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Flashcards in FN: Epilepsy Investigation and Management Deck (16):
1

General principles of epilepsy

1. After any seizure advise against driving, swimming, etc until a diagnosis is established
2. Dont diagnose epilepsy from a single seizure
3. Diagnosis should be made by a specialist
4. After Diagnosis, cannot drive until seizure-free for >1yr - 10 yrs for HGV (no meds)

2

Investigations

1. basic bloods: FBC, U+Es, glucose
2. SE increased Prl 10min after fit (relative to baseline)
3. Se AED levels
4. Urine toxicology
5. ECG

3

EEG

1. Use to support Dx (cannot exclude or prove)
2. Helps classification and prognosis
3. Use with hyperventilation and photic stimulation

4

Neuroimaging used and shows

Typically MRI
1. Not routine for idiopathic generalised epilepsy

5

MRI indications

Developed epilepsy as an adult
Any evidence of focal onset
Seizures continue despite 1st line Rx

6

Tonic clonic seizure first line and 2nd line treatment

Valproate
Lamotrigine

7

Abscenses 1st and 2nd line rx

Valproate/Ethosuximide
Lamotrigine

8

tonic, atonic or myoclonic 1st and 2nd line Rx

Valproate
Levetiracetam

9

Focal ± secondary generation 1st and 2nd line

Lamotrigine
CBZ

10

In women/Pregnancy Rx

1. Avoid valproate: take lamotrigine (or CBBZ)
2. 5mg folic acid daily if child-bearing age
3. CBZ and PHE are enzyme inducers and decrease the efectiveness of the OCP

11

Other Rx options apart from medical

Neurosurgical resection can be an option if a single epileptogenic focus is identified
Vagal nerve stimulation can reduced seizure freqeuncy and severity in 33%

12

Side effects of Common AEDs - enzyme effects

Inducers: CBZ, PHE and barbiturates
Inhibitors: Valproate

13

Lamotrigine SE

1. Skin rash - SJS: occurs w/i 1st 8 wks
2. Rash may be assoc. with hypersensitivity - fever, raised LFTs, DIC
3. diplopia, blurred vision
4. Levels affected by enzyme inhibitors/inducers

14

Valproate

1. Appetite increased - increased wt.
2. Liver fialure: monitor LFTs over 1st 6mo
3. Pancreatitis
4. Reversible hair loss
5. Oedema
6. Ataxia
7. Teratogenicity, tremor, thrombocytopenia
8. Encephalopathy: due to raised ammonia

15

Carbamazepie SE

Leukopenia
Skin reactions
Diplopia, blurred vision
SIADH - hyponatraemia

16

Phenytoin SE

Gingival hypertrophy
Hirsutism
Cerebellar syn.
1. Ataxia
2. Nystagmus
3. Dysarthria

Peripheral sensory neuropathy
Diplopia
Tremor

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