Seizures and Epilepsy Flashcards
What is epilepsy?
Tendency to recurrent, unprovoked seizures
What is a focal/partial seizure?
Seizure activity in only one part of the brain
What are the two types of partial seizure?
Simple
Complex
What is a generalised seizure?
Whole brain is involved
Describe a simple partial seizure
No loss of conc
Aura experienced
Describe a complex partial seizure
Sudden loss of conc, no warning
Some repetitive movements eg, lip smacking, fidgeting, chewing
What are the 5 main types of generalised seizure?
Atonic Tonic Tonic-clonic Absence Myoclonic
Describe an atonic seizure
Sudden, “drop attack” and complete loss of muscle tone
No post-ictal symptoms
Describe a myoclonic seizure
Brief, involuntary movements
No post-ictal symptoms
Describe an absence seizure
Blank appearance, “space out”
Mild post ictal confusion
Describe a tonic seizure
Sudden rigidity leading to fall
Rapid recovery
Describe a generalised tonic clonic seizure
Tonic phase followed by clonic phase followed by relaxation
Post ictal drowsiness, confusion, myalgia, headache
How is epilepsy investigated?
MRI or CT after first seizure
EEG
What should be ruled out before epilepsy diagnosis?
TIA Migraine Syncope Diabetes NEAs
What should the patient avoid in epilepsy?
Drugs
Alcohol
Any other known trigger
Give examples of drugs which inhibit voltage activated Na+ channels
Sodium valproate
Carbamazepine
Lamotrigine
Phenytoin
Which anti-epileptics increase the action of voltage gated K+ channels?
Retigabine
What is the mechanism of action of levetiracetam?
Inhibit SV2A to prevent neurotransmitter release
Synaptic vesicle glycoprotein 2A
Which anti-epileptics work on voltage gated Ca2+ channels?
Pregabalin
Gabapentin
Which anti-epileptic is known to increase GABA synthesis?
Sodium valproate
Which drugs are used to treat partial seizures first line?
Carbamazepine
Lamotrigine
Which drugs are used to treat absence seizures first line?
Sodium valproate
Ethosuximide
(Or topiramate, levetiracetam second line)
Which drugs are used to treat myoclonic seizures?
Sodium val
Levetiracetam
Clonazepam
(or lamotrigine or topiramate second line)
Which drugs are used to treat atonic, tonic and generalised TC seizures?
Sodium val
Second line: lamotrigine, levetiracetam, topiramate
Which contraceptive method cannot be used with anticonvulsant use?
POP
COCP also less effective
What are the main side effects of carbamazepine?
Dizziness
Nausea
Ataxia
Rash
What are the side effects of sodium valproate?
Weight gain
Hair loss
Tremor
What are the side effects of lamotrigine?
Rash
What are the side effects of phenytoin?
Gingival hypertrophy
Facial coarsening
Osteoporosis
Cerebellar features
What are the side effects of topiramide?
Paraesthesia
Cog impairment
Speech disturbance
Kidney stones
What are the side effects of levetiracetam?
Behaviour change
Irritability
