EPILEPSY + SEIZURES Flashcards
Describe a typical absence seizure
usually in childhood
a few a day
sudden start and end
unresponsive for 5-10 seconds
Lip smacking is indicative of epilepsy affecting which lobe?
temporal lobe
Generalised seizure in women of child-bearing age
lamotrigine
How long is driving restricted after an epileptic seizure?
CAR:
- If no diagnosis + first seizure = 6 months
- if awake = 1yr
- if asleep = can still drive if no seizures awake for past 3yrs
BUS/LORRY
- If no diagnosis + first seizure = 5yr
- If diagnosis = must be seizure and medication free for 10yr
Investigations for epilepsy
ECG
CT if skull #, deteriorating GCS, focal signs or head injury
EEG
What does an EEG show for primary generalised?
generalised spike-wave abnormalities
What is the cause of a
a) primary generalised
b) focal
seizure?
a) genetic
b) structural
What is the difference between prodrome and aura?
prodrome are the changes in mood and behaviour
aura is the awareness before a seizure eg. dejavu, smells
In which type of seizure do you get post-ictal dysphasia?
focal temporal
Localising features of a temporal seizure
HEAD
Hallucinations (auditory/gustatory/olfactory)
Epigastric rising/Emotional
Automatisms (lip smacking/grabbing)
Deja vu/Dysphasia post-ictal
Localising features of a frontal seizure
Movements of the head or legs
Posturing
Post-ictal weakness
Localising features of a parietal seizure
paraesthesia
Localising features of an occipital seizure
floaters/flashes
manage a first ever seizure
admit for 24 hours
bloods, drug screen, EEG, CT/MRI
What is the difference between a simple partial and a complex partial seizure?
complex has impaired awareness +/- post-ictal symptoms whereas simple does not
What is a Jacksonian-March seizure?
a spreading frontal motor seizure with retained awareness
What does tonic clonic mean?
tonic = limbs stiffen clonic = limbs jerk
What is an atonic seizure?
a sudden loss of muscle tone causing a fall
no LOC
What are infantile spasms associated with?
tuberous sclerosis
Can epilepsy be managed in primary care?
no, specialist review is needed following a 1st seizure
During which phase of a tonic-clonic seizure does the patient become cyanosed?
tonic phase (1min)
1st line treatment for a focal seizure
carbamazepine
2nd line treatment for a focal seizure
lamotrigine
sodium valproate
topimarate
1st line treatment for a generalised seizure
sodium valproate
SE of sodium valproate
teratogenic, nausea, tremor, oedema, ataxia, pancreatitis, weight gain, liver failure, encephalopathy, thrombocytopenia
VALPROATE Appetite inc Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, tremor, thrombocytopenia Encephalopahy
What is the biggest issue with lamotrigine?
takes months to titrate up to therapeutic dose
SE of lamotrigine
rash, SJS, tremor, agitation, diplopia
Sodium valproate MOA
Increases GABA activity and targets voltage channels
Lamotrigine MOA
Sodium channel blocker
Which type of seizure is made worse by carbamazepine?
general
SE of carbamazepine
leucopenia, drowsiness, double vission, blurred vision, impaired balance
Carbamazepine MOA
Binds to sodium channels increasing their refractory period
Phenytoin MOA
Binds to sodium channels increasing their refractory period
Phenytoin SE
LOTS
P450 inducer, dizziness, ataxia, drowsiness, gum hypertrophy, coarse facial features, peripheral neuropathy
Treat acute seizure
10mg rectal diazepam
If a patient in an acute seizure does not respond to rectal diazepam what is the term?
status epilepticus
Which AED induce hepatic enzymes and affect contraception?
carbamazepine
phenytoin
topiramate
Which forms of contraception shouldnt be used with enzyme-inducing AEDs?
COCP
POP
progesterone implant
inc dose of morning after pill and depo
