Epilepsy Flashcards
What are types of generalised seizure?
Tonic clinic Isolated tonic click Absence seizure Myoclonic - sudden jerk of limb/face Atonic - no loc, sudden loss of muscle tone
What is a generalised seizure?
A seizure in which consciousness is impaired and there is distortion of activity of whole or a large part of the brain
What is a partial seizure?
Limited to one hemisphere, discretely localised or more widely distributed
Awareness may be retained (simple) or impaired (complex)
May progress to generalised seizures
What occurs with temporal lobe partial seizures?
Automatisms - complex movements eg fumbling performed with limited awareness
Abdominal rising sensation or pain
Dysphasia
Memory phenomena - déjà/jamais vu
Hippocampal involvement - emotional disturbance
Hallucinations of taste/smell
Delusional behaviour
What occurs with frontal lobe partial seizures?
Motor features - posturing, eye/head movements
Jacksonian March - retained awareness in spreading motor seizure
Motor arrest
Subtle behavioural disturbances
Speech arrest/dysphasia
Subtle behavioral disturbances
What occurs in parietal lobe partial seizures?
Sensory disturbances - tingling, numbness and pain
Motor symptoms
What happens in occipital lobe partial seizures?
Visual phenomena - spots, lies, flashes
What is the treatment of general seizures?
First line usually sodium valproate
Adjunct treatment may include: Lamotrignine Clobazam Levetiracetam Topiramate
What is the treatment of partial seizures?
First line: carbamazepine or Lamotrignine
Second line: levetiracetam, oxcarbazepine, valproate
Adjunct - carbamazepine, clobazam, retigabine (if age >18)
How can patients be supported to self manage in epilepsy?
Keep diary to document seizures and know triggers
Regular reviews - 3-12 months depending on control
Maintain hold physical and mental health
Self management programs
Formulate care plan with specialist nurse or gp
What are the side effects of carbamazepine?
Drowsiness Agitation Diplopia Blurred vision Leukopenia Hepatic failure SIADH
What are the side effects of valproate?
Weight gain Hepatotoxicity Pancreatitis Mild GI disturbances Alopecia Tremor Rash Thrombocytopenia
What are the side effects of Lamotrignine?
Hyponatraemia
Nausea
Rash
What drugs does valproate interact with?
May reduce valproate levels: Phenytoin Phenobarbital Topiramate Carbamazepine
May increase valproate levels:
Amitriptyline
Nortriptyline
