PR - CNS > EPILEPSY > Flashcards

EPILEPSY Flashcards

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1
Q

What is epilepsy?

A

Common condition that affects the brain and causes frequent seizures

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2
Q

What are the types of seizures?

A
  1. Focal
  2. Generalised
  3. Status epilepticus
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3
Q

What is a FOCAL seizure?

A
  • Affects one hemisphere
  • Can become generalised
  • Patient aware they are having a seizure
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4
Q

What is a GENERALISED seizure?

A
  • Can affect both hemispheres
  • Typically associated with impaired awareness (unconscious, pt may not know they’ve had a seizure)
    o Tonic clonic
    o Absence
    o Atonic
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5
Q

What is the FIRST line treatment for FOCAL seizures?

A

Lamotrigine
Levetiracetam

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6
Q

What is the SECOND line treatment for FOCAL seizures?

A

Carbamazepine
Oxcarbazepine
Zonisamide

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7
Q

What is the treatment for TONIC CLONIC seizures?

A
  1. SV
  2. L/L
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8
Q

What is the treatment for ABSENCE seizures?

A
  1. E
  2. SV
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9
Q

What is the treatment for ABSENCE + OTHER seizures?

A
  1. SV
  2. L/L
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10
Q

What is the treatment for MYOCLONIC seizures?

A
  1. SV
  2. Levetiracetam
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11
Q

What is the treatment for ATONIC/TONIC seizures?

A
  1. SV
  2. Lamotrigine
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12
Q

Should women take first or second line?

A
  • Women to take second-line option if at child bearing potential age – currently or in the future.
  • Except for in absence
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13
Q

What is SUDEP?

A

Sudden Unexpected Death in Epilepsy (SUDEP)
* Rare
* Person dies during or following seizure

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14
Q

What are the risk factors for SUDEP?

A
  • Uncontrolled/poorly controlled seizures
  • Frequent seizures
  • Nocturnal seizures
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15
Q

What is the non-pharmacological treatment for management of seizures?

A
  • Write seizure in a seizure diary: date, time, brought on by any certain activity, day time, night time
  • Protect from injury
  • Do not restrain them or put anything in their mouth
  • Check airways and place in recovery position
  • Observe until recovered
  • Examine for injuries
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16
Q

What is status epilepticus?

A

Seizure last more than 5 mins/ recurrent seizure with no recovery

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17
Q

FIRST line treatment of SE in community

A

Buccal midazolam or
PR diazepam

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18
Q

FIRST line treatment of SE in hospital

A

IV lorazepam

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19
Q

What do we give if there is no response within 5-10 mins of first line treatment for SE?

A

NO RESPONSE within 5-10mins of 1st dose = 2nd DOSE

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20
Q

SECOND line treatment of SE

A

LEVETIRACETAM, PHENYTOIN, SV
- If no response, try a different 2nd line
- If still no response = phenobarbital or
general anaesthesia

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21
Q

When would you call an ambulance for SE?

A
  • Call ambulance for urgent hospital admission if seizures DO NOT respond promptly to treatment
  • Call an ambulance for urgent hospital admission if seizures DO respond to treatment but:
    a. Seizures were prolonged or recurrent before treatment
    b. High risk of recurrence
    c. Difficulties monitoring persons conditions
    d. First seizure
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22
Q

Category 1 AEDs

A
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Primidone
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23
Q

Category 2 AEDs

A
  • Clobazam
  • Clonazepam
  • Lamotrigine
  • Oxcarbazepine
  • Perampanel
  • Rufinamide
  • Topiramate
  • Valproate
  • Zonisamide
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24
Q

Category 3 AEDs

A
  • Brivaracetam
  • Leveiracetam
  • Ethosuximide
  • Gabapentin
  • Lacosamide
  • Pregabalin
  • Tiagabine
  • Vigabatrin
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25
Which drugs interact with AEDs to cause hepatotoxicity?
- amiodarone - itraconazole - macrolides (mycins) - alcohol
26
Which AEDs are CYP enzymes INDUCERS?
- carbamazepine - phenytoin - phenobarbital
27
Phenytoin as an enzyme inducer
Reduces conc of - hormonal concentreptive/ HRT - warfarin - levothyroxine Causes increased antifolaxe effect with methotrexate and trimethoprim
28
Which drugs interact with AEDs to lower seizure threshold?
o Tramadol o Theophylline o Quinolones
29
What are the SFx of Carbamazepine?
* Oedema * Hyponatraemia
30
What drugs should you avoid with carbamazepine?
Hyponatraemic drugs - SSRIS - Diuretics
31
What are the SFx of Phenytoin?
- Antifolate reaction - Coarsening appearance e.g. gingivitis + facial hair
32
What drugs should you avoid with Phenytoin?
Anti-folates - methotrexate - trimethoprim can lead to blood dyscrasias
33
What is blood dyscrasia
An imbalance of the four bodily fluids - blood, bile, lymph, phlegm
34
AEDs SFx general
* Depression + suicide * Hepatotoxicity * Hypersensitivity: CPPPLamo * Blood dyscrasia: C,V,E,T,Phen,Lamo,Z (C VET PLZ) * Vit d def * Skin rash e.g. stevens-johnsons syndrome: lamotrigine * Eye disorder o Vigabatrin (reduces visual field) o Topiramate (secondary glaucoma) * Encephalopathy: Vigabatrin * Respiratory depression: Gabapentin, pregabalin
35
What is the therapeutic range for carbamazepine?
4-12mg/L
36
What is the therapeutic range for Phenytoin?
10-20mg/L
37
What are the signs of toxicity of carbamazepine?
Hyponatraemia Ataxia Nystagmus Drowsiness Blurred vision Arrythmias Gastrointestinal disturbances
38
What are the signs of toxicity of Phenytoin?
Slurred speech Nystagmus Ataxia Confusion Hyperglycaemia Double vision
39
What AEDs cause blood dyscrasia?
Carbamazepine Valproate Ethosuxidimide Topiramate Phenytoin Lamotrigine Zonisamide C VET PLZ
40
Which AED reduces visual field?
Vigabatrin
41
Which AED causes encephalopathy?
Vigabatrin
42
Which AED can cause secondary glaucoma
topiramate
43
Which AEDS can cause respiratory depression
Gabapentin Pregabalin
44
When would you consider Vit D supplementation in epileptic patients
- In those who are immobilised for long period of time - Inadequate sun exposure or dietary intake of Ca
45
Monitoring for AEDs
- Test for HLA-B* 1502 allele in individuals of Han Chinese or Thai origin - Risk of SIS - Plasma conc - Renal - Hepatic
46
What is the dose equivalence between phenytoin sodium and the phenytoin base
100mg of phenytoin sodium is approx equivalent in therapeutic effect to 92mg phenytoin base
47
Driving with epilepsy: 1st unprovoked/ single isolated
- Driver must stop immediately and inform the DVLA - must not drive for 6 months
48
Driving with epilepsy: established epilepsy
o 1 year (or pattern of seizures established for 1 year with no impact on consciousness)
49
Driving with epilepsy: seizure while asleep
o Not permitted to drive for 1 yr
50
Driving with epilepsy: med change withdrawal
o Should not drive for 6 months after last dose o Seizure occurs: license revoke for 1 year, reinstated after 6 months if treatment resumed and no further seizures occurred
51
Teratogenicity and sodium valproate
* Increased risk of teratogenicity associated with the use of AEDs o Valproate highly teratogenic o Congenital malformations and neurodevelopmental disorders
52
What are safer alternative to sodium valproate
lamotrigine levetiracetam
53
What is the risk to babies of topiramate
cleft palate
54
Folic acid in pregnancy
reduces the risk of neural tube defects in 1st trimester
55
Vitamin K injection in pregnancy
administered at birth to minimises risk of neonatal haemorrhage o Phytomenadione
56
What should infants be monitored for
o Sedation o feeding difficulties o adequate weight gain o developmental milestones
57
BREASTFEEDING: high presence in breast milk
Primidone, Etho, Lamo, Z (PELZ)
58
BREASTFEEDING: Risk of drowsiness
Primidone, Phenobarbital, Benzodiazepines
59
BREASTFEEDING: Withdrawal effects
Phenobarbital, Primidone, Benzodiazepines, Lamotrigine
60
AEDS and suicidal thoughts and behaviour
* Symptoms may occur as early as 1 week after starting treatment. * Patients advised to seek medical advice of any mood changes, distressing thoughts, or feelings about suicide or self-harming develop
60
Antiepileptic hypersensitivity syndrome
Rare * Potentially fatal syndrome associated with: o carbamazepine lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide
61
When do symptoms of Antiepileptic hypersensitivity syndrome begin to present?
Symptoms start between 1 and 8 weeks of exposure
62
What are the symptoms of Antiepileptic hypersensitivity syndrome
fever, rash, and lymphadenopathy * If signs hypersensitivity syndrome occur, the drug should be withdrawn.
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