Lesson 5 mindmap by Zoe Soo

Epilepsy*

zoe_soo1 — 2020-11-16 05:48:08 UTC

risk factors

zoe_soo1 — 2020-11-16 05:48:14 UTC

- babies who are born small for their age
- babies who have seizures in their first months [jiezi]
- babies who are born with abnormal areas in the brain [jiezi]
- family history of epilepsy [jiezi]
- brain tumours [jiezi]
- cerebral palsy [Arbanah]
-Alzheimer's disease [Arbanah]
-Autism spectrum disorder
-conditions with intellectual and developmental disabilities
- Use of illegal drugs such as cocaine
- brain tumors (jolyn)
- family history of epilepsy or fever-related seizures (jolyn)
- abnormal blood vessel in the brain

pathophysiology

zoe_soo1 — 2020-11-16 05:48:32 UTC

- neurons are synchronously active (fatin)
- when there is an imbalance between the excitatory (glutamate) and inhibitory (GABA) forces within the network of cortical neurons in favor of a sudden-onset of net excitation (increase of excitation or decrease in inhibition)
- fast or long-lasting activation of NMDA receptors --> too much excitation
- GABA receptors are not able to inhibit signals --> dysfunctional --> too little inhibition [due to genetic mutation, brain tumors, brain injuries or infection]

types of seizures*

zoe_soo1 — 2020-11-16 05:48:46 UTC

partial seizures (focus on explanation)

zoe_soo1 — 2020-11-16 05:49:06 UTC

Seizures that initially affect one specific area in one hemisphere of the brain.
- May or may not cause an alteration of consciousness
- Symptoms include muscle twitching, repetitive motions and the appearance of "daydreaming"
Partial seizures can become generalised seizures

types:
- Simple (without impairing consciousness)
-Complex
- Secondary generalised

generalised seizures (focus on explanation)

zoe_soo1 — 2020-11-16 05:49:38 UTC

- seizures that affects BOTH hemispheres of the brain
- results in a loss of consciousness
- symptoms include blank stares, falling to floor, sudden muscle jerks, repetitive contracting and relaxing of muscles

tonic clonic seizures (list down the symptoms)

zoe_soo1 — 2020-11-16 05:49:56 UTC

Both tonic and clonic phase

Tonic phase:
- Muscle suddenly become stiff --> patient to fall backwards, loss of consciousness, extension of arms, legs, face, fingers and jaw clenched

Autonomic symptoms: increased blood pressure and heart rate, increased bladder pressure, flushing, sweating, increased salivation, bronchial secretion, apnoea

Clonic phase:
- Muscles relax completely and muscle tone returns
- Produces rhythmic jerks of the body and head (also known as convulsions)
- In the postictal phase drooling, biting of the tongue, cheek, or lip ; and urinary incontinence are common

Summary:
Patient would fall backwards due to stiff muscles (tonic) then experience convulsions (clonic)

others (just list down the name)

zoe_soo1 — 2020-11-16 05:50:04 UTC

1. Absence
2. Myoclonic
3. Clonic
4. Atonic
5. Tonic
6. Infantile spasms

complications

zoe_soo1 — 2020-11-16 05:51:04 UTC

1. Status epilepticus (medical emergency!)
- seizures that last more than 5 mins or longer
- can develop in any type of condition; most common: tonic-clonic seizures
- cause brain damage and can be fatal

2. Sudden unexplained Death in Epilepsy (SUDEP)
--> small percentage of people with epilepsy

management

zoe_soo1 — 2020-11-16 05:51:44 UTC

how to select the meds?

zoe_soo1 — 2020-11-16 05:52:16 UTC

Selecting Drug according to
-Gender(child bearing age)
-previous medical history.
- Cost
- lifestyle
-concurrent medications

- which drug would be the best fit for the patient as a whole (E.g. Valproic acid is not recommended for patients who are overweight/obese, as it has the highest risk of weight gain as a side effect. Another medication can be given instead) -

Carbamazepine

zoe_soo1 — 2020-11-16 05:52:37 UTC

- Indication: generalized tonic-clonic and partial seizures (first line!)
- Dose: 100-200mg OD-BD (initial)
800mg to 1200mg daily in divided doses (usual)
Max dose 2g daily in divided dose
- Side effects: Dizziness, drowsiness, dry mouth, headaches, hyponatraemia, blood dyscrasias, suicidal thoughts or behavior and heptototoxicity

CYP inducer

other (non first line/ going further)

zoe_soo1 — 2020-11-16 07:30:24 UTC

1. Phenobarbitone
2. Topiramate

Valproic Acid

190066401 — 2020-11-16 07:36:38 UTC

Indication: All types of Epilepsy
Dose: Initial 600mg twice daily; Once daily for CR tablets
Maintenance dose: 1-2 g daily, Max 2.5g per day

Common S/E: Dizziness, drowsiness, Increased appetite, suicidal thoughts and behaviours, hyponatremia

Valproate is a potent CPY 450 inhibitor. (2C9)
Substrate of: CYP2A6 (minor), CYP2B6 (minor), CYP2C19 (minor), CYP2C9 (minor), CYP2E1 (minor)

Anti-Epileptics

2020-11-16 07:37:35 UTC

Levetiracetam

2020-11-16 07:38:31 UTC

Dose
- Initial: 250mg OD
- Max dose: 1.5g BD
Indications
- Monotherapy of partial seizures with or without secondary generalisation
Side Effects:
- CNS Symptoms (>10%)
  - Dizziness, nervousness, aggression, psychosis, behavioural changes
    - Common during first month of therapy
- GI (>10%)
  - Vomitting
- Blood disorders (<1%)
- Suicidal tendencies (<1%)

Lamotrigine

zeldachew001 — 2020-11-16 07:41:43 UTC

*first line treatment for primary and secondary generalised tonic-clonic seizure and partial seizures

- Dose:
initial: 25mg OD; maintenance: 100-200mg daily in 1-2 divded doses, increased if necessary up to 500mg daily

main side effects: dizzieness, drowsiness, headache, nausea, pain, rash, vomiting, diarrhoea, weight chances

cautions:
- myoclonic seizures (may worsen)
- Parkinson's disease (may worsen) --> if well controlled can still use but need to be monitored

***DONT have CYP drug-drug interaction

Phenytoin

2020-11-16 07:48:06 UTC

Dose
- Initial: 150-300mg in 2 divided doses
- Maintenance: 200-500mg OD
Indication
- Generalised tonic-clonic seizures, partial seizures, status epilepticus
Side Effects--> Gingival hyperplasia (gum overgrowth), hirsutism (hale hair growth on women), coarse facial features; CNS Symptoms, Dizziness, sedation, drowsiness

CYP inducer

Gabapentin

2020-11-16 08:03:51 UTC

Indication: Monotherapy for partial seizures with or without secondary generalisation

Initial dose: 300mg OD
Usual dose: 900mg- 3.6g daily in 3 divided doses
(frequent administration)
Max 1.6g per dose TDS

Side effects: Dizziness, drowsiness, dry mouth, diarrhea, nausea, weight gain, headache, suicidal thoughts or behaviour