Epilepsy_Flashcards
What should be done with all patients suspected of having a first epileptic seizure?
Urgently refer all patients suspected of having a first epileptic seizure to a neurologist (first fit clinic).
What is the initial management advice for epilepsy?
MDT approach: SALT, OT, PT, Family counselling, behavioural intervention and educational assistance. Manage associated conditions.
What initial advice should be given to parents and carers regarding seizures?
oAdvise parents and carers how to recognise a seizure.
oAdvise parents to record any future episode of possible seizures (e.g. by video).
o Advise that the patient avoid dangerous activities until the diagnosis is confirmed (e.g.
swimming, bathing)
o Advise the parent to seek help if another seizure occurs before the referral
What should parents be advised to do if another seizure occurs before referral?
Advise the parent to seek help if another seizure occurs before the referral.
What role does the epilepsy specialist nurse play?
Epilepsy specialist nurse may assist families by providing education and continuing lifestyle advice.
What factors influence the decision to treat epilepsy?
Decisions on treating epilepsy depend on the risk of recurrence, how dangerous or impairing the seizures are, and how upsetting further seizures would be to the patient’s life.
Is treatment usually given for childhood rolandic epilepsy?
Treatment is NOT usually given for childhood rolandic epilepsy.
What is the goal of treating childhood absence epilepsy?
Treatment of childhood absence epilepsy is aimed at maximising their educational potential and supporting social development.
Do all children with epileptic seizures require AED therapy?
Not all children with epileptic seizures require AED therapy.
On what basis should decisions to treat with AED be made?
Decisions to treat should be based on seizure type, epilepsy type, frequency, and social/educational consequences against the possibility of unwanted effects of antiepileptic drugs.
What should be considered when choosing an appropriate AED?
Choose an appropriate AED for the seizure and epilepsy (e.g. carbamazapine can make absence and myoclonic seizures worse).
What is the recommended approach for AED therapy?
Monotherapy should be used, at the minimum dosage required to prevent seizures, to reduce the risk of adverse effects. All AEDs have potential adverse effects.
Are AED levels regularly checked?
AED levels are not checked regularly but may be measured to check adherence.
What is the rescue therapy for children with prolonged epileptic seizures?
Children with prolonged epileptic seizures (convulsive seizures with loss of consciousness > 5 mins) are given rescue therapy to keep with them. This is usually buccal midazolam.
When may AED therapy be discontinued?
AED therapy may be discontinued after 2 years free of seizures.
What is the first-line AED for generalized tonic-clonic seizures?
Sodium valproate for boys and girls who are not of childbearing potential. Otherwise, offer lamotrigine or levetiracetam.
What are the alternative AEDs for tonic-clonic seizures?
Alternatives: carbamazepine, oxcarbazepine. Note: these can exacerbate myoclonic (lamotrigine) and absence (carbamazepine and oxcarbazepine) seizures.
What is the first-line AED for absence seizures?
Ethosuximide.
What is the second-line treatment for absence seizures?
Valproate (or lamotrigine in females of childbearing age).
What is the first-line treatment for myoclonic seizures?
Valproate or levetiracetam (if female of childbearing age).
What are the alternatives for myoclonic seizures?
Topiramate.
What is the first-line treatment for focal seizures?
Levetiracetam, lamotrigine (preferred for girls of childbearing potential).
What are the alternative treatments for focal seizures?
Alternatives: oxcarbazepine, valproate.
What are some side effects of carbamazepine/oxcarbazepine?
Rash, neutropenia, hyponatraemia, ataxia, liver enzyme induction, interferes with other medications.
What are some side effects of lamotrigine?
Rash.
What are some side effects of topiramate?
Drowsiness, withdrawal, weight loss.
What are some side effects of levetiracetam?
Sedation (rare).
What are some side effects of valproate?
Weight gain, hair loss, rare idiosyncratic liver failure.
What are some side effects of vigabatrin?
Visual field restriction, sedation.
What are some side effects of ethosuximide?
Nausea and vomiting.
What are some side effects of gabapentin?
Insomnia.
What are some side effects of benzodiazepines?
Sedation, tolerance, increased secretions.
What are other treatment options for children with intractable epilepsies?
Ketogenic diets (low carb, fat based), Vagal nerve stimulation, Surgery (only in children with epilepsy that has a well localized structural cause).
What is the tendency in epilepsy?
It is a tendency to have unprovoked seizures.
What is the aim in managing epilepsy?
Aim to promote independence and confidence.
What should be done regarding the school environment?
The school should be made aware of the condition.
What situations should be avoided by epilepsy patients?
Situations where having a seizure could lead to injury or death should be avoided (e.g. deep baths, swimming unsupervised).
When is driving allowed for epilepsy patients?
Driving is only allowed after 1 year free of seizures.
