AED

Question 1

First line treatment for generalised or unclassified epilepsy

Answer 1

Sodium valproate

Question 2

First line treatment for partial (focal) epilepsy

Answer 2

Lamotragine > carbamazepine > others

Question 3

First line treatment for Absence seizures

Answer 3

Ethosuximdie

MOA: lower threshold calcium currents in thalamic neurons

Question 4

potential adverse effects of AED

Answer 4

Cognitive - fatigue, cognition, psychiatric

Na Channel Effects - headache, nausea, ataxia

Bone health - reduced BMD (multifactorial)

Rash - SJS (lamotragine, cabamazepine, phenobarbitone)

Teratogen - neural tube defects (1% VPA and CBMA), congenital heart disease, orofacial cleft, intestinal atresia, club foot

Question 5

RISK: Steven Johnson Syndrome strongly associated HLA-B*1502

Han Chinese, Hong Kong Chinese, Thai

Answer 5

carbamazepine

also PHT and OXC

Question 6

What AED would you use in a child
awaiting liver transplant with new onset
seizures?
1. Sodium valproate
2. Gabapentin
3. Carbamazepine
4. Lamotrigine
5. Levetiracetam

Answer 6

Levetiracepam:

renal excretion & more likely to be effective than GBP

Question 7

Which AED are renally excreted

Answer 7

GBP - gabapentin
VGB - vigabactrin
TPM - topiramate
LVT - levetiracetam
ZNS - zonisamide

Question 8

Which AED undergo hepatic clearance

Answer 8

phenytoin
carbamazepine
sodium valproate
lamotrigine
diazepam

Question 9

Which AED causes exacerbation of absence seizures

Answer 9

carbamazepine

Question 10

which AED is not to be prescribed in patients under 2 yrs of age due to risk of intellectual disability

Answer 10

sodium valproate

Question 11

which AED may cause thrombocytopenia and platelet dysfunction

Answer 11

sodium valproate

Question 12

MOA ethosuximide

Answer 12

blocks T-type Calcium channels, thalamo-cortical circuit

Question 13

which AED is recommended in pregnancy

Answer 13

Lamotrigine

Question 14

First line treatment for infantile spasms associated with Tuberosclerosis

Answer 14

Vigabatrin

Question 15

MOA Vigabatrin

Answer 15

increases GABA levels through irreversible inhibition of GABA transaminase

Question 16

MOA Benzodiazepines

Answer 16

bind to GABA A receptor –> opening chloride channel –> inhibits neurotransmitter release

Question 17

MOA levetiracetam

Answer 17

modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A

inhibits N-type high voltage activated calcium channel, inhibits the release of intracellular calcium, modulates GABA channel currents

renal excretion

Question 18

Cannabidiol (CBD) is available (but not funded) for which refractory seizure conditions

Answer 18

Dravet syndrome

Lennox Gastaut sundrome

*** AE: abnormal LFTs