What are the 3 types of seizures and where do they affect the brain?
- Focal - seizure starts in one side of the brain
- Generalized – affects both sides of brain
- Status epilepticus Uninterrupted seizure activity (life threatening condition)
What are the seizure characteristics?
Tonic-Clonic – increased muscle tone and jerking (Most common)
Absence – suddenly stop (appear to be daydreaming)
Myoclonic- single repetitive jerking 1 or more muscle group
Atonic – drop attack loss of muscle tone
Tonic – immediate increase of muscle tone
Clonic – repetitive jerks
Which antiepileptics will need specific brands ?
Category 1: Carbamazepine, phenobarbital, phenytoin, primidone –
GP ensure pt is maintained on a specific manufacturer’s product.
Which antiepileptics may need specific brands?
Category 2: Clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, topiramate, valproate, zonisamide,
need for continued same brand depends on clinical judgement and pt preference
Which antiepileptics dont need speicific brands
Category 3: Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin -usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product.
What seizures is carbamazepine used for?
Tonic-clonic, focal seizures and complex focal seizures
responds poorly to absence, atonic and tonic seizures
What are the SE of carbamazepine?
Sedation, Dizziness, drowsiness
Mental disturbances
headache
Water retention, weight increased
Nausea, vomiting, hyponatraemia
What form of carbamazepine should be given?
controlled- release
How should the dose of carbamazepine be increased?
Increases in dose at a rate of 200 mg every 1-2 weeks may be required to achieve a stable seizure threshold
Stable carbamazepine concentrations occur usually within 2-3 weeks after commencement of treatment
What are common interactions of carbamazepine?
> Phenytoin/phenobarbital – increases carbamazepine clearance
Warfarin levels are decreased
Erythromycin, cimetidine, propoxyphene, and CCB decrease the metabolism of carbamazepine
!!! Carbamazepine can reduce effectiveness birth control, could lead to unexpected pregnancies !!!
it accelerates elimination of many benzodiazepines and decreases their action
What are the common SE of valproate?
- Nausea
- gastric irritation
- diarrhoea
- weight gain
- hyperammonaemia
- thrombocytopenia
- transient hair loss.
What seizures is valproate used for?
- First-line treatment to children, young people, and adults with newly diagnosed generalised tonic-clonic seizures and used in absence seizures.
- Often used in infantile epilepsy due to low toxicity and lack of sedative action.
Is valproate suitable for childbearing or potential women?
- Hepatotoxicity
- Pancreatitis
- Risk of teratogenesis - spina bifida, organ and limb malformation
what types of seizures is lamotrigine used for?
o Partial seizures
o Primary and secondary tonic-clonic seizures
o Seizures associated with Lennox-Gastaut syndrome (childhood epileptic encephalopathy)
what are the SE of lamotrigine?
- Aggression, agitation, irritability
- Arthralgia – (pains in a joint)
- Diarrhoea
- Dizziness, drowsiness
- dry mouth
- fatigue
- headache
What is the treatment guidelines for absence seizures in children?
Ethusuximide - in girls
ethusuximide or valproate for boys
then combine with lamotrigine
specialist will initiate:clobazam, clonazepam, levetiracetam, topiramate or zonisamide.
What advice should be given for topiramate?
Advise that topiramate can impair the effectiveness of hormonal contraceptives.
What is the treatment for status epilepticus?
Community- diazepam or midazolam may be given.
If the seizure stops, recovery position and airway kept clear throughout.
In hospital - IV lorazepam. If initial benzodiazepine treatment does not control the seizures, phenytoin, fosphenytoin or phenobarbital should be used. If this is not effective, anaesthetic with full intensive care may be required.
How is diazepam administered for status epilepticus?
Diazepam- as a rectal solution. The drug is absorbed quickly and although this route of administration may be thought of as unpleasant by some, it is very effective when the oral route cannot be used (medication must not be given orally during a seizure as there is a high risk of choking).
How is midazolam administered for status epilepticus
Midazolam is given as oromucosal solution – this is a small volume of liquid which is given into the buccal cavity (into the space between the gum and cheek).
What does the DVLA recommend about driving and epilepsy?
- pts shouldn’t drive during any medication changes and for 6 months after their dose change
- if a seizure occurs due to a prescribed change the driving license will be revoked for 1 year
- relicensing may be considered earlier if treatment has been reinstated for 6 months and no further seizures have occurred.
What is the treatment for focal seizures?
- Carbamazepine
- Lamotrigine
- Gabapentin
- Pregabalin
Oxcarbazepine, sodium valproate and levetiracetam may be used if first line are unsuitable or not tolerated
What is the treatment for tonic-clonic seizures?
- Sodium Valproate
- Carbamazepine
- Lamotrigine
Can tramadol be used for pts with epilepsy?
no - lowers seizure threshold
