Epilepsy

Today, i did another BMJ Learning assessment. the topic is on epilepsy.

first line tx : Epilim (Sodium Valproate)
2nd line tx : Lamotrigine
if failed, then combine.

when to start anticonvulsant ?
- not after first unprovoked seizure episode UNLESS there are neurological deficit, abnormal EEG, abnormal brain imagining. otherwise, usually started after 2nd seizure episode.

Rectal Diazepam is safer than IV Diazepam. IV Diazepam should only be given in ICU setting.

In pregnancy, seizures does not increase in frequency and hence, do not require frequent monitoring. Antiepileptic has a low risk of teratogenic effect and is safe for breastfeeding. However, they should be started on folic acid prior to pregnancy.

If patient is fit-free for 2 years, then we can taper down the dosage slowly. If patient is on combi therapy, stop the drug one at a time.

In elderly patients, other than checking for electrolytes level, don't forget to order ECG.

Absence seizure does not have aura and lasts for a few seconds. Complex partial seizures meanwhile involves presence of aura, automatism and loss of awareness. simple partial is like complex partial but without LOA.

side effects of vigabatrin : irreversible visual field defect
side effects of phenytoin : gum hypertrophy, hirsutism, facial coarseness
side effects of carbamazepine : reacts with COCP or POP hence reducing the effectiveness. solution? increase the dosage of COCP/POP
SE if Epilim + Lamotrigine IF lamotrigine's dosage is increased fast : Steven Johnson's Syndrome