Seizure Disorder Flashcards
Treatment of focal epilepsy and complex partial seizures
Carbamazepine
Epilepsy v. Seizures
Epilepsy is characterized by recurrent seizures and is divided into syndromes on the basis of various causes, seizure types, associated neurologic symptoms, anatomic correlates, age, and family history
A seizure can be defined as an isolated event in which a group of neurons produces excessive electrical discharges in the brain
Two Broad Categories of Seizures
Focal - activity is in one hemisphere
Generalized - activity is in both hemispheres
Simple Partial Seizures
No impairment of consciousness
Focal
May have aura
May have motor or non-motor types
Complex Partial Seizure
Activity spreads to both hemispheres or the brainstem
Altered consciousness or behavior occurs
Automatisms more common
Primary Generalized Seizures
primary generalized seizures occur when the initial abnormal electrical activity begins in both cerebral hemispheres and involves bilaterally distributed neuronal networks. These seizures are usually seen with idiopathic or hereditary types of epilepsy. Consciousness is almost always impaired, and the seizure may be convulsive or nonconvulsive
Secondary Generalized Seizure
Focal seizure that spreads to both hemispheres and involves the motor cortex
Non-convulsive Generalized Seizures
Absence seizure is the most common
New Onset Seizures Assessment
Recent history of headache, illness, trauma, neurological deficits
Any unusual feeling, aura, or signs?
General exam and assessment to rule out causes (Neuro, CV, Infection)
Seizure Diagnostics
CBC, CMP, Alcohol / Tox
EKG
MRI preferred but CT useful
EEG, Lumbar Puncture
Referral to Epilepsy Center
If a diagnosis of epilepsy cannot be confirmed or excluded after an accurate history, EEG, or imaging study
Seizure Differentials
CV causes (syncope, etc.) CVA/TIA Movement Disorders Psych Tumors Trauma
Nonepileptic Seizures
Psychogenic seizures / pseudo seizures
treatment with an anti-epileptic drug results in increase in seizure frequency
Stress or conversion disorder
Status Epilepticus
Continuous seizure lasting 5 mins or more or 2 consecutive seizures in a row without mental clearing
Medical emergency
Status treatment
ABC management EKG Check glucose (treat if low) IV Access - CBC / CMP / Tox Benzodiazepines
Benzos for SE
IM midazolam 10mg for >40kg, 5mg for 13-39 kg
IV lorazepam 0.1mg/kg - max 4mg
IV diazepam 0.15-0.2 mg/kg - max 10mg
OR
IV IV phenobarbital 15mg/kg
When to start anti-epileptic meds
Most first seizures are not treated with anti-epileptic meds
complex partial seizures are more likely to be recurrent than generalized tonic-clonic ones
abnormal EEG or imaging may prompt need for meds
Preferred AEDs for women
Levetiracetam (safer in pregnancy)
Lamotrigine (safer in pregnancy)
Levetiracetam
Effective for focal and generalized
Does not cause sedation or have liver effects
Risk of agitation, anxiety, depression
Lamotrigine
Wide spectrum of efficacy, preferred for women
High rate of allergic rash (SJS risk)
Valproate
Good for Generalized Seizures
Side effects - weight gain, hair loss, PCOS, Liver toxic, severe fetal toxic
Carbamazepine
Most effective for focal and complex-partial seizures
Cheap
Makes generalized seizures worse - so not for patients with multiple seizure types
Toprimate
Broad spectrum of efficacy
Significant cognitive side effects - not a first line option
May cause weight loss and prevent migraines
Gabapentin
Worsens generalized epilepsy
Only for focal seizures
Useful for pain management, so may help patients with pain and focal seizures
Adding or Changing AED medications
Add new medication to current regimen, once well tolerated and effective, slowly reduce/withdraw the first one.
Some patients require 2 or 3 drugs with different mechanisms of action
AED Side Effects
CNS such as somnolence, cognitive issues
GI issues
Rashes
Weight changes
Monitor drug levels to achieve steady state with dosing
AEDs and Vitamin D / Calcium
All patients taking enzyme-inducing AEDs are at risk for osteoporosis and should be taking calcium and vitamin D
