EPILEPSY: TYPES OF SEIZURES

Question 1

What are the types of seizures?

Answer 1

Focal
Generalised
Status epilepticus

Question 2

What is a FOCAL seizure?

Answer 2

• Affects one hemisphere
• Can become generalised
• Patient aware they are having a seizure

Question 3

What is a GENERALISED seizure?

Answer 3

• Can affect both hemispheres
• Typically associated with impaired awareness (unconscious, pt may not know they’ve had a seizure)
  o Tonic clonic
  o Absence
  o Atonic

Question 4

What is the FIRST line treatment for FOCAL seizures?

Answer 4

Lamotrigine
Levetiracetam

Question 5

What is the SECOND line treatment for FOCAL seizures?

Answer 5

Carbamazepine
Oxcarbazepine
Zonisamide
COZ

Question 6

What is the treatment for TONIC CLONIC seizures?

Answer 6

1. SV
2. L/L

Question 7

What is the treatment for ABSENCE seizures?

Answer 7

1. E
2. SV
3. L/L

Question 8

What is the treatment for ABSENCE + OTHER seizures?

Answer 8

1. SV
2. L/L

Question 9

What is the treatment for MYOCLONIC seizures?

Answer 9

1. SV
2. Leve

Question 10

What is the treatment for ATONIC/TONIC seizures?

Answer 10

1. SV
2. Lamo

Question 11

Should women take first or second line?

Answer 11

Women to take second-line option if at child bearing potential age – currently or in the future.
Except for in absence

Question 12

Who initiates epilepsy treatment

Answer 12

Specialist
Monotherapy
Lowest effective dose

Question 13

How would you change from one epilepsy drug to another?

Answer 13

Slowly withdraw 1st drug only when new regimen has been established

Question 14

What is SUDEP?

Answer 14

Sudden Unexpected Death in Epilepsy (SUDEP)
* Rare
* Person dies during or following seizure

Question 15

What are the risk factors for SUDEP?

Answer 15

Uncontrolled/poorly controlled seizures
Frequent seizures
Nocturnal seizures

Question 16

What is status epilepticus?

Answer 16

Seizure last more than 5 mins/ recurrent seizure with no recovery

Question 17

FIRST line treatment of SE in community

Answer 17

Buccal midazolam or
PR diazepam

Question 18

Midazolam - administration + counselling

Answer 18

• Dose does not need to be shaken
• Does not need to be stored in the fridge
• If pt vomits whilst having a seizures – ambulance
• Wait 5 mins before administering as the seizure may stop on its own

Question 19

FIRST line treatment of SE in hospital

Answer 19

IV lorazepam

Question 20

What do we give if there is no response within 5-10 mins of first line treatment for SE?

Answer 20

NO RESPONSE within 5-10mins of 1st dose = 2nd DOSE

Question 21

SECOND line treatment of SE

Answer 21

LEVETIRACETAM, PHENYTOIN, SV
- If no response, try a different 2nd line
- If still no response = phenobarbital or
general anaesthesia

Question 22

Apart from pharmacological methods mentioned, what else can be done?

Answer 22

• Positioning pt to avoid injury
• Provision of O2
• Maintaining bp
• Correction of any hypoglycaemia

Question 23

What can be potential causes of SE and what can be given?

Answer 23

1. Alcohol abuse - parenteral thiamine
2. Pyridoxien def - pyridoxine

Question 24

When to call an ambulance for SE?

Answer 24

• if seizures DO NOT respond promptly to treatment
• If DO respond to treatment but:
  a. Seizures were prolonged or recurrent before treatment
  b. High risk of recurrence
  c. Difficulties monitoring persons conditions
  d. First seizure