-
what is the differential diagnosis of gum hypertrophy?
- pregnancy
- scurvy
- acute monocytic leukaemia
- familial gingival fibroplasia
- drugs: phenytoin, nifedipine, ciclosporin, ACEi
-
how would you evaluate a person with a FIRST ever seizure?
- 1. really 1st one? family, deja vu
- 2. really a seizure? witness
- 3. was a seizure provoked? CNS insult (alcohol, head injury, stroke, hypoglycaemia or drugs such as clozapine, tramadol), temp high, electrolytes
- 4. was seizure unprovoked? higher chance recurrence
- 5. was seizure triggered? strobe lighting, tv?
-
what investigations need do be done in a first time seizure?
- REFER TO CONSULTANT NEUROLOGIST
- Blood: FBC, U&E, LFT, glucose, calcium, INR, alcohol and drug toxin screen (serum and urine), LP (if CT shows no increase in ICP)
- Imaging: CT, MRI brain
- EEG
- ECG: arrhythmia, long QT (if miss this, AED very cardiotoxic!)
- Cardiac echo
-
what is the differential diagnosis of seizures?
- syncope
- TIA
- hypoglycaemia
- Drug/alcohol intoxication
- Migraine
- Clonus
- Hyperventilation
- Narcolepsy
- Breath holding spell: episodes of apnoea esp. in children may get LOC
-
what are the precipitants of a seizure? meaning and example
- precipitants: lower the seizure THRESHOLD. if diagnosed with epilepsy, should avoid theses precipitants
- febrile illness
- hyperventilation
- sleep deprivation
- emotional stress
- physical or mental exhaustion
- photic stimulation: flickering lights
- drugs
- alcohol intoxication or withdrawal
-
what are the rules for epilepsy and driving?
- 1. patient must inform the DVLA themselves and tell them about their seizure
- 2. if 12 months seizure free then can drive
- 3. if only night/sleep seizures for 3 years then can drive
- 4. if the patient had a SINGLE seizure with a normal MRI and EEG, they can drive after 6 months
-
which drugs are used for generalised seizures?
- sodium valproate
- lamotrigine
-
which drugs are used for partial seizures?
- carbamazepine
- sodium valproate
- lamotrigine
-
which ant-epileptic drug is safest in pregnancy and breast feeding?
carbamazepine
-
which info about AED needs to be given to the patient?
- side effects
- dosage schedule, what happens if missed dose
- interactions: OCP, NSAIDS
- pregnancy
-
how is AED treatment started?
- one drug initially
- build UP dose
- note there will be initial side effects but have to continue to take (dizzy)
- if one monotherapy doesn't work then try ANOTHER MONOTHERAPY BEFORE DUAL
-
how is the progress monitored?
- seizure frequency
- drug levels
- side effects
-
what is the termination policy for AED?
- if been seizure free on drug after 3 years then can stop
- unfavourable factors for stopping: seizure on AEDs, need for >1 drug
- favourable factors for stopping: increased length of remission on trial
-
what are the 2 main SE of carbamazepine?
-
what is the dose-serum level relationship?
LINEAR
-
what is carbamazepine used for?
- partial seizures
- and tonic-clonic seizures with PARTIAL ONSET
-
which other drug must you be careful to take with carbamazepine?
OCP as cbz is hepatic enzyme inducer so could get pregnant on it
-
what is sodium valproate used for?
drug of choice for primary GENERALISED epilepsy
-
what are the SE of valproate?
- teratogenic
- acute hepatitis
- weight gain
- tremor at high dose
- hair thinning
-
what effect does valproate have on hepatic enzymes?
INHIBITS liver enzymes
-
what is the mechanism of action of valproate?
increased GABA activity/secretion
-
what is lamotrigine used for?
monotherapy or adjunctive for ALL types of seizure
-
what are the side effects of lamotrigine?
- rash
- stephen-johnson's syndrome
- toxic epidermal necrolysis
- GI symp
- psych symp
- blood dyscrasias
-
what is phenytoin used for?
tonic clonic seizures
-
what are the side effects of phenytoin?
- hirsutism
- weight gain
- acne
- gum hypertrophy
-
what happens in overdose of phenytoin?
- sedation
- cerebellar syndrome
-
if a pregnant women needs AED what needs to be done?
- risk of AED v risk of seizure
- refer to specialist
- all cause neural tube defects: counsel the pt
- offer screening for neural tube defects: aFP
- give folate supplementation
- breastfeeding: cbz is ok
-
name some drugs which are hepatic enzyme inducers and their effects on specific drugs
- phenytoin
- phenobarbitone
- carbamazepine
- rifampicin
- effects: reduced AED, warfarin and OCP effect so seizure, clot and pregnant!
-
name some drugs which are hepatic enzyme inhibitors
- sodium valproate
- allopurinol
- amiodarone
- erythromycin
- effects: increase AED, warfarin and oral hypoglycaemic
-
which drugs have high protein bindings? and which drugs can displace them?
- valproate
- phenytoin
- displaced by: warfarin, NSAIDs, AEDs
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