Wk 32 - Epilepsy in practice Flashcards
What are the causes of epilepsy?
- Structural: stroke, trauma, malformation
- Genetic: dravet syndrome
- Infection: TB, malaria, HIV
- Metabolic: porphyria, pyridoxine deficiency
- Immune: anti-NMDA receptor encephalitis
What are some complications of epilepsy?
- Sudden unexpected death in epilepsy
- Injuries: cause trauma
- Depression + anxiety
- Absence from work/school
What is the treatment for status epilepticus outside of hospital (had previous seizures)?
- Rectal diazepam 10-20mg
- Buccal midazolam 10mg
- Repeat once after 15 mins
What is the treatment for early status (hospital or ambulance)?
- IV lorazepam 4mg
- Repeat once after 10-20 minutes
What is the treatment for established status?
- IV phenytoin infusion 15-18mg/kg
- Other: fosphenytoin + phenobarbital
What is the treatment for refractory status (60 - 90 mins after initial treatment)?
- Anaesthesia eg, midazolam
- Until seizure free for 12-24hrs then taper
What are general measures to make?
- Secure airway + resuscitate
- Administer oxygen
- Establish IV access
What are emergency investigations that could be made?
- Bloods: glucose, renal and liver function, calcium and magnesium, full blood count (including platelets), blood clotting, AED drug levels
- Chest x-ray: possibility of aspiration
What should be monitored?
- Regular neurological obs
- Pulse, BP, temp, ECG, bloods
- EEG for refractory status
When should AEDs be discontinued?
- Seizure free for 2 years
- Taper slowly over 2-3 months
What is under category 1?
- Phenytoin, carbamazepine, phenobarbital + primidone
- Maintain on specific manufacturers prod
What is under category 2?
- Valproate, lamotrigine, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, zonisamide, topiramate
- Continued supply of particular brand based on clinical judgement + consultation/ patient + carer - take into account freq. + history
What is under category 3?
- Lacosamide, tiagabine, gabapentin, pregabalin, vigabatrin
- Unnecessary to ensure patients maintained on specific brand
Outline the MHRA advice on risk of suicidal thoughts + behaviours
- ALL AEDs associated w/ inc risk of suicidal thoughts
- Occur 1 week after starting
- Seek medical advice if mood changes but don’t stop treatment
Which drugs cause antiepileptic hypersensitivity syndrome?
- Carbamazepine
- Lacosamide
- Lamotrigine
- Phenobarbital
- Phenytoin
- Primidone
- Symptoms starts 1-8 wks
What should be done if antiepileptic hypersensitivity syndrome occurs?
W/draw immediately + must not be re-exposed
What are the symptoms of antiepileptic hypersensitivity syndrome?
- Start 1-8 wks
- Fever, rash + lymphadenopathy common
- Liver dysfunction, haematological, renal, + pulmonary abnormalities, vasculitis, + multi-organ failure
Outline the MHRA advice on adverse effects on bones
- LT use: carbamazepine, phenytoin, primidone, + sodium valproate = dec bone mineral density
- Leads to: osteopenia, osteoporosis + inc fractures
- Consider: Vit D
What contraceptives are not recommended when taking AEDs?
Progestogen only pill + implant
What are the effects of AEDs on pregnancy + give examples of drugs that cause such effects
- Inc risk of major congenital malformations: 1st trimester
- Highest: valproate
- Risk: carbamazepine, phenobarbital, phenytoin, + topiramate
- Lamotrigine = safer
