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Flashcards in Epilepsy Deck (22):
1

Definition

Recurrent spontaneous intermittent excessive electrical activity in part of brain causing seizure.

2

Aetiology

Often idiopathic, possibly due to channelopathies.
Structural- cortical scarring, developmental, SOL, stroke, sclerosis, vascular malformation.
Sarcoidosis, SLE

3

Symptoms

Various types of seizure, see other cards.
Sometimes triggers.
In general distrubed conciousness, behaviour, emotion, motor function, sensation.

4

Management

Drugs
Surgical resection
Acutely may need paralysis and intubation.

5

Partial seizure

One hemisphere, focal onset with site specific features.
-Simple- retain awareness, often precursor to larger seizure (aura). Focal motor, sensory, autonomic or psychic symptoms.
-Complex- lose awareness, odd behaviour eg lip smacking. Commonly temporal lobe= post ictal confusion.
-Secondary generalisation- electrical disturbance starts focal and spreads widely.

General symptoms eg amnesia, los bladder tone. Headache, drowsy.

6

Frontal lobe partial seizure

Abnormal head movement
Swearing and shouting
Unusual posturing
Repeated movements eg rocking

7

Temporal lobe partial seizure

Deja vu
Strange taste or smell
Rising sensation in stomach
Lip smacking, swallowing, chewing

8

Parietal lobe partial seizure

Abnormal sensation
Feeling like body part missing
Hallucinations
Cant understand language or reading

9

Occipital lobe partial seizure

Hallucinations
Disturbed vision
Eye pain
Nystagmus

10

Generalised seizure

Both hemispheres so cross corpus callosum. Simultaneous throughout cortex. Impaired conciousness.
-tonic clonic- LOC, stiffen, jerk, loss bladder control, tongue bite, respiratory arrest. Post ictal confusion and drowsy.
-atonic- sudden loss tone, no LOC.
-myoclonic- sudden jerking limb, face or trunk.
-absence- under 10 seconds. Unresponsive pause. May be blinking or slight jerking. Often in kids.

11

Diagnosis

Often clinical
Seizure characteristics
Triggers? Eg photic and hyperventilation.
EEG supports diagnosis only.
Check bloods, glucose, electrolytes, LFT, UE, ECG.

12

Management

AED depends on type
-VGSC blocker eg carbamazepine, phenytoin, lamotrigine.
-benzodiazepine GABA enhancement.
-valproate decrease GABA breakdown and increase synthesis.
Emergency management if over 5 mins-
buccal midazolam
ABCDE
Blood glucose
IV lorazepam, IV phenytoin.
Look for cause eg drug, withdrawal, electrolytes, infection.
Surgery if very severe.

13

Differentials

Syncope
Arrhythmia
TIA
Migraine
Sleep disorder
Panic attack
-Non epileptic causes-
Trauma
Stroke
Haemorrhage
RICP
Alcohol or benzo withdrawal
Hypoxia, electrolytes, glucose, urea
Liver disease
Infection eg meningitis, syphillis, HIV
Drugs eg TCA, cocaine, tramadol, theophylline.
Pseudoseizures.

14

AED in pregnancy

Lomotrigine safest, including during breast feeding.
Valproate teratogenic

15

AEDs by seizure type

-generalised tonic clonic- valproate or lamotrigine 1st line. Then carbamazepine.
-absence- valproate, lamotrigine, ethosuximide.
-other generalised eg atomic, myoclonic- same as tonic clinic but NOT carbamazepine.
-partial- carbamazepine 1st line. Then valproate, lamotrigine etc.
Aim for monotherapy. Start low dose.

16

Complications

Status epilepticus convulsions over 5 mins. Tx with IV lorazepam or phenytoin.
Brain dysfunction or damage.

17

Important benzo points

-benzodiazepines-
Lorazepam for status epilepticus
Clonazepam for absence ST
AE- sedation, tolerance, confusion, lack coordination, agression, dependance, withdrawal can trigger seizure.
OD reversed by IV flumazenil but this can trigger seizure or arrhythmia.

18

Important valproate points

Used for all types
Less severe AE eg sedation, ataxia, tremor, weight gain, transaminase increase, nausea.
Inhibited by antiDs and antipsychotics.
Aspirin competes binding.
Monitor plasma level, blood, hepatic and metabolism disorders.

19

Phenytoin important points

Not used for LT control
Not usd for absence
IV acutely as therapeutic level reached fast
AE- gingival hyperplasia, ataxia, dizzy, headache, nystagmus, anxiety, hypersensitivity, tremor, dysarthria, decreased intellect, depression.
Non linear PK, very variable dose responses.
Monitor plasma level.
Compete for binding with valproate, NSAIDs.
OCP decrseas, cimetidine increases.

20

Lamotrigine important points

1st choice in adults NOT paeds as ADRs
Safer in pregnancy.
Used for all types
Less AE. Occasional rash and hypersensitivity, blurred vision, photosensitvity, tremor, vomiting, agitation, aplastic anaemia.
No CYP induction
Use with other AEDs
Valproate binding completion.
OTC decreases plasma level.

21

Carbamazepine important points

Not for absence
Contra indicated in AV conduction problems
AE include BP fluctuation, hypoNa, neutropenia, parasthesia, motor, blurred vision, diplopia, balance.
Induces own CYP metabolism.
Warfarin, phenytoin, OCP and systemic CS all decrease.
AntiD interfere
Monitor effect and adjust dose as levels fall.

22

Explanation

-Epilepsy is when you have seizures due to abnormal excitation in brain. The seizures can range from causing jerking involuntary muscle movements to just being short losses of alertness that can look like daydreaming.
-with treatment it can be well controlled. If not there is slight risk of brain damage with repeated seizures. Also risk of injury if tonic clinic seizure.
-you should carry with you emergency medicine and wear an alert bracelet. Also try to avoid any triggers if possible. Compliance to medication is important.
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