Seizures and psychogenic non-epileptic seizures Flashcards
Seizure definition
Seizure classification
Epilepsy definition
Seizure semiology
How a seizure starts and progresses, as reflection of area of brain involved in the abnormal electric activity giving rise to the seizure.
I.e.
The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves.
What is the most common inter-ictal EEG finding in adult with focal seizures?
Anterior temporal lobe spike discharge
Types of epileptiform tracings on EEG
Spikes (shorter duration)
Sharp waves (longer duration)
Different patterns of these on BG activity correspond to different epilepsy syndromes
Why would you try to avoid use of Carbamazepine and Lamotrigine in a patient with epilepsy of Chinese origin?
Han Chinese populations have high rate of HLAB1502 mutations which are associated with Stevens Johnson reaction to Carbamazepine and Lamotrigine
Special consideration for patients taking hormonal therapies (incl OCP, HRT), with regards to AEDs?
Should be warned of interaction between Topiramate and Lamotrigine with hormonal treatments - e.g. Topiramate > 100mg od induces metabolism of OCP -> renders the OCP ineffective
If patient is pregnant or taking OCP on Lamotrigine, this reduces its effectiveness -> need to increase the dose of Lamotrigine
Considerations when adding AED
Pharmacologically redundant to add a drug that has the same mechanism of action to the current one - need to exploit different mechanism
Choice of AED based on seizure type
Depends on type of epilepsy
- Focal seizures -> usually best to use Na+ channel blockers e.g. Carbamazepine, Lamotrigine, Lacosamide
- Generalised -> sodium valproate, levetiracetam, Lamotrigine, Ethosuximide (reserved for use in childhood absence seizures), Zonisamide, Perampanel
AED to avoid in those with mood issues
Levetiractam
AED to avoid in those with PCOS, obesity
Na valproate
AED to avoid in those with bone marrow/haematological issue
Na valproate - known to cause thrombocytopenia
AED to avoid in those with hyponatratemia
Carbamazepine
AED to avoid in those with movement disorders
Na valproate
AED to avoid in those with cognitive issues
Topiramate and phenobarbital
AED to avoid in those with kidney stones
Topiramate, Zonisamide
AED to avoid in those with insomnia
Lamotrigine - or at least make sure take all dose in morning so no evening peak to cause insomnia
AED to avoid in those with liver impairment
Na valproate