Paeds: Epilepsy georgie Flashcards Preview

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Flashcards in Paeds: Epilepsy georgie Deck (33):
1

AED for partial seizures

• Carbamezapine (first libe treatment)
• Sodium valporate
• Lamotrigine
• Topiramate
Levetiracetam

2

AEDs for Generalized

• Sodium valporate (first line teatment)
• Lamotrigine
• Topiramate
Levetiracetam

3

Complex partial
Prevalence

60%

4

Prevalence Secondary generalized tonic-clonic

60%

5

Prevalence Primary generalized tonic-clonic

30%

6

Prevalence Generalized absence

5%

7

Prevalence Generalized myoclonus

5%

8

Simple partial Prevalence

rare

9

West syndrome

age and comments

4-6 months
• Violent flexor spasms of the head, trunk and limbs followed by extension of the arms (so-called ‘salaam spasms’). Flexor spasms last 1–2 s, often multiple bursts of 20–30 spasms, often on waking, but may occur many times a day.
• Many causes; two-thirds have underlying neurological cause.
Most will subsequently lose skills and develop learning disability or epilepsy

10

Management of west syndorme

• Treatment is with vigabatrin or corticosteroids good response in 30-40%

11

Childhood absence syndrome

4-12 Years

• It is associated with brief interruptions of 3-5s in awareness, with minimal or no motor manifestation
• Accounts for 2% of epilepsy
• Prognosis is good, with 95% remission in adolescence; 5–10% may develop tonic-clonic seizures in adult life

12

childhood absence syndrome management

It responds to sodium valporate or ethosuximide

13

Juvenile myoclonic epilepsy age and presentation

• Associated with early morning myoclonic jerks
• Generalized tonic-clonic seizures occur in most
• Childhood absence seizures in 30%
• Precipitants: sleep deprivation, alcohol

14

Juvenile myoclonic epilepsy management

Best response to sodium valproate

15

Tonic-clonic generalised seizures first-line Rx

Valproate, carbamazepine

16

Tonic-clonic generalised second line

Lamotrigine
Topiramate

17

Absence generalised seizures first-line

Valproate, ethosuximide

18

Absence generalized seizures second line

Lamotrigine

19

Myoclonic generalised seizures first line

Valproate

20

Focal seizures first line

Carbamazepine or valproate
Lamotrigine shown since to be most effective - but slow titration

21

Focal seizures second line

Topiramate, levetricatam, oxcarbazepine, gabapentin, tiagabine, vigabatrin

22

Treatment info for parents

-70% of epilepsy controlled on AED therapy
- of these 80% on monotherapy, 10-15% on two drugs
30% not controlled

23

If the response is poor to AED

1. Switch to another 1st line AED as monotherapy
2. Add 2nd AED
3. Explore full range of doses
4. Avoid polytherapy
5. Surgery

24

Valproate SE

weight gain
Hair loss
Rare idiosyncratic liver failure

25

Carbamazepine/oxcarbazepine SE

Rash
Neutropenia
Hyponatraemia
Liver enzyma induction
Can interfere with other medication

26

Vigabatrin SE

Restriction of visual fields, which has limited its use
Sedation

27

Lamotrigine SE

Rash

28

Ethosuximide SE

N and V

29

Topiramate SE

Drowsiness, withdrawal and weight loss

30

Gabapentin SE

Insomnia

31

Levetiracetam SE

Sedation - rare

32

Benzos SE

Sedation
tolerance to effect
Increased secretion

33

Sudden death in epilepsy (SUDEP)

• Risk of SUDEP should be discussed with all patients (NICE)
• Not only patients with poorly controlled seizures are at risk.
• Mainly respiratory arrest (central hypoventilation)
• Risk highest in Generalized tonic-clonic seizures, also complex partial seizures of temporal origin (bradyarrythmia/ asystole)

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