L9 Epilepsy Lecture Notes PDF

EPILEPSY  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptom...

EPILEPSY  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  A seizure is a single occurrence of sudden, uncontrolled electrical disturbance in the brain. Epilepsy is a brain disorder characterized by two or more unprovoked seizures. Epilepsy syndrome refers to a specific set of clinical features that define a unique type of epilepsy: Definition Childhood Absence Epilepsy: Characterized by frequent absence seizures in children, typically with a good prognosis. Lennox-Gastaut Syndrome: A severe form of epilepsy that includes multiple types of seizures and often has a poor prognosis. Juvenile Myoclonic Epilepsy: Features myoclonic jerks, typically in the morning, with a strong genetic component.  Theory: Excessive electrical activity due to imbalance of excitatory (e.g. glutamate) and inhibitory neurotransmitter (e.g. GABA) Pathophysiology  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug. Classification of Seizures Seizures are divided into groups depending on: The onset of a seizure (where they start in the brain) Level of awareness Whether movements happen during a seizure  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug. Motor Symptoms Myoclonus: Muscle twitching Clonic: Muscle jerking Motor Symptoms Tonic: Muscle rigidity Atonic: Weak muscle Non-Motor Symptoms Absence: Blanking Absence: staring Absence seizure : main symptoms do not involve muscle movement  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  Any injury to the brain: Bleeding, Swelling in the brain, Lack of oxygen to the brain, Stroke, Brain tumors, Infections such as meningitis Risk factors Children: Small size at birth, Seizures in the first month of life, Problems with the structure of the brain, Having seizures due to high fever Genetics (1 in 3 people with epilepsy have a family member who also has it) At least TWO (2) unprovoked seizures occurring more than 24 hours apart Diagnosis Assessments by Neurologist, these include EEG (electroencephalogram) tests and CT or MRI scans Difficulty learning, aspiration pneumonia, injury from Complications falls/driving/operating machinery during a seizure, mood problems, permanent brain damage.  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  Non- Surgery to remove a small part of the brain that's causing the seizures pharmacological A procedure to put a small electrical device inside the body that can treatments help control seizures (Vagus nerve stimulator) Avoid swimming or using dangerous things alone Avoid triggers (individual) – lack of sleep/Stress Keep a diary of your seizures Don’t stop taking or change dose Lifestyle advice Make sure don’t run out of meds When to call 999? ❑ first time seizure ❑ Seizure that last more than 5 minutes or more than 1 seizure within 5 min period without returning to a normal consciousness (status epilepticus) ❑ Injured during seizure  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  Mechanism of Actions High-voltage- Activated Calcium channel blocker Voltage-gate sodium ion AMPA receptor channel blocker blocker Inhibit GABA Inhibit reuptake glutamate release Inhibit GABA transferase NMDA receptor blocker Calcium channel GABA receptor 1. Inhibit glutamate activity blocker agonist 2. Potentiate/increase GABA activity  Examples Lamotrigine Topiramate Carbamazepine Gabapentin Oxcarbazepine Pregabalin Lamotrigine Topiramate Phenytoin Topiramate Zonisamide Tiagabine Levetiracetam Vigabatrin Felbamate Zonisamide Benzodiazepine Barbiturate  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug. Examples, Brand and Generic Name of AED IV/IM/Rectal BZD usually used for acute treatment of epilepsy  General: nausea, abdominal pain, dizziness, sleepiness, irritability, anxiety or mood changes. Phenytoin: Hirsutism Gingival hyperplasia Cleft palate Side Carbamazepine/Oxcarbazepine: effects Diplopia Bruising Jaundice Carbamazepine, phenobarbital, phenytoin and sodium valproate may cause thinner and brittle bones: (vitamins, exercise) Phenobarbital and BZD: Tolerance, dependence, respiratory depression  Objectives At the end of this lecture, students should be able to: 1. Understand the definition and pathophysiology of epilepsy. 2. Determine the classification of epilepsy according to onset, level of awareness and involvement of movements. 3. Identify motor and non-motor symptoms of epilepsy 4. Understand the risk factors, diagnosis and complications of epilepsy 5. Determine non-pharmacological treatment and lifestyle advices of epilepsy 6. Differentiate the drugs used for Epilepsy (mechanism of actions) 7. List the examples, side effects, generic and trade names of antiepileptic drugs 8. Understand the general information regarding antiepileptic drug.  General Information Facts: They do not cure epilepsy, but aim to try and stop seizures happening Factors to consider: seizure types, concomitant medications, comorbidity, age, sex Some are used for neuropathic pain; Gabapentin, Pregabalin AEDs are taken at regular times each day – may trigger seizure if missed Antiepileptic Hypersensitivity Syndrome: may cause fever, rash and other multiorgan abnormalities. (even fatal) Unknown mechanism Cross-sensitivity; phenytoin, carbamazepine, phenobarbital and lamotrigine  General Information When to start: Once diagnosed, start low, taper up according to response, take weeks to months to achieve maintenance dose When to stop: Gradually withdrawn, for multiple, one drug at a time, after at least 2 years seizure free Drug interactions: Enzyme inducers: Phenytoin, Carbamazepine, Phenobarbital Enzyme inhibitors: Sodium valproate Oral contraceptives : COC become less effective when combined with enzyme inducers (hence use other contraception methods or double dose COC)  General Information Pregnancy and breastfeeding Valproate is teratogenic – it increases the risk of neural tube defects in newborn by disrupting folate metabolism and causing oxidative stress, both of which harm neural tube development. If seizure not a threat during pregnancy – usually withdraw drug, then continue starting 3rd trimester If taking AED during pregnancy – must take folate supplementation + vitamin K injection to the newborn to minimise risk of neonatal haemorrhage associated with AED Safer in pregnancy: Carbamazepine, oxcarbazepine, lamotrigine Ok for breastfeeding if monotherapy/closed monitoring  General Information Add or change: One to two drugs – add another AED to patient who are still having seizures Two to three drugs – switch one AED to another to patient who are still having seizures Patient experienced unacceptable side effects – change AED How to change: Slowly withdraw the first drug when the new regimen has been established– ensure that there is always enough medicine in your body to control seizures. General Information  General Information – AED not working? The person may not be taking their AED regularly The person’s epilepsy itself may have changed The cause of the person’s epilepsy may have changed The person’s body may have got used to the AED, so it no longer works