Epilepsy Extras Flashcards
What are generalised seizures?
Involve both sides of the brain at the onset
consciousness lost immediately
Subdivided into:
motor:
tonic-clonic (grand mal)
tonic
clonic
myoclonic: brief, rapid muscle jerks
atonic
and non motor:
typical absence (petit mal)
What are focal seizures?
these start in a specific area, on one side of the brain
level of awareness can vary
can be motor, non motor, or associated with aura
What are the key localising features of temporal lobe seizures?
HEAD
Hallucinations (auditory/gustatory/olfactory)
Epigastric rising sensation (aura)
Automatisms (lip smacking/grabbing/plucking)
Deja vu / Dysphasia post-ictally
What are the key localising features of frontal lobe seizures?
Motor
Head/leg movements
posturing
Jacksonian march (clonic movements travelling proximally)
post-ictal weakness
What are the key localising features of parietal lobe seizures?
sensory
Paraesthesia
What are the key localising features of occipital lobe seizures?
Visual
Floaters/flashes
What are the key features of infantile spasms?
Brief spasms beginning in first few months of life
- Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times
- Progressive mental handicap
- EEG: hypsarrhythmia
Poor prognosis
What are the key features of benign rolandic epilepsy?
paraesthesia (e.g. unilateral face), seizures characteristically occur at night
What are the key features of Juvenile myoclonic epilepsy (Janz syndrome)?
Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Sudden, shock-like myoclonic seizure
3. Daytime absences
Usually good response to sodium valproate
How can suspected epilepsy be investigated?
EEG and MRI
When is treatment started for epilepsy?
usually after second epileptic seizure
NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
neurological deficit
brain imaging shows a structural abnormality
EEG shows unequivocal epileptic activity
the patient/family/carers consider the risk of having a further seizure unacceptable
What is the first line mx for generalised tonic clonic seizures?
males: sodium valproate
females: lamotrigine or levetiracetam
What is the first line mx for focal seizures?
first line: lamotrigine or levetiracetam
second line: carbamazepine
What is first line mx for absence seizures?
ethosuximide
N.B. carbamazepine may exacerbate absence seizures
What is the first line mx for myoclonic seizures?
males: sodium valproate
females: levetiracetam
What is the first line mx for tonic-clonic seizures?
males: sodium valproate
females: lamotrigine
MOA of sodium valproate?
Increases GABA activity
ADRs of sodium valproate?
increased appetite and weight gain
alopecia
P450 enzyme inhibitor
teratogenic
MOA of Carbamazepine?
Binds to sodium channels increasing their refractory period
ADRs of Carbamazepine?
P450 enzyme inducer
dizziness and ataxia
drowsiness
agranulocytosis
SIADH
MOA of phenytoin?
Binds to sodium channels increasing their refractory period
ADRs of phenytoin?
P450 enzyme inducer
dizziness and ataxia
drowsiness
gingival hyperplasia
megaloblastic anaemia
peripheral neuropathy
MOA of lamotrigine?
Sodium channel blocker
Main ADR of lamotrigine?
Stevens-Johnson syndrome
Define status epilepticus
a single seizure lasting >5 minutes, or
2 seizures within a 5-minute period without the person returning to normal between them
How can status epilepticus be managed?
benzos first line
prehospital setting = PR diazepam or buccal midazolam
in hospital = IV lorazepam, may be repeated once after 5-10minutes
What can you give in status epilepticus that is not responding to benzos?
IV levetiracetam, phenytoin or sodium valproate
