Epilepsy Flashcards
What are the two main types of generalised seizure?
- Tonic-clonic (grand mal) - rigidity then shaking
- Typical absence (petit mal)
Which AED is first line therapy for every type of epileptic seizure apart from focal seizures? Suggest a reason why this first line therapy may contra-indicated and therefore suggest what the
Sodium valproate.
This could be contra-indicated in pregnancy and therefore the safer drug to use would be lamotrigine.
Which two AEDs can be used to treat focal (partial) seizures?
- Lamotrigine
- Carbamazepine
Other than sodium valproate, suggest an AED that can be used to treat a petit-mal (typical absence) seizure? Why is this a good drug for use in this type of seizure?
Ethosuximide as it blocks T-type calcium channels which are implicated in typical absence seizures.
Suggest TWO parts of a history/examination that would suggest the patient has had an epileptic seizure. (as opposed to a different type)
- Biting side of the tongue
- Prolonged recovery from the seizure
Which type of epileptic seizures are commonly preceded by a psychomotor warning aura? (burning rubber etc.)
Partial (focal) seizure
Which two drugs are commonly used in the treatment of status epilepticus?
- Benzodiazepines (lorazepam)
- Phenytoin
Suggest some common ADRs of sodium valproate.
- GI
- Headache, diplopia, strabismus
- Tremor
- Hormone disturbances
There are shitloads of them.
Suggest some possible ADRs of lamotrigine.
- Skin reactions (Steven-Johnsons) so things like rash, fever, fatigue (also seen with phenytoin)
- Headache, diplopia, strabismus
Generally, how do both lamotrigine & carbamazepine work?
Inhibition of Na+ channels prolongs inactivation state & reduces AP firing.
How would you reduce the risk of teratogenicity when treating a women with lamotrigine?
- Vitamin K supplements
- Folates
How does sodium valproate work?
Enhances GABA activity:
- Increased production of GABA in the brain
- Reduced breakdown by inhibiting GABA inactivating enzymes
