Epileptic seizures are subdivided into:
- partial seizures = features come from one part of the brain
- simple partial = consciousness not impaired
- complex partial = consciousness impaired - usually temporal lobe, aura may preceed and automatisms may feature
- generalised seizures = features not localisable to one part of the brain
- absence = petit mal = brief <10 second pauses - 3Hz spikes
- atonic = becomes flaccid
- tonic-clonic - classic stiffening and jerking
Treatment is usually started after the second seizure. It would be started after the first if any of the following conditions apply:
- neurological deficit
- structural abnormality
- EEG unequivocal
- pt/family/carers keen for treatment
First line treatment depends on the seizure type:
- 1st line: sodium valproate
- 2nd line: lamotrigine
- 1st line: carbamezepine
- 2nd line: sodium valproate
- sodium valproate or ethosuximide
- note that carbamazepine may worsen absence seizures
Remember that both sodium valproate and lamotrigine are associated with Steven Johnson syndrome.
Cannot drive until seizure-free for 1 yr, or 3 yrs of night time only seizures.
HGV drivers need to be off meds and seizure-free for 10 yrs.
If a pt has no seizures for 2 yrs, you may consider stopping meds over 2-3 months.
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