Seizure treatment Flashcards
Which its may not need to be treated with seizure meds/
Simple pediatric febrile seizure
Seizure following withdrawal from medication (e.g. benzodiazepine)
Some benign pediatric epilepsies
Who should be treated with seizure?
Epilepsy: patient who has ≥2 unprovoked seizures Those with 1 seizure who are at high risk for recurrence Those with 0 seizures who are at high risk for seizure
Who are those with 1 seizure at high risk for recurrence?
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What should be done after the first seizure?
- Careful history and physical
- MRI brain with contrast
- EEG
- Other targeted testing as appropriate
Who are at risk for pts with 0 siezures?
Hemorhagges- at high risk may want to treat
What should meds be stopped?
idiopathic etiology
normal mentation
normal neurologic
seizure free interval greater than 2 years
When should you not stop seizure medication?
abnormal neurologic exam
EEG abnormalities
When does breakthrough seizures happen?
- Missed doses of medications (Or low serum drug) level
- Alcohol
- Sleep loss
- Illness (UTI, URI, etc.)
- Medications can lower seizure threshold
- Tramadol (Ultram)
- Buproprion (Wellburtin)
- Clozapine (Clozaril)
What is treatment failure?
- Patient continues seizing after trials of 2 seizure medications
- Consider ketogenic diet (children) or epilepsy surgery
When does seizure frequency in women?
- Twofold increase in seizure frequency during phase of menstrual cycle. ~1/3 of women with intractable epilepsy
- Estrogen, pro-convulsant
- Progesterone: anticonvulsant
- Drug level fluctuations based on hormonal phase
What are the teratogenic effects of women on seizure medication?
- Cardiac septal defects (ASD)
- Nerve tube defects
- Spina bifida
- Cleft lip/palate
- Urogenital defects
- Treat with folate 0.4-5 mg/day
- *MIDLINE DEFECTS*
