Epilepsy Flashcards
Definition of a seizure
Abnormal firing of neurones manifesting as changes in motor control, sensory perception, behaviour and autonomic function
What is epilepsy?
Recurrent, spontaneous seizures arising from abnormal, synchronous and sustained electrical activity in the brain
What should be collected before diagnosing a patient with epilepsy?
Description of attack Family history Bloods ECG Medication history
What two tests can be used when diagnosing and classifying epilepsy and why?
MRI - to identify structural abnormalities
EEG - Classify the type of epilepsy (monitoring electrical activity in the brain)
What determines the types of epilepsy?
Area in the brain in which the seizure occurs
What are the types of partial seizures? Describe them (2)
Simple partial - General strange feelings, sometimes described as an aura, remain awake and aware
Complex partial - Loss of awareness accompanied by random body movements (smacking lips, hand/arm movements, random noises etc.), no memory of this seizure
What are the types of generalised seizures? Describe them (6)
Tonic - Muscles seize up, may lose balance and fall
Clonic - Shaking and jerking, may lose consciousness
Tonic-Clonic - Initial tonic stage, then body starts jerking (clonic stage), may have difficulty remembering
Myoclonic - Very quick, sudden twitch/jerk (like an electrical shock), normally aware
Absence - Short-term loss of awareness, may appear to be daydreaming or staring into space, unlikely to remember them
Atonic - Sudden relaxation of all muscles, may result in falling, generally able to resume normal activity soon after
What are common seizure triggers? (8)
Menstrual cycle Fatigue/Lack of sleep Stress Alcohol Flashing lights Excitement Missing meals Medication
What types of medication reduce seizure threshold? (8)
Quinolones SSRIs Tramadol Illicit drugs Tricyclic antidepressants Theophylline Antipsychotics Some penicillins
When would treatment for epilepsy be started and what is the general principle of treatment?
After second seizure
Start low, go slow
When would epilepsy treatment be initiated after a first seizure? (4)
If there is a neurological deficit present
EEG shows definitive epileptic activity
Risk of further seizure is considered unacceptable by patient
Brain imaging shows structural abnormality
When would adjunctive therapy be considered for epilepsy treatment?
If two first-line drugs have been tried as monotherapy
How should antiepileptics be switched?
Optimise second drug before withdrawing initial therapy
What should be done if combination therapy is not effective?
Revert back to regimen that has best seizure control
What can result from initiating antiepileptic therapy?
Suicidal ideation
What should all patients be given alongside antiepileptics?
Vitamin D supplements
What are MHRA category 1 AEDs and which drugs are included?
Have to prescribe same brand to prevent loss of seizure control
Phenytoin, carbamazepine, primidone, phenobarbital
What are MHRA category 2 AEDs and which drugs are included?
Decision to keep patient on same brand is down to clinical judgement
Clobazam, clonazepam, topiramate, valproate, esclicarbazepine, oxcarbazepine, rufinamide, zonisamide, perampanel, lamotrigine
What are MHRA category 3 AEDs and which drugs are included?
No need to keep patients on same brand
Ethosuxamide, lacosamide, gabapentin, pregabalin, levetiracetam, tiagabine, vigabatrin
What is antiepileptic hypersensitivity syndrome?
Rare but potentially fatal reaction to AEDs
Usually occurs within 1-8 weeks of initiating treatment
Symptoms - Fever, rash, liver dysfunction, lymphadenopathy, haematological/renal/pulmonary abnormalities, vasculitis, multi-organ failure
When could AED withdrawal be considered? How should this be actioned?
If 2 years seizure free
Under specialist, gradual withdrawal over 2-3 months, if combined therapy only one drug at a time
What should be done if a patient experiences seizures after AED withdrawal?
Reverse last reduction of treatment
What are the rules surrounding driving with epilepsy/seizures? (3)
Stop driving immediately -
If epileptic seizures (after diagnosis) - Can reapply after a year without seizures
If seizure was due to medication change or reduction - can reapply after 6 months seizure-free and on previous medication
If one-off seizure without epilepsy diagnosis - can reapply after 6 months if no seizures/medical advice states not high-risk of a recurrent seizure
What are the rules surrounding driving if having seizures whilst asleep/seizures that do not affect consciousness? (3)
Awake and asleep - If only seizures in past 3 years have been asleep, may still be able to drive
Asleep only - May still be able to drive if it has been at least 12 months since first seizure
Not affecting consciousness - May still be able to drive if these are the only type of seizures had and first was 12 months ago
Driving should still be stopped until appropriate guidance from the DVLA is received
