Epilepsy Part 1 Flashcards
What is the definition of epilepsy?
Recurrent tendency to have spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures
What are the elements of a seizure?
A prodrome - lasting hours-days, prior to seizure
Aura - part of the seizure for which the patient is aware
Seizure
Post-ictal - period after the seizure, there may be confusion, headache, myalgia and a sore tongue or temporary weakness (Todd’s palsy) or dysphasia
What are some of the cause of epilepsy?
2/3 are idiopathic
Structural - cortical scarring from HI, developmental, space-occupying lesions, stroke, hippocampus sclerosis, vasc malformation
Others - tuberous sclerosis, sarcoidosis, SLE, PAN
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What are the other causes for seizures than epilepsy?
Trauma
Stroke
Haemorrhage
Raised icp
Benzodiazepine withdrawal
Metabolic disturbance: hypoxia, hypo/hypernatraemia, hypocalcaemia, hypo/hyperglycaemia, uraemia
Liver disease
Infection - meningitis, encephalitis, syphilis, cysticercosis, HIV
Hypethermia
Drugs - tricyclics, cocaine, tramadol, theophylline
Pseudoseizures
How are seizures classified?
Partial or primary generalised seizures
What are the types of partial seizure?
Simple partial - awareness unimpaired, no post-octal symptoms
Complex partial - awareness impaired, postictal confusion common in temporal lobe seizures
Partial seizure with secondary generalisation - in 2/3 patients of partial, typically convulsive
What are the types generalised seizures?
Absence seizures - brief pauses (<10s)
Tonic-clonic - loss of consciousness, limbs stiffen then jerk, post-ictal confusion and drowsiness
Myoclonic - sudden jerk of limb/face/trunk, pt can be thrown suddenly to ground
Atonic/akinetic- sudden loss of muscle tone causing a fall, no LOC
infantile spasm - commonly associated with tuberous sclerosis
What are some localising features of partial seizures?
Temporal - automatisms such as lip-smacking, chewing or swallowing with impaired awareness and no recollection after, dysphasia, memory phenomena (deja vu etc), sudden emotional disturbance, auditory hallucinations, delusional behaviour
Frontal - motor features eg posturing, Jacksonian March, motor arrest, speech arrest/dysphasia, post-ictal Todd’s palsy
Parietal - sensory disturbance, motor symptoms due to spread to prevent real gyrus
Occipital - visual phenomena eh spots, lines, flashes
What are the non pharmacological management options for epilepsy?
Patient education on triggers and activities to avoid such as swimming
Relaxation training
Aura interruption
What are the pharmacological management options for epilepsy?
Generalised tonic-clonic: sodium valproate or lamotrigine 1st like, then carbamazepine or topiramate
Absence: sodium valproate, lamotrigine, ethosuximide
Tonic, atonic and myoclonic: same as generalised but avoid carbamazepine and oxcarbazepine
Partial: carbamazepine 1st line, then sodium valproate, lamotrigine, oxcarbazepine or topiramate
What is the dosing and side effects of sodium valproate?
Initially 300mg/12h, increase by 100mg every 3 days up to 30mg/kg
VALPROATE side effects Appetite incr, weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity, tremor, thrombocytopenia Encephalopathy
What anti-epileptic medicines can be used in women of childbearing age? What else should be given if they want to get pregnant?
Lamotrigine
Folic acid 5mg/day
What are the anti-epileptic drugs that can be taken whilst breastfeeding?
Carbamazepine not found in breast milk
Lamotrigine not thought to be harmful to infants
What anti-epileptic medicines interfere with the Pill? What are the other contraceptive options other than switching anti epileptic drug?
Valproate, carbamazepine, fisphenytoin sodium, oxcarbazepine, phenobarbital, phenytoin, topiramate
> 50microg oestrogen, decrease pill free days 7->4, depo-provera, IUD
