Paeds: Epilepsy georgie Flashcards
AED for partial seizures
• Carbamezapine (first libe treatment) • Sodium valporate • Lamotrigine • Topiramate Levetiracetam
AEDs for Generalized
• Sodium valporate (first line teatment)
• Lamotrigine
• Topiramate
Levetiracetam
Complex partial
Prevalence
60%
Prevalence Secondary generalized tonic-clonic
60%
Prevalence Primary generalized tonic-clonic
30%
Prevalence Generalized absence
5%
Prevalence Generalized myoclonus
5%
Simple partial Prevalence
rare
West syndrome
age and comments
4-6 months
• Violent flexor spasms of the head, trunk and limbs followed by extension of the arms (so-called ‘salaam spasms’). Flexor spasms last 1–2 s, often multiple bursts of 20–30 spasms, often on waking, but may occur many times a day.
• Many causes; two-thirds have underlying neurological cause.
Most will subsequently lose skills and develop learning disability or epilepsy
Management of west syndorme
• Treatment is with vigabatrin or corticosteroids good response in 30-40%
•
Childhood absence syndrome
4-12 Years
• It is associated with brief interruptions of 3-5s in awareness, with minimal or no motor manifestation
• Accounts for 2% of epilepsy
• Prognosis is good, with 95% remission in adolescence; 5–10% may develop tonic-clonic seizures in adult life
•
childhood absence syndrome management
It responds to sodium valporate or ethosuximide
Juvenile myoclonic epilepsy age and presentation
- Associated with early morning myoclonic jerks
- Generalized tonic-clonic seizures occur in most
- Childhood absence seizures in 30%
- Precipitants: sleep deprivation, alcohol
Juvenile myoclonic epilepsy management
Best response to sodium valproate
Tonic-clonic generalised seizures first-line Rx
Valproate, carbamazepine
Tonic-clonic generalised second line
Lamotrigine
Topiramate
Absence generalised seizures first-line
Valproate, ethosuximide
Absence generalized seizures second line
Lamotrigine
Myoclonic generalised seizures first line
Valproate
Focal seizures first line
Carbamazepine or valproate
Lamotrigine shown since to be most effective - but slow titration
Focal seizures second line
Topiramate, levetricatam, oxcarbazepine, gabapentin, tiagabine, vigabatrin
Treatment info for parents
-70% of epilepsy controlled on AED therapy
- of these 80% on monotherapy, 10-15% on two drugs
30% not controlled
If the response is poor to AED
- Switch to another 1st line AED as monotherapy
- Add 2nd AED
- Explore full range of doses
- Avoid polytherapy
- Surgery
Valproate SE
weight gain
Hair loss
Rare idiosyncratic liver failure
Carbamazepine/oxcarbazepine SE
Rash Neutropenia Hyponatraemia Liver enzyma induction Can interfere with other medication
Vigabatrin SE
Restriction of visual fields, which has limited its use
Sedation
Lamotrigine SE
Rash
Ethosuximide SE
N and V
Topiramate SE
Drowsiness, withdrawal and weight loss
Gabapentin SE
Insomnia
Levetiracetam SE
Sedation - rare
Benzos SE
Sedation
tolerance to effect
Increased secretion
Sudden death in epilepsy (SUDEP)
- Risk of SUDEP should be discussed with all patients (NICE)
- Not only patients with poorly controlled seizures are at risk.
- Mainly respiratory arrest (central hypoventilation)
- Risk highest in Generalized tonic-clonic seizures, also complex partial seizures of temporal origin (bradyarrythmia/ asystole)
