Management of Epilepsy Flashcards
when is medical intervention needed for epilepsy?
to prevent repeated seizures which may cause tragic consequences
what are some consequences of repeated seizures
> progressive intellectual disability
sudden unexplained death in epilepsy (SUDEP)
status epilepticus
reduced quality of life
what is the process of Diagnosis & Investigations
> > Specialist medical practitioner with training and expertise in epilepsy
- Clinical History
the detailed description of the event, an eyewitness to the attack (where possible) - Evaluate with 12-lead Electrocardiogram ECG
- biochemistry test - e.g. serum electrolytes, glucose, calcium
- neuroimaging tests if underlying structural cause is suspected
- drug hisotry - e.g use of recreational drugs
What is the aim of treatment
why do you conduct biochemistry tests
metabolic disturbance, including hypoglycaemia, can result in seizures.
what are the steps when the person’s history and examination suggests an epileptic seizure, and a diagnosis of epilepsy is suspected
- Electroencephalogram (EEG)/Video telemetry
- Neuroimaging scans - Magnetic resonance imaging (MRI)
what are the steps when the person’s history and examination suggests an epileptic seizure, and a diagnosis of epilepsy is suspected NOS
- Electroencephalogram (EEG)/Video telemetry
- Neuroimaging scans - Magnetic resonance imaging (MRI)
- Genetic testing - under 2 or those with additional clinical features
- Antibody testing - autoimmune encephalitis is suspected
In what form are Carbamazepine available as?
Tablet
Modified-release tablet
Oral suspension/solution
Suppository (100mg tabs= 125mg Suppository)
Key feature of Carbamazepine
Most be prescribed with brand names
Side effect of Lamotrigine
Rash (in the first 8 weeks, if given too quickly) - this can be life threatening
Blood disorders
Drug-drug interactions
With valproate: increased plasma concertation
Enzyme inducing AEDs: decrease plasma concentration
What are the formulations of Phenytoin available
Capsules
Oral solution
IV solutions
What are the CI of Levetiracetam
Renal impairment
Depression, thoughts of harming/killing
Pregnancy
What formulations of Levetiracetam are able
Tablets,
liquid,
granules,
solution for infusion
Formulations of Sodium valproate
Tablets – crushable, enteric-coated, modified-release
Liquid
Solution for IV injection
How should AED therapy be started
After a consultation
4 weeks of treatment in hospital then continuation in primary care
