Session 13 - Lecture 1 - Anti-Epileptic Drugs Flashcards
2 - ILO
INTENDED LEARNING OUTCOMES
• Appreciate the general criteria used in determining whether a patient is epileptic
• Know the general classification of epilepsy based on partial and generalised seizures
• Understand the difference between primary and secondary causes of epilepsy
• Describe some of the major recognised precipitants of epilepsy
• Understand the broad models of how epilepsy is generated within the brain
• Recognise the major drug classes used to treat epilepsy and their general sites of action
• Describe the major and use limiting side effects of commonly prescribed anticonvulsants in these classes
• Describe safe prescribing principles in epilepsy, particularly relating to monotherapy, drug interactions, liver enzyme induction & inhibition and cessation of therapy
• Describe the safety concerns of anti-convulsant therapy in pregnancy
• Appreciate the value of therapeutic drug monitoring in phenytoin therapy
• Apply the basic knowledge of anticonvulsant therapy to the management of a tonic clonic seizure and status epilepticus
{simple defs, drugs involved,
considerations to think about when looking at pts who’ve had a first seizure,
considerations you need to take in terms of pregnancy and side effects.
Status epilepticus – medical emergency – basic principles of how to treat that.}
3 - Definitions
- Seizure = a sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions
- Convulsion = uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles
- Aura = a perceptual disturbance experienced by some prior to a seizure, e.g. strange light, unpleasant smell, confusing thoughts
- Epilepsy = neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain
- Status epilepticus = epileptic seizures occurring continuously without recovery of consciousness in between
{1. activity/impulses get produced – symptoms depends on which part of the brain is affected & whether it spreads to diff parts or whether it involves the whole.
- Diagram – lower: seizure suddenly starts in one area – disorders randomly, ripple effect in surrounding areas – normally electrical d/c should be more uniform and controlled.
uniform = normal
disordered = seizure
2. leads to seizure – area of brain responsible for movement. Formative IUPA – mentioned seizure – TC seizure, occurred in primary motor cortex – example of convulsion occurring – part of movement affected by seizure.
3. Can be thought of as part of a seizure; can occur with seizure itself or before. auditory sense may be affected, pt might hear some funny sounds – spread to primary motor cortex.
4. RECURRENCY - Has to be >1 seizure happening and the same type of seizure e.g. a TC seizure and there was a preceeding aura of a strange smell or wavy lights, if that happened again 2 wks later – that’s a 2nd seizure of the same type happening again – can be diagnosed as epilepsy (Some exceptions to the rule).
5. medical emergency – where seizures occur without a break of recovery – continuous seizures occur, no self-resolution of the symptoms. Can be dangerous – result in pt losing ability to breathe}
4 - Classification of seizures
Seizures
- Partial
- – Simple
- – Complex
- Generalised
- – Absence
- – Myoclonic
- – Tonic-clonic
- – Tonic
- – Atonic
{Learn this! THis one is technically slightly old - there was a new one in 2017 - but basic principle is same and this helps you identify seizures}
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