EPILEPSY: TYPES OF SEIZURES Flashcards
What are the types of seizures?
Focal
Generalised
Status epilepticus
What is a FOCAL seizure?
- Affects one hemisphere
- Can become generalised
- Patient aware they are having a seizure
What is a GENERALISED seizure?
- 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
What is the FIRST line treatment for FOCAL seizures?
Lamotrigine
Levetiracetam
What is the SECOND line treatment for FOCAL seizures?
Carbamazepine
Oxcarbazepine
Zonisamide
COZ
What is the treatment for TONIC CLONIC seizures?
- SV
- L/L
What is the treatment for ABSENCE seizures?
- E
- SV
- L/L
What is the treatment for ABSENCE + OTHER seizures?
- SV
- L/L
What is the treatment for MYOCLONIC seizures?
- SV
- Leve
What is the treatment for ATONIC/TONIC seizures?
- SV
- Lamo
Should women take first or second line?
Women to take second-line option if at child bearing potential age – currently or in the future.
Except for in absence
Who initiates epilepsy treatment
Specialist
Monotherapy
Lowest effective dose
How would you change from one epilepsy drug to another?
Slowly withdraw 1st drug only when new regimen has been established
What is SUDEP?
Sudden Unexpected Death in Epilepsy (SUDEP)
* Rare
* Person dies during or following seizure
What are the risk factors for SUDEP?
Uncontrolled/poorly controlled seizures
Frequent seizures
Nocturnal seizures
What is status epilepticus?
Seizure last more than 5 mins/ recurrent seizure with no recovery
FIRST line treatment of SE in community
Buccal midazolam or
PR diazepam
Midazolam - administration + counselling
- 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
FIRST line treatment of SE in hospital
IV lorazepam
What do we give if there is no response within 5-10 mins of first line treatment for SE?
NO RESPONSE within 5-10mins of 1st dose = 2nd DOSE
SECOND line treatment of SE
LEVETIRACETAM, PHENYTOIN, SV
- If no response, try a different 2nd line
- If still no response = phenobarbital or
general anaesthesia
Apart from pharmacological methods mentioned, what else can be done?
- Positioning pt to avoid injury
- Provision of O2
- Maintaining bp
- Correction of any hypoglycaemia
What can be potential causes of SE and what can be given?
- Alcohol abuse - parenteral thiamine
- Pyridoxien def - pyridoxine
When to call an ambulance for SE?
- 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
