Epilepsy Management Flashcards
What is the first mandatory investigation done to someone who is suspected of having a seizure or a period of syncope?
ECG
When is a CT scan indicated over MRI acutely in suspected seizure or syncope?
- Skull fracture
- Head injury w/ seizure
- Deteriorating GCS
- GCS not 15/15 4 hrs after arrival
- Focal signs
- Suggestion of other pathology
When is EEG used in epilepsy/seizure/syncope?
- Classification of epilepsy
- Confirmation of non-epileptic attack
- Surgical evaluation
- Conformation of non-convulsive status
How long should a patient not drive for after their first seizure, car & HGV?
Car - 6 months
HGV - 5 years
How long should a patient not drive for after a diagnosis of epilepsy, car & HGV?
Car - 1 year / 3 years if during sleep
HGV - 10 years of no seizures off medication
How long do epileptic seizures normally last?
seconds - minutes
What are the two broad classifications of epileptic seizure?
Generalized
Partial - Focal sight of origin
What investigations are used to classify epileptic seizures?
Semiology
EEG
Name the types of partial epileptic seizure?
Simple - Without impaired consciousness
Complex: with impaired consciousness
What are the different types of generalized epileptic seizure?
- Absence
- Myoclonic
- Atonic
- Tonic
- Tonic-clonic
What are some key features of generalized epilepsy?
- Genetic predisposition
- Present in childhood and adolescence
- Generalized spike-wave abnormality on EEG
What are some key features of partial/focal epilepsy?
- Localized
- Can generalize laterally
What is the treatment of choice and an alternative for primary generalized epilepsy?
Treatment of choice: Sodium valporate
Alternative: Lamotrigine
How does juvenile myoclonic epilepsy present?
- Early morning jerks
- Generalized seizures
Risk factors: Sleep deprivation & flashing lights
What medication is given for focal onset epilepsy?
Carbamazepine or Lamotrigine
What type of epilepsy is associated with hippocampal sclerosis?
Frequent focal onset epilepsy
What is the mechanism of anti-epileptic drugs?
Decrease pre-synaptic excitability
&
Decrease neurotransmitter release
What does GABA-A receptor do when responding to GABA?
Reduces neuronal excitability
What is the 1st line treatment for generalized absence seizure?
Ethosuximide
What is the 1st line treatment for generalized myoclonic seizure?
1st line: Sodium valproate
What is the 1st line treatment for generalized Atonic, Tonic & tonic-clonic seizure?
Sodium valproate
When is phenytoin used in epilepsy/seizure?
ONLY in acute management
What anti-convulsants should not be used alongside progesterone contraceptives?
- Carbamazepine
- Oxcarbazepine
- Phenobarbitol
- Phenytoin
- Primidone
- Topiramate
What anti-epileptic medications effect the morning after pill?
Enzyme-inducing AED’s
