Epilepsy

• What is epilepsy?


  Umbrella term for a condition where there is a tendency to have seizures

  Seizures are transient episodes of abnormal electrical activity in the brain

  NOTE: There are many different types of seizure
• What are the different types of seizures?

  Generalised Tonic-Clonic

  Focal

  Absence

  Atonic

  Myoclonic

  Infantile spasms

  Febrile convulsions
• What are generalised tonic-clonic seizures?


  Loss of consciousness + tonic (muscle tensing) + clonic (muscle jerking)

  May be associated

  • tongue biting
  • incontinence
  • groaning
  • irregular breathing

  After seizure, prolonged post-ictal period

  Person is confused, drowsy & feels irritable or low
• What is the management of generalised tonic-clonic seizures?


  Sodium valproate (1st line)

  Lamotrigine or carbamazepine
• What are focal seizures?


  Start in temporal lobes

  Affect hearing, speech, memory & emotions

  Various presentations

  • hallucinations
  • memory flashbacks
  • deja vu
  • doing strange things on autopilot
• What is the management of focal seizures?


  Carbamazepine or lamotrigine (1st line)

  Sodium valproate or levetiracetam
• What are absence seizures?


  Typically occur in children

  Pt becomes blank, stares into space & then abruptly returns to normal

  During episode - unaware of surroundings & won't response

  Typically lasts 10-20 seconds

  Most pts (90%) stop having them when they get older
• What is the treatment of absence seizures?

  Sodium valproate or ethosuximide (1st line)
• What are atonic seizures?


  Also known as drop attacks

  Characterised by brief lapses in muscle tone

  Don't usually last more than 3 mins

  Typically begin in childhood

  May be indicative of Lennox-Gastaut syndrome
• What is the treatment of atopic seizures?


  Sodium valproate (1st line)

  Lamotrigine
• What are myoclonic seizures?


  Sudden brief muscle contractions (like a sudden jump)

  Pt usually remains awake during episode

  Occur in various forms, typically happen in children
• What is the management of myoclonic seizures?


  Sodium valproate (1st line)

  Lamotrigine, levetiracetam or topiramate
• What are infantile spasms?


  Also known as West syndrome

  Rare disorder starting in infancy (around 6 months)

  Characterised by clusters of full body spasms

  Poor prognosis
• What is the treatment of infantile spasms (West syndrome)?


  Prednisolone

  Vigabatrin
• What are the DDx for epilepsy?


  Syncope

  TIA

  Migraines

  Panic disorder

  Non-Epileptic Attach Disorder (NEAD)
• What are the Inx for epilepsy?

  Obs

  Full Hx & neurological examination

  ECG

  Urine cultures

  Blood glucose

  Lumbar puncture

  Bloods (FBC, U&Es, LFTs, CRP, cultures)

  CT/MRI

  EEG
• What are the possible complications of epilepsy?


  Status epilepticus

  Psychiatric complications

  Sudden unexpected death in epilepsy (SUDEP)
• What is status epilepticus?


  Seizure lasting more than 5 mins

  Needs immediate medical intervention

  
  

  Actual definition = seizure lasting more than 30 mins, but we assume status epilepticus after 5 mins
• Why are anti-epileptic drugs given?

  Raise seizure threshold
• Give 5 anti-epileptic drugs.


  Sodium valproate (1st line for most seizures, except focal)

  Carbamazepine (1st line in focal seizures)

  Phenytoin

  Ethosuximide

  Lamotrigine
• What are the side effects of sodium valproate?


  Teratogenic

  Liver damage & hepatitis

  Hair loss

  Tremor
• What are the side effects of carbamazepine?


  Agranulocytosis

  Aplastic anaemia

  Induced the p450 system (many drug interactions)
• What are the side effects of phenytoin?


  Folate & vitamin D deficiency

  Megaloblastic anaemia (folate deficiency)

  Osteomalacia (vitamin D deficiency)
• What are the side effects of ethosuximide?


  Night terrors

  Rashes
• What are the side effects of lamotrigine?


  Stevens-Johnson syndrome or DRESS syndrome (life-threatening skin rashes)

  Leukopenia
• What is the management of seizures?


  Put pt in a safe position

  Place in recovery position (if possible)

  Put something soft under head

  Remove obstacles that could lead to injury

  Make a note of time at the start & end of seizure

  Call an ambulance if seizure lasts longer than 5 mins OR if this is their first seizure