Seizures/ epilepsy Flashcards
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23
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suggest starting antiepileptics when ?
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after the first seizure AND any of the following :
neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable
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MX of Generalised tonic-clonic seizures
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males: sodium valproate
females: lamotrigine or levetiracetam
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mx OF FOCAL SEIZURES
first line: levetiracetam if not try lamotrigine
second line: carbamazepine, oxcarbazepine or zonisamide
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mx of absence seizures ?
first line: ethosuximide
second line :
male: sodium valproate
female: lamotrigine OR levetiracetam
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CONTRAINDICATED IN ABSENCE SEZIURES ?
carbamazepine may exacerbate absence seizures
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Mx of myoclonic seizures ?
males: sodium valproate
females: levetiracetam
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Mx of atonic siezures
males: sodium valproate
females: lamotrigine
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what tends to increase myoclonic seizures ?
feels they become worse when he is tired, stressed or has consumed alcohol the night before
often stimulus sensitive.
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e. Focal cortical myoclonus is the most common form of myoclonus and is usually caused by an underlying lesion of the
sensori-motor cortex, which produces hyperexcitability (e.g. vascular, inflammatory or neoplastic
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Other uses of Carbamazepine include ?
trigeminal neuralgia
bipolar disorder
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Carbamazepine is known to exhibit
autoinduction, hence when patients start carbamazepine they may see a return of seizures after 3-4 weeks of treatment
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some adverse effects of carbamezapine ?
dizziness and ataxia
visual disturbances (especially diplopia)
Steven-Johnson syndrome - Stevens-Johnson syndrome is a rare condition arising from 'over-reaction' of the immune system to a trigger such as a mild infection or a medicine, leading to blistering and peeling of the skin and surfaces of the eyes, mouth and throat.
drowsiness
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carbamezapine effect on haematology ?
leucopenia and agranulocytosis
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carbamezapie secondary to syndrome of inappropriate ADH secretion causes?
hyponatraemia
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Carbamazepine Mechanism of action?
binds to sodium channels increases their refractory period
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least teratogenic of the antiepileptics?
lamotrigine: studies to date suggest the rate of congenital malformations may be low. The dose of lamotrigine may need to be increased in pregnancy
carbamazepine
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Breast feeding with anti epileptics ?
Breast feeding is acceptable with nearly all anti-epileptic drugs
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WHICH ANTIBIOTICS SHOULD NOT BE TAKEN WITH SEZIURE MEDICATIONS ?
Quinolones - cipro/levofloxacillin
lowers seizure threshold
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when can anti epileptic mediations be stopped
seizure free for 2 years
with anti epileptics stopped over 2-3 months
