372.2 𩺠åèç
372.2.1 é«é »èé»
372.2.1.1 Epilepsy Definition
- ⥠2 unprovoked seizures > 24 hr apart, OR
- 1 + ⥠60% recurrence risk, OR
- Syndrome
372.2.1.2 Provoked Causes
- Hypoglycemia, hyponatremia, hypocalcemia
- Alcohol withdrawal
- Drug toxicity (cocaine, amphetamine)
- Drug withdrawal
- Fever (febrile)
- Stroke
- Head injury
- CNS infection
372.2.1.3 Distinguishing from Syncope
- Aura (more specific seizure)
- Tonic-clonic
- Lateral tongue bite (specific)
- Post-ictal confusion (minutes)
- Convulsive syncope: brief jerks during syncope, no post-ictal
372.2.1.4 Distinguishing from PNES
- Eyes closed (vs open in epileptic)
- Asynchronous movements
- Pelvic thrusting
- Side-to-side head movements
- Memory recall during event
- No post-ictal
- Normal EEG during event
- Video-EEG gold standard
372.2.1.5 Absence
- 3 Hz spike-wave EEG
- Childhood
- No post-ictal
- Ethosuximide (best for absence only) or valproate
- Lamotrigine alternative
372.2.1.6 JME (Juvenile Myoclonic Epilepsy)
- Adolescent onset
- Myoclonic (morning)
- GTC + sometimes absence
- Photosensitive
- Valproate most effective (avoid in women of childbearing age â use levetiracetam, lamotrigine)
372.2.1.7 ASMs by Type
| Type | First-Line |
|---|---|
| Focal | Levetiracetam, lamotrigine, lacosamide, cenobamate, carbamazepine |
| Generalized | Valproate, lamotrigine, levetiracetam, topiramate |
| Absence | Ethosuximide, valproate |
| Myoclonic | Valproate, levetiracetam |
| Lennox-Gastaut | Valproate, lamotrigine, clobazam, rufinamide, cannabidiol |
| Dravet | Valproate, clobazam, stiripentol, cannabidiol, fenfluramine |
372.2.1.9 Drug Interactions
- Enzyme inducers: carbamazepine, phenytoin, phenobarbital (â OCP, warfarin, etc.)
- Valproate: enzyme inhibitor
- Levetiracetam: minimal interactions (renal)
- Lamotrigine: â by valproate, â by inducers
372.2.1.10 HLA-B*1502
- Asian populations
- Risk of CBZ-induced SJS/TEN
- Screen before starting CBZ
- Also affects oxcarbazepine, phenytoin