Define epilepsy
- Two or more unprovoked seizures occurring more than 24-hours apart
- One seizure with probability of second-seizure more than general recurrence risk (60%) after two unprovoked seizures
- Epilepsy syndrome
What is epilepsy
- Recurrent tendency to spontaneous, intermittent. abnormal electrical activity in part of the brain manifesting as seizures
What are convulsions
Motor signs of electrical discharge
What is the main cause of epilepsy
Idiopathic
What are other causes of epilepsy
Genetic TBI Infection Alcohol-related SOL
What are seizure-triggers
Sleep deprivation
Alcohol
Stress
Flashing-lights
What are 4 risk factor for epilepsy
- FH
- Hypoxic-Ischemic
- Meningitis or Encephalitis
- TBI
What investigations should those with epilepsy first receive
EEG
MRI
If someone is having a seizure in public what should be done
ACTION first-aid
Assess danger Cushion head Time Identity bracelet Over - recovery position Never put object in their mouth
What are criteria for calling an ambulance
- First seizure
- Persists beyond 5 minutes
- Two episodes without regaining consciousness
- Difficultly breathing
When are seizures treated medically
Persist beyond 5-minutes.
3 or more seizures in 24-hours
What is first-line for seizure management in the community
Buccal midazolam
If buccal midazolam is unavailable, what is given
Rectal diazepam
What benzodiazepine is preferred where possible
IV lorazepam
When are anti-epileptic medications started
After second-seizure
What is first-line for generalised tonic-clonic seizures
Sodium valproate
What is first-line for absence seizures
Ethosuximide, Sodium Valproate
What is first line for myoclonic seizures
Lamotrigine, Valproate, Clonazepam
What is first line for focal seizures
Carbamazepine
When is surgery for epilepsy indicated
Hippocampal resection - if tubero sclerosis (associated with infantile spasms)
What other surgical procedures can be ordered for epilepsy
DBS
Vagal nerve stimulation
Describe interaction between anti-epileptics and contraception
Anti-Epileptics affect CYP450 and may alter efficacy of contraceptives. Lamotrigine does not affect CYP450 - but does reduce effectiveness of oestrogen-containing contraceptives
What medication should women of child-bearing age not be on
Sodium Valproate
What is least teratogenic medication
Carbamezapine
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1(E): tLOC45
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1(E): Epilepsy37
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1(E): Seizure30
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1(E): Status Epilepticus14
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1(E): Meningitis44
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1(E): Encephalitis, Cerebral Abscess, Toxoplasmosis47
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1: Headaches98
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1(E) - Cerebrovascular Accident125
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1(E) Intracranial Haemorrhage63
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1(E): Intracranial Venous Thrombosis34
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1(E): Head Injury35
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1: Disorders Of Consciousness66
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1: Neurorehabillitation17
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2(E): Raised ICP94
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2(E): Spinal Cord Disease103
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2: Functional Neurological Disorders8
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2: Brain Tumours33
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2: Movement Disorders56
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2: Movement Disorders - Parkinsons Disease55
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2: Movement Disorders - Huntington's Disease17
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2: Peripheral Mononeuropathies76
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3(E): Peripheral Polyneuropathies38
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3: Multiple Sclerosis54
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3: Cerebellar Disorders19
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3: MND29
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3: Myopathy45
