Epilepsy in Adults Flashcards
Generalized seizures:
Types:
Arise bilaterally.
Tonic-clonic, absence, clonic, tonic, atonic, myoclonic.
Focal seizures:
Begin in 1 hemisphere. May have no alteration of awareness.
Can be auras or motor.
Majority of adult seizures arise in?
Temporal lobe : > 65%
Most from deep mesial temporal structures: hippocampus, amygdala.
Frontal lobe: ~25%.
ER evaluation for seizures should include:
White count.
Metabolic profile.
Drug screen.
-maybe CT w&w/o contrast to rule out structural causes.
-maybe LP if mental status does not rapidly clear.
-MRI if can take 24hrs.
-EEG - only 30% sensitive.
Treat unprovoked seizure when?
usually after 2 unprovoked seizures
Narrow spectrum drug that is only effective for absence seizures:
Ethosuximide
Anti-seizure medications that can worsen generalized seizures such as myoclonus or absence:
- Carbamazepine
- Oxcarbazepine
- Gabapentin
- Pregabalin
- Gabatril
Broad spectrum anti-seizure meds:
Valproic acid Lamotrigine Levetiracetam Topiramate Zonisamide
Side effects of Valproid acid
Weight gain
Birth defects if mother on it
Which meds are associated with weight loss?
Topiramate
Zonisamide
Which meds have fewest effects on fetus/baby?
Lamotrigine
Levetiracetam
Goal of management in pregnant women?
Single drug at lowest effective serum concentration.
Which meds to avoid in co-morbid conditions such osteoporosis, AIDS, cancer?
Inducers of hepatic metabolism:
phenytoin,
carbamazepine,
phenobarbital
Intractable epilepsy:
Other treatment possible:
Unable to control seizures with medication: Fail 2 or 3 meds. Refer them to epilepsy center.
Can sometimes do surgical treatment for intractable focal epilepsy.
Implantable devices - neurostimulators sometimes possible.
Vagus nerve stimulators may be possible.
