - Drowsiness - Headache - Dry mouth - Diplopia - Rash - when given with other AEDs - Hypersensitivity syndrome - Suicidal ideation - Blood disorders
30
lamotrigine pharmacokinetics
induces its own metabolism when given with other hepatic enzyme inducers or inhibitors, half life is altered
31
lamotrigine monitoring
skin reactions bone marrow failure
32
levetiracetam indications
all seizure types - excluding absent
33
phenobarbital indications
generalised tonic clonic focal myoclonic
34
phenobarbital side effects
- Stevens-Johnson's - Bone fracture disorders - Blood disorders - Folate deficiency - Drowsiness - Suicidal behaviours - Hepatic disorders
35
phenobarbital pharmacokinetics
cyp inducer
36
phenobarbital monitoring
increased hypersensitivity risk blood dyscrasias if IV - ECG and BP
37
clobazam indications
no monotherapy - myoclonic - atonic - tonic - generalised tonic clonic
38
clobazam side effects
- Similar to other benzodiazepines - Suicidal behaviours - Muscle weakness Skin reactions
39
lacosamide indications
generalised tonic clonic focal
40
lacosamide side effects
- dizziness - suicidal ideation - PR interval prolongation - Hypersensitivity syndrome
41
gabapentin indications
potential add on for all seizure types
42
gabapentin side effects
- Respiratory depression - MHRA warning - Suicidal ideation - Increased seizures - Drowsiness - Dizziness
43
pregabalin indications
add on in focal seizures
44
pregabalin side effects
- Hypersensitivity reactions - angioedema - Dizziness - Drowsiness - Weight gain - Blurred vision
45
rufinamide indications
add on or third line for atonic or atonic
46
rufinamide side effects
hypersensitivity syndrome - TERATOGENIC
47
Vigabatrine indications
focal seizures
48
vigabatrine side effects
- visual field defects - 6m testing - encephalopathic symptoms - suicidal ideation - head ache - GI disturbances - joint pain
49
tiagabine indications
focal seizures
50
tiagabine side effects
- Suicidal behaviours - Visual field disorders - Depression - Drowsiness - Tremor - Increased seizures
51
topiramate indications
add on - focal - tonic - atonic - tonic clonic - myoclonic
52
topiramate s/e
- Drowsiness - Dizziness - Confusion - Decreased sweating - Hyperthermia - Suicidal behaviours - Mood disturbances - Vision disorders - Weight changes
53
zonisamide indications
add on - tonic clonic - focal - myoclonic
54
zonisamide s/e
- decreased sweating - kidney stones - suicidal ideation - metabolic acidosis - weight loss - blood disorders
55
Perampanel indications
add on for tonic clonic, focal seizures
56
perampanel s/e
- suicidal behaviours - Severe cutaneous skin reactions - dizziness - drowsiness - aggression - weight gain
57
brivaracetam indications
add on for focal and myoclonic seizures
58
brivaracetam s/e
- suicidal ideation - decreased appetite - drowsiness - dizziness - fatigue
59
what is a category one AED and what are the examples
patient MUST be kept on one brand only - carbamazepine - phenobarbital - phenytoin
60
what is a category two AED and what are the examples
need to supply of singular brand should be based on clinical judgement and consultation - perampanel - zonisamide - topiramate - rufinamide - clobazam - lamotrigine - levetiracetam - oxcarbamazepine - esilcarbazepine
61
what is a category three AED and what are the examples
usually unnecessary to be on one brand - therapeutic equivalence is assumed - brivaracetam - tiagabine - vigabatrine - pregabalin - gabapentin - lacosamide - levetiracetam - ethosuximide
62
what is the ketogenic diet
high fat, low protein, low carb diet- mimics starvation in the brain forcing the body to break down fat to produce ketones (anti-convulsive)
63
how are AEDs withdrawn
if patients have been seizure free for 2 years - slowly over 3m minimum - one at a time
64
what are the risks associated with stopping AEDs
seizure recurrence SUDEP
65
how do AEDs impact bone health
long term AED use can increase the likelihood of bone loss- supplementation required for those at risk
66
which contraception is recommended for women taking enzyme inducing AEDs
PO depot IUD - hormonal or non - COC if absolutely no other alternatives unlicensed tricycling
67
what emergency contraception can be offered to patients on enzyme inducing AEDs
1. Copper IUD 2. Levonorgestrel 1.5mg double dose - effectiveness unknown Ulipristal acetate - not really appropriate
68
what contraceptive methods can people taking non-inducing AEDs
* Can use normal contraceptive methods EXCEPT LAMOTRIGINE - COC reduces lamotrigine effectiveness (non oral preferred)
69
which medications are recommended for monitoring at preconception
□ Phenobarbital, phenytoin, carbamazepine, lamotrigine, levetiracetam, Oxcarbamazepine
70
what supplement must be given in 1st trimester in pregnant epileptic patients
folic acid 5mg OD - reduces neural tube defect
71
what must pregnant epileptic mothers do
notify uk epilepsy and pregnancy register
72
what type of pregnant epileptic patients require more frequent monitoring
* Bilateral tonic clonic * Learning difficulties * Under 18s * Seizure within last year * Modifiable factors for SUDEP
73
which AEDs are the safest in pregnancy
lamotrigine and levetiracetam
74
what happens after an epileptic patient has given birth
baby given 1mg vit k breastfeeding advised

year three exam 2 (38 decks)

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