6 possible triggers of a isolated seizure
- CNS infection/inflammation
- Stroboscopic lighting
- Metabolic dysfunction
- Head injury
- Fever (especially in children)
- Drug-related (prescription and recreational)
6 co-morbidities
- Cognitive decline (drug and disease-related)
- Anxiety
- Depression
- Agitation, anger and emotional outbursts
- Suicide (5-15x more likely)
- ADHD
- Reproductive problems (male and female)
- Insomnia
- Migraine
what is the 4 types of seizure and what generally happens
- Generalised: involves the whole brain (e.g. tonic-clonic or absence seizures)
- Partial: Just involves one specific brain area
- Secondary generalisation: partial seizures can spread to affect the whole brain.
- Simple/complex: whether consciousness is impaired/affected.
3 parts to a tonic clonic seizure
- Limb extension and rigidity, respiration stops, defaecation, micturation and salivation often occur (~1 min).
- Followed by violent synchronous jerks (~2-4 mins).
- Patient gradually regains consciousness after a few more minutes and is likely to feel confused, ill and disorientated
2 steps generalised absence seizure and occurance
- Less physically dramatic but may occur more frequently.
- Patient typically ceases any action, stares vacantly ahead, unaware of surroundings, dangers, other people.
- Patient recovers very quickly with no after-effects
2 partial symptopms what and how
- Seizure discharge begins and typically remains restricted to a local brain area.
- Accompanied by simple symptoms (involuntary movements, abnormal sensory experiences) but rarely loss of consciousness.
pathway for drug therapy
1st seizure that is likely to recur or second seizure then give 1st choice monotherapy
if not work/toxic try 2nd choice then dual therapy add adjunctive drug then alernatice dual therapy, lastly reassess and considert vagal nerve stimualtion or surgery
at any point if control acheived the monior and contiue the consider withdrawl after adequate seizure free time
how sodium channel blockers work and example
- Action potential generation is dependent upon the opening of voltage-gated sodium channels.
- Inhibition of these channels has been found to prevent or ameliorate seizures.
- e.g. phenytoin, carbamazepine, carisbamate, valproate
how enhancement of GABA actions work and example
- Enhancement of GABA-mediated Cl- channels increase inhibition and attenuates seizures.
- e.g. phenobarbitone, diazepam
1st line AEDs and adjunctive AEDs for most
AED - sodium valporate
adjunctive AED - lamotragine
