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Epilepsy (Medication (Focal Carbamazepine or Lamotrigine Second line =…
Epilepsy
Medication
Focal
Carbamazepine or Lamotrigine
Second line = Sodium Valproate
Generalised tonic clonic
Sodium Valproate
Second line = Lamotrigine
Third line = Carbamazepine
Absence
Ethosuximide or Sodium Valproate
Myoclonic / Tonic / Atonic
Sodium Valproate
Second line = Lamotrigine
Refractory
Carbamazepine
Infantile Spasm
Steroid (prednisolone) or Vigabatrin
Management
Buccal midazolam prescribed for those with recurrent and prolonged seizures
Counselling for girls of childbearing age - contraception, breastfeeding
Information giving:
First aid
Insurance issues
Disclosure at work/school
Road safety
Not doing dangerous sports alone
Drugs, alcohol, sleep reduction and sex (lower seizure threshold)
After a second seizure, start treatment:
Monotherapy is preferable
Where a single drug fails, replacement should be increased to a maximum and then the original drug tapered off
If seizure free for 2+ years, withdrawal can be completed over 2-3 months
Types of seizure:
Primary generalised seizures:
Tonic clonic: LOC, stiff then jerking, confusion and drowsy after
Absence: brief, pauses, presents in childhood
Myoclonic: sudden jerking of single limb/trunk
Partial/focal seizures:
Simple: no impairment of awareness, focal symptoms, no post octal symptoms
Complex: awareness impaired, commonly from temporal lobe, post-ictal confusion
Secondary generalisation: 2/3 patients with partial seizures develop into generalised convulsive seizures
Atonic
- sudden loss of tone causing fall, no LOC
Recurrent episodes of spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures.
Causes of epilepsy
66% are idiopathic (some are familial)
Cortical scarring (from head trauma)
Developmental (cortical dysgenesis)
Space occupying lesion
Stroke, vascular manifestations
Hippocampal sclerosis
Causes of seizures
Trauma, stroke, haemorrhage, ICP, alcohol withdrawal, metabolic disturbances, liver disease, infection, drugs
Signs and symptoms
Aura preceding the seizures sometimes
Feeling of deja vu / flashing lights / strange smells common
Post-ictally - drowsiness, confusion, myalgia
Tongue biting
Slow recovery
Investigations
All those with recent suspected seizure should be seen by a specialist
Bloods (FBC, U&E, Ca, drugs screen, infection screen
ECG (?arrythmia)
MRI (done in those <2, >18 with new diagnosis) and with focal onset of seizures
DVLA
Must inform DVLA after any epileptic attacks
DVLA will ask more questions and make decision about license
Must be seizure free for 1 year before driving again