what investigations are indicated after a first fit
blood test and ECG
EEG- usefull for categorizing epilepsy
Sleep recordings and 24h EEG
MRI - not essential in young pts with electro-clinical diagnosis of PGE
How can prolonged seizure or repeated seizure be terminated
rectal diazepam
IV lorazepam
buccal midazolam
What is status epilepticus
medical emergency
Continous seizures for 30 mins or longer (or 2+ seizures without recovery of consciousness between)
Mortality 10-15 percent
Rhabdomyolisis may lead to AKI
50 percent occur without previous epilepsy history
can be absence seizures too - ie a continuous state of stuporose
What is first line Tx for partial/focal seizures
carbamazepine
Lamotrigine
What is second line/add on drugs for partial seizures
gabapentin
Tiagabine
Pregabalin
What is first line treatment for absence seizures
Sodium valoproate
Ethosuximide
What is first line treatment for myoclonic seizures
sodium valproate
levetiracetam
clonazepam
What is first line treatment for GTCS
sodium valproate
levetiracetam
What is second line/add on treatment for GTCS
phenobarbital
clobazam
Which drug can make PGE worse
carbamazepine
Oxcarbazepine
what are the side effects of sodium valproate
weight gain, tetatrogenic, hair loss, fatigue
whne is phenytoin used
Acute management only eg status epilepticus
what are the side effects ot topiramate
sedation
dysphasia
weight loss
What is the side effect of levetiracetam
mood swings
Which anticonvulsants induced hepatic enyzmes
carbamazepine, phenobarbital, phenytoin, primidone, topiramate
Why is it important to consider the enzyme inducing effects of anticonvulsants
Alters efficacy of COC, progesterone implants and POP
If on depot progesterone then need more frequent dosing
morning after pill not adequete
when can withdrawal from AEDs be considered
if seizure free for 2-3 yrs
50 percent reccurence rate with withdrawal
when is surgery indicated
temporal lobectomy will result in seizure freedom in 50-70 percent of pts with uncontrolled seizures due to hippocampal sclerosis
