What are the features of a tonic clonic seizure?

Patient goes stiff, falls, convulsions.

cyanosis, incontinence, tongue biting

What are the features of absence seizures?

Patients go blank and stare.

fluttering of eyelids, head flops

lasts a few seconds

may go unnoticed

What are the features of a myoclonic seizure?

very brief jerking of arms or head or whole body

occurs after going to sleep

non-epileptic

How do simple partial seizures differ from complex partial seizures?

Simple Partial – awareness, memory and consciousness preserved

Complex Partial – one of the above not preserved

How is epilepsy diagnosed?

Clinical manifestations

EEG

Brain MRI

Describe the treatment during an epileptic seizure

Laydown patient, cushion head.

When seizure stops, turn patient to recovery position and check airway

Treatment for persistant seizure (>10min)?

Diazepam - 10-20mg, IV or rectal

What is the indication for long term AED therapy?

2 or more seizures in less than 2 years.

single seizure associated with clear brain disorder

Describe the long term AED therapy general principles?

Start with monotherapy, low dose

Increase slowly.

If alternative drug is required, add. Then gradually reduce stepwise first drug (over 2-3 months for example).

What are the 1st line AEDs? and the target Cps

Carbamazepine - 5-20 mg/L

Lamotrigine - increases Cp of valproate

Valproate - 40 mg, doesn't correlate well with clinical effects

Phenytoin - 10-20 mg/L

What are the second line drugs for tonic-clonic seizures?

Clobazam

Phenobarbitol

What is the target Cp for carbamazepine in epilepsy treatment?

5-20 mg/L

What is the desirable Cp for sodium valproate in epilepsy treatment?

40mg/L

*Though, Cp is not well correlated with its clinical effectiveness

What is the target Cp for phenytoin in epilepsy treatment?

10-20mg/L

** small dose increases produce large increase in Cp and clinical effect, non-linear PK

In what scenario would the normal dose of lamotrigine be halved.

When the epileptic patient is also taking sodium valproate.

What drugs are used in the treatment of absence seizures?

ethosuximide, lamotrigine, and valproate

*all equivalent and equal alternatives

What AED is used in the treatment of simple partial seizures?

carbamazepine

What AEDs are used in the treatment of complex partial seizures?

phenytoin, valproate, lamotrigine

How is status epilepticus treated?

clonazepam 1mg iv bolus, followed by 0.5-1mg/min iv until seizures cease; OR

diazepam 0.05mg/kg/min iv until seizure stops; OR

phenytoin 500mg iv bolus over 10 min, followed by 250mg iv as bolus every 2 hours

How is status epilepticus treated if IV not possible?

rectal diazepam

What are febrile seizures?

convulsions caused by fever in infants

How are febrile seizures treated?

phenobarbitone OR valproate

temperature reduction methods for prophylaxis

  - fanning, paracetamol, tepid bathing

Which antiepileptics make oral contraceptive unrealiable?

carbamazepine

phenytoin

phenobarbitone

Which antiepileptics have greatest risk in causing teratogeneticity? Which ones have lesser risk?

Most risk

sodium valproate and carbamazepine

Less risk

phenytoin and phenobarbitone

second-line not clear....

Why should Cp of some AEDs be monitored?

Get Cp at begining of therapy to find minimal effective dose

Ensure adverse effects are not because of excessive high dose

detect drug interactions, checking compliance

What are the adverse effects of carbamazepine that should be monitored?

skin rash

GIT upset

hyponaturamia

What adverse effects of phenytoin should be monitored?

skin rash

gum hypertophy, hirsutism (hairy)

folate deficiency

osteomalacia

ataxia(movement dysfuction), and lethargy

What are the adverse effects of sodium valproate that should be monitored?

GIT upset

weight gain

alopecia

skin rash

thrombocytopenia

What adverse effects of phenobarbitone should be monitored?

decrease in cognitive function

tolerance

skin rash

ataxia

folate deficiency

osteomalacia

What are the side effects of vigabatrin that should be monitored?

decreasing phenytoin levels

behavioural - agitation, confusion

drowsiness

ataxia, tremor

weight gain

depression

Which AEDs may disregard hepatic impairment when considering starting dose size?

vigabatrin and gabapentin

Which antiepileptic drug may cause a decrease in phenytoin Cp?

vigabatrin

Which epilepsy is gabapentin used for?

Partial seizures - 2nd line