features of generalised tonic-clonic seizures
- tonic (muscle tensing) and clonic (muscle jerking) associated with a complete loss of conciousness.
- may experience aura before seizure.
- after the seizure there is a prolonged post-ictal period (confusion, tiredness, irratibility etc).
partial (focal) seizures features
- often occur in temprol lobes, affect hearing, speech, memory and emotions.
- patients remain awake and ware during simple partial seizures but loose awareness during complex partial seizures.
- some associated symptoms: deja vu, strange smells, tastes, sight or sounds, unusual emotions, abnormal behaviours.
what is the drug of choice for treating absence seizures?
ethosuximide
what are the drugs of choice for treating partial (or focal) seizures?
lamotrigine or levetiracetam
drugs of choice for treating generalised tonic clonic seizures?
differentiate between men and women
- men and women who cannot have children»_space; sodium valproate
- women able to have children»_space; lamotrigine or levetiracetam
what are the drugs of choice for myoclonic seizures?
- men and women who cannot have children: sodium valproate
- women: levetiracetam
drugs of choice for tonic and atonic seizures?
- men: sodium valproate
- women: lamotrigine
side effects of sodium valproate
Teratogenic (harmful in pregnancy)
Liver damage and hepatitis
Hair loss
Tremor
Reduce fertility
define status epilepticus
a medical emergency defined as either:
- a seizure lasting more than 5 minutes
- multiple seizures without rgaining conciousness in the interim
what is the management of status epilepticus?
- ABCDE approach
- benzodiazepine, repeated after 5-10 mins if seizure continues
- 2nd line: IV levetiracetam, phenytoin or sodium valproate
- 3rd line: phenobarbital or general anaesthesia
what benzodiazepine options are used when treating status epilepticus?
- buccal midazolam (10mg)
- rectal diazepam (10mg)
- intravenous lorazepam (4mg)
