epilepsy

Question 1

seizure vs epilepsy

Answer 1

seizure = single episode
epilepsy = >2 unprovoked seizures

not all people with seizures have epilepsy.
all people with epilepsy have seizures

Question 2

idiopathic generalised epilepsy characteristics

Answer 2

• appears in childhood/adolescence
• can be: absence, generalised, myoclonic

Question 3

idiopathic partial epilepsy characteristics

Answer 3

• begins in childhood, outgrown by puberty
• never diagnosed in adulthood
• seizures occur during sleep
• partial motor- seizure involving face

Question 4

evidence of high risk for recurrence
[3]

Answer 4

1. previous seizure
2. epileptiform EEG
3. abnormal brain scan

Question 5

evidence of low risk for recurrence [3]`

Answer 5

• single seizure
• normal EEG
• normal brain scan

Question 6

types of generalised seizures [5]

Answer 6

1. generalised tonic clonic (grand mal)
2. absence (petit mal)
3. myoclonic
4. clonic
5. tonic
6. atonic

Question 7

Generalised tonic-clonic seizure (grand mal) characteristics

Answer 7

1. unconsciousness
2. body stiffening (tonic)
3. violent jerking (clonic)
4. deep sleep (postictal)

• shrill cry, apnoea, incontinence, dilated pupils

Question 7

absence (petit mal) characteristics

Answer 7

• sudden behavioural arrest
• 1-15 sec
• brief LOC
• interrupts activity, may occur several times a day

Question 8

myoclonic characteristics

Answer 8

• bilateral sporadic jerks

Question 9

clonic characteristics

Answer 9

bilateral rhythmic jerks

Question 9

tonic characteristics

Answer 9

muscle stiffness, rigidity

Question 10

atonic characteristics

Answer 10

• loss of muscle tone in 4 limbs

Question 11

types of partial seizures [3]

Answer 11

1. simple
2. complex
3. partial with 2ndary generalisation

Question 12

phenytoin MOA

Answer 12

block Na channels –> decrease membrane excitability

Question 13

phenytoin considerations [3]

Answer 13

• narrow therapeutic range
• non-linear r/s btw dose & serum conc. > req frequent monitoring
• teratogenetic –> contraindicated for pregnancy

Question 14

carbamazepine MOA

Answer 14

block Na channels –> reduce membrane excitability

Question 15

carbamazepine considerations

Answer 15

• accelerates elimination of other drugs (hepatic enzyme CYP450 inducer, half-life shortens with repeated doses)
• aplastic anemia: rare but severe S/E

Question 16

which drugs block Na channels to reduce membrane excitability

Answer 16

phenytoin and carbamazepine

Question 17

valporate MOA [2]

Answer 17

1. block Na & Ca channels
2. increase GABA (inhibitory neurotransmitter)

Question 18

can valporate be used for all seizures

Answer 18

yes

Question 19

can phenytoin be used for all seizures

Answer 19

no, not for absence seizures

Question 20

can carbamazepine be used for all seizures

Answer 20

no, not for absence seizures

Question 21

general antiepileptic dose-related side effects

Answer 21

• drowsiness, confusion, mental changes
• nystagmus
• ataxia
• slurred spech
• nausea

Question 21

valporate considerations

Answer 21

strongly binds to plasma proteins and DISPLACES OTHER ANTIEPILEPTICS

Question 22

general antiepileptic non dose related side effects [6]

Answer 22

- hirsutism (abnormal hair growth_ - acne - gingival hyperplasia - folate deficiency - osteomalacia (bone tissue softening) - hypersensitivity (steven-johnson)

Question 23

benzodiazepine MOA

Answer 23

enhance GABA

Question 24

benzodiazepines onset of action

Answer 24

short: hours intermediate: up to 24h long: >24h

Question 25

which type of benzodiazepines are used for seizures?

Answer 25

intermediate & long acting - used for refractory seizures (not controlled w first line) and status epilepticus

Question 26

simple seizures characteristics

Answer 26

- no LOC - motor: jerking, muscle rigidity, spasm, head turning - sensory

Question 27

complex seizures characteristics

Answer 27

- automatism, involuntary but coordinated movement - no awareness of what they are doing but no LOC

Question 28

partial seizure with secondary generalisation characteristics

Answer 28

initially associated with preservation of consciousness & evolves into LOC & convulsions

Question 29

nursing management for seizure [5]

Answer 29

- maintain airway > turn to side, monitor SpO2 - oral suctioning - establish IV access (med adm) - mark serizure start time, observe duration & characteristics - protect from hitting hard surfaces

Question 30

which drug can be used for absence seizures

Answer 30

sodium valporate

Question 31

when to test antiepileptic drug levels

Answer 31

- assess compliance - possible antiepileptic drug toxicity - titration of dose - routine testing is not required