anti epileptics Flashcards
Flashcard:
Question: What steps are recommended if monotherapy with a first-line antiepileptic drug is ineffective or intolerable?
Answer: If monotherapy with a first-line antiepileptic drug proves ineffective or causes intolerable side effects, switching to an alternative drug should be considered. Before initiating the new drug, it’s crucial to reevaluate the diagnosis if the initial drug showed a lack of efficacy. When transitioning from one antiepileptic drug to another, a cautious approach is advised, gradually withdrawing the first drug only after establishing the effectiveness of the new regimen. While combination therapy may be necessary in some cases, it increases the risk of adverse effects and drug interactions. If combination therapy fails to reduce seizures, reverting to the regimen that previously offered the best balance between tolerability and efficacy is recommended. Whenever possible, prescribing a single antiepileptic drug is preferred.
Flashcard:
Question: What steps are recommended if monotherapy with a first-line antiepileptic drug is ineffective or intolerable?
Answer: If monotherapy with a first-line antiepileptic drug proves ineffective or causes intolerable side effects, switching to an alternative drug should be considered. Before initiating the new drug, it’s crucial to reevaluate the diagnosis if the initial drug showed a lack of efficacy. When transitioning from one antiepileptic drug to another, a cautious approach is advised, gradually withdrawing the first drug only after establishing the effectiveness of the new regimen. While combination therapy may be necessary in some cases, it increases the risk of adverse effects and drug interactions. If combination therapy fails to reduce seizures, reverting to the regimen that previously offered the best balance between tolerability and efficacy is recommended. Whenever possible, prescribing a single antiepileptic drug is preferred.
Flashcard:
Question: What factors are considered when selecting an antiepileptic drug?
Answer: When choosing an antiepileptic drug, factors such as seizure type, epilepsy syndrome, need for treatment, risks and benefits of the drug, its importance in reducing the risk of epilepsy-related death, as well as the patient’s age, sex, comorbidities, concomitant medication, and personal circumstances (e.g., education, employment, likelihood of pregnancy) should all be taken into account.
Flashcard:
Question: How is the dosage frequency of antiepileptic drugs determined?
Answer: The dosage frequency of antiepileptic drugs is often determined by the plasma-drug half-life. It’s usually kept as low as possible to encourage adherence to the prescribed regimen. While most antiepileptics are given twice daily, those with long half-lives like lamotrigine, perampanel, phenobarbital, and phenytoin can be given once daily at bedtime. However, larger doses might require more frequent administration to avoid adverse effects linked to high peak plasma-drug concentration.
Flashcard:
Question: What factors are considered when selecting an antiepileptic drug?
Answer: When choosing an antiepileptic drug, factors such as seizure type, epilepsy syndrome, need for treatment, risks and benefits of the drug, its importance in reducing the risk of epilepsy-related death, as well as the patient’s age, sex, comorbidities, concomitant medication, and personal circumstances (e.g., education, employment, likelihood of pregnancy) should all be taken into account.
Flashcard:
Question: How is the dosage frequency of antiepileptic drugs determined?
Answer: The dosage frequency of antiepileptic drugs is often determined by the plasma-drug half-life. It’s usually kept as low as possible to encourage adherence to the prescribed regimen. While most antiepileptics are given twice daily, those with long half-lives like lamotrigine, perampanel, phenobarbital, and phenytoin can be given once daily at bedtime. However, larger doses might require more frequent administration to avoid adverse effects linked to high peak plasma-drug concentration.
Q: What warning did the MHRA/CHM issue in August 2008 regarding antiepileptic drugs?
A: They noted a small increased risk of suicidal thoughts and behaviors associated with all antiepileptic drugs, which might manifest as early as a week after treatment initiation.
Q: How should patients and caregivers respond to potential symptoms highlighted by the MHRA/CHM warning in August 2008?
A: They should be vigilant for mood changes, distressing thoughts, or feelings related to suicide or self-harm and seek immediate medical advice if such symptoms arise. Patients should not alter their treatment without consulting a healthcare professional.
Q: What guidance was issued in November 2017 regarding switching between different manufacturers’ versions of antiepileptic drugs?
A: The guidance categorized drugs into three risk-based groups:
Category 1: Carbamazepine, phenobarbital, phenytoin, primidone. Doctors should maintain patients on specific manufacturer products.
Category 2: Decision on maintaining a specific product should consider clinical judgment and patient/carer consultation for drugs like clobazam, lamotrigine, valproate, etc.
Category 3: Drugs assumed to have therapeutic equivalence but non-clinical factors can influence patient adherence. Special considerations for certain patient conditions were highlighted.
Q: What should prescribers consider when managing Category 3 antiepileptic drugs according to the 2017 MHRA/CHM advice?
A: While therapeutic equivalence is assumed, factors like packaging, appearance, and patient-specific conditions (autism, mental health issues) should be considered as they can influence patient adherence.
Q: What warning did the MHRA/CHM issue in August 2008 regarding antiepileptic drugs?
A: They noted a small increased risk of suicidal thoughts and behaviors associated with all antiepileptic drugs, which might manifest as early as a week after treatment initiation.
Q: How should patients and caregivers respond to potential symptoms highlighted by the MHRA/CHM warning in August 2008?
A: They should be vigilant for mood changes, distressing thoughts, or feelings related to suicide or self-harm and seek immediate medical advice if such symptoms arise. Patients should not alter their treatment without consulting a healthcare professional.
Q: What guidance was issued in November 2017 regarding switching between different manufacturers’ versions of antiepileptic drugs?
A: The guidance categorized drugs into three risk-based groups:
Category 1: Carbamazepine, phenobarbital, phenytoin, primidone. Doctors should maintain patients on specific manufacturer products.
Category 2: Decision on maintaining a specific product should consider clinical judgment and patient/carer consultation for drugs like clobazam, lamotrigine, valproate, etc.
Category 3: Drugs assumed to have therapeutic equivalence but non-clinical factors can influence patient adherence. Special considerations for certain patient conditions were highlighted.
Q: What should prescribers consider when managing Category 3 antiepileptic drugs according to the 2017 MHRA/CHM advice?
A: While therapeutic equivalence is assumed, factors like packaging, appearance, and patient-specific conditions (autism, mental health issues) should be considered as they can influence patient adherence.
Q: What is Antiepileptic Hypersensitivity Syndrome (AHS)?
A: A rare but potentially fatal syndrome associated with certain antiepileptic drugs, characterized by fever, rash, lymphadenopathy, and potentially severe systemic symptoms.
Q: Which antiepileptic drugs are commonly associated with Antiepileptic Hypersensitivity Syndrome (AHS)?
A: Carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide have been linked. Some other antiepileptics (eslicarbazepine, stiripentol, zonisamide) have a theoretical risk.
Q: When do symptoms of Antiepileptic Hypersensitivity Syndrome typically arise?
A: Symptoms usually manifest between 1 to 8 weeks after exposure to the triggering antiepileptic drug.
Q: What are the common signs and symptoms of Antiepileptic Hypersensitivity Syndrome?
A: Fever, rash, lymphadenopathy are commonly observed. Other systemic signs include liver dysfunction, hematological, renal, and pulmonary abnormalities, vasculitis, and multi-organ failure.
Q: How should Antiepileptic Hypersensitivity Syndrome be managed if suspected?
A: The offending drug should be immediately withdrawn, the patient must not be re-exposed, and expert medical advice should be sought promptly.
Q: What is Antiepileptic Hypersensitivity Syndrome (AHS)?
A: A rare but potentially fatal syndrome associated with certain antiepileptic drugs, characterized by fever, rash, lymphadenopathy, and potentially severe systemic symptoms.
Q: Which antiepileptic drugs are commonly associated with Antiepileptic Hypersensitivity Syndrome (AHS)?
A: Carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide have been linked. Some other antiepileptics (eslicarbazepine, stiripentol, zonisamide) have a theoretical risk.
Q: When do symptoms of Antiepileptic Hypersensitivity Syndrome typically arise?
A: Symptoms usually manifest between 1 to 8 weeks after exposure to the triggering antiepileptic drug.
Q: What are the common signs and symptoms of Antiepileptic Hypersensitivity Syndrome?
A: Fever, rash, lymphadenopathy are commonly observed. Other systemic signs include liver dysfunction, hematological, renal, and pulmonary abnormalities, vasculitis, and multi-organ failure.
Q: How should Antiepileptic Hypersensitivity Syndrome be managed if suspected?
A: The offending drug should be immediately withdrawn, the patient must not be re-exposed, and expert medical advice should be sought promptly.
Q: When should withdrawal of antiepileptic drugs be considered for seizure-free patients?
A: Withdrawal may be considered after at least two seizure-free years, depending on individual circumstances and the assessment of seizure recurrence risk upon discontinuation.
Q: Who should assess the risk of seizure recurrence upon discontinuation of antiepileptic drugs?
A: An assessment should be carried out by an epilepsy specialist, especially if there’s any doubt or concern regarding the risk of seizure recurrence.
Q: How should multiple antiepileptic drugs be withdrawn in patients receiving several medications?
A: Only one drug should be withdrawn at a time to monitor the effects. Gradual reduction in dosage is essential, usually over a period of at least three months. Abrupt withdrawal, especially of barbiturates and benzodiazepines, can trigger severe rebound seizures.
Q: What should be done if seizures reoccur during or after discontinuation of an antiepileptic drug?
A: If seizures reoccur, the last dose reduction should be reversed, and guidance from an epilepsy specialist should be sought for further management.
Q: When should withdrawal of antiepileptic drugs be considered for seizure-free patients?
A: Withdrawal may be considered after at least two seizure-free years, depending on individual circumstances and the assessment of seizure recurrence risk upon discontinuation.
Q: Who should assess the risk of seizure recurrence upon discontinuation of antiepileptic drugs?
A: An assessment should be carried out by an epilepsy specialist, especially if there’s any doubt or concern regarding the risk of seizure recurrence.
Q: How should multiple antiepileptic drugs be withdrawn in patients receiving several medications?
A: Only one drug should be withdrawn at a time to monitor the effects. Gradual reduction in dosage is essential, usually over a period of at least three months. Abrupt withdrawal, especially of barbiturates and benzodiazepines, can trigger severe rebound seizures.
Q: What should be done if seizures reoccur during or after discontinuation of an antiepileptic drug?
A: If seizures reoccur, the last dose reduction should be reversed, and guidance from an epilepsy specialist should be sought for further management.
Q: What should a driver do if they experience a seizure?
A: Stop driving immediately and inform the Driver and Vehicle Licensing Agency (DVLA).
Q: After a first unprovoked seizure, when can driving be resumed?
A: Driving can be resumed after 6 months if the patient has been assessed by a specialist, deemed fit to drive, and investigations don’t suggest a risk of further seizures.
Q: Can individuals with established epilepsy drive?
A: Yes, if they are compliant with treatment, not a danger to the public, and have been seizure-free for at least one year. They should also have no history of unprovoked seizures.
Q: What’s the driving restriction for those who have had seizures while asleep?
A: They cannot drive for one year after each seizure unless a pattern of solely asleep seizures is established over one year from the first sleep seizure, or over three years if previous seizures occurred while awake.
Q: What does the DVLA recommend during medication changes or withdrawal of antiepileptic drugs?
A: Patients shouldn’t drive during these periods and for 6 months after their last dose. If a seizure occurs due to medication changes, relicensing may occur after 1 year if treatment is reinstated for 6 months with no further seizures.
Q: What should a driver do if they experience a seizure?
A: Stop driving immediately and inform the Driver and Vehicle Licensing Agency (DVLA).
Q: After a first unprovoked seizure, when can driving be resumed?
A: Driving can be resumed after 6 months if the patient has been assessed by a specialist, deemed fit to drive, and investigations don’t suggest a risk of further seizures.
Q: Can individuals with established epilepsy drive?
A: Yes, if they are compliant with treatment, not a danger to the public, and have been seizure-free for at least one year. They should also have no history of unprovoked seizures.
Q: What’s the driving restriction for those who have had seizures while asleep?
A: They cannot drive for one year after each seizure unless a pattern of solely asleep seizures is established over one year from the first sleep seizure, or over three years if previous seizures occurred while awake.
Q: What does the DVLA recommend during medication changes or withdrawal of antiepileptic drugs?
A: Patients shouldn’t drive during these periods and for 6 months after their last dose. If a seizure occurs due to medication changes, relicensing may occur after 1 year if treatment is reinstated for 6 months with no further seizures.
Q: What risks are associated with antiepileptic drugs (AEDs) during pregnancy?
A: Increased risk of teratogenicity, especially if used in the first trimester. Valproate, in particular, is highly teratogenic and linked to congenital malformations and neurodevelopmental disorders.
Q: What are the safety recommendations for AED use during pregnancy?
A: Avoid valproate in females of childbearing potential unless Pregnancy Prevention Programme conditions are met and alternative treatments are ineffective. Lamotrigine and levetiracetam are safer options, showing no increased risk of major malformations.
Q: Which AEDs show increased risks during pregnancy?
A: Carbamazepine, phenobarbital, phenytoin, and topiramate are associated with increased risk of major congenital malformations. Phenobarbital and phenytoin also pose potential risks of adverse neurodevelopmental effects.
Q: How should treatment be managed for female patients taking AEDs during pregnancy?
A: Encourage discussion with specialists before initiating or discontinuing treatment. Monotherapy and lowest effective dose are recommended. Plasma concentrations can change during pregnancy; consult product literature for dosing and monitoring.
Q: What advice is recommended for females of childbearing potential on AEDs?
A: Emphasize effective contraception methods, considering the potential effects of AEDs on contraceptive efficacy. Seek specialist advice if planning a pregnancy.
Q: What precautions are advised once an unplanned pregnancy is discovered in a female on AEDs?
A: Specialist advice should be sought. Continue essential treatment; risk of harm from seizures outweighs risks from therapy. Folate supplementation is advised in the first trimester.
Q: What postnatal considerations are recommended for infants born to mothers taking AEDs?
A: Routine vitamin K injection at birth minimizes neonatal hemorrhage risk. Withdrawal effects might occur in newborns exposed to certain AEDs.
Q: What risks are associated with antiepileptic drugs (AEDs) during pregnancy?
A: Increased risk of teratogenicity, especially if used in the first trimester. Valproate, in particular, is highly teratogenic and linked to congenital malformations and neurodevelopmental disorders.
Q: What are the safety recommendations for AED use during pregnancy?
A: Avoid valproate in females of childbearing potential unless Pregnancy Prevention Programme conditions are met and alternative treatments are ineffective. Lamotrigine and levetiracetam are safer options, showing no increased risk of major malformations.
Q: Which AEDs show increased risks during pregnancy?
A: Carbamazepine, phenobarbital, phenytoin, and topiramate are associated with increased risk of major congenital malformations. Phenobarbital and phenytoin also pose potential risks of adverse neurodevelopmental effects.
Q: How should treatment be managed for female patients taking AEDs during pregnancy?
A: Encourage discussion with specialists before initiating or discontinuing treatment. Monotherapy and lowest effective dose are recommended. Plasma concentrations can change during pregnancy; consult product literature for dosing and monitoring.
Q: What advice is recommended for females of childbearing potential on AEDs?
A: Emphasize effective contraception methods, considering the potential effects of AEDs on contraceptive efficacy. Seek specialist advice if planning a pregnancy.
Q: What precautions are advised once an unplanned pregnancy is discovered in a female on AEDs?
A: Specialist advice should be sought. Continue essential treatment; risk of harm from seizures outweighs risks from therapy. Folate supplementation is advised in the first trimester.
Q: What postnatal considerations are recommended for infants born to mothers taking AEDs?
A: Routine vitamin K injection at birth minimizes neonatal hemorrhage risk. Withdrawal effects might occur in newborns exposed to certain AEDs.
Treatment Options for Focal Seizures
Q: What are the first-line monotherapy options for treating focal seizures?
A: Consider lamotrigine or levetiracetam as initial treatment options. If monotherapy with one is unsuccessful, consider switching to the other.
Q: Which drugs are recommended as second-line monotherapy options if initial treatment fails?
A: If initial monotherapy fails, consider carbamazepine, oxcarbazepine, or zonisamide as second-line options.
Q: What is recommended as third-line monotherapy for focal seizures?
A: Consider lacosamide as a third-line monotherapy option.
Q: When should adjunctive treatment be considered for focal seizures, and what are the first-line options?
A: If monotherapy fails, consider adjunctive treatment. First-line adjunctive options include carbamazepine, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, topiramate, or zonisamide.
Q: What are the second-line options for adjunctive treatment if first-line options are ineffective?
A: Second-line adjunctive options include brivaracetam, cenobamate, eslicarbazepine acetate, perampanel, pregabalin, or sodium valproate (in males or females unable to have children).
Q: Which drugs are considered third-line options for adjunctive treatment in focal seizures?
A: Third-line adjunctive options include phenobarbital, phenytoin, tiagabine, or vigabatrin.
Treatment Options for Focal Seizures
Q: What are the first-line monotherapy options for treating focal seizures?
A: Consider lamotrigine or levetiracetam as initial treatment options. If monotherapy with one is unsuccessful, consider switching to the other.
Q: Which drugs are recommended as second-line monotherapy options if initial treatment fails?
A: If initial monotherapy fails, consider carbamazepine, oxcarbazepine, or zonisamide as second-line options.
Q: What is recommended as third-line monotherapy for focal seizures?
A: Consider lacosamide as a third-line monotherapy option.
Q: When should adjunctive treatment be considered for focal seizures, and what are the first-line options?
A: If monotherapy fails, consider adjunctive treatment. First-line adjunctive options include carbamazepine, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, topiramate, or zonisamide.
Q: What are the second-line options for adjunctive treatment if first-line options are ineffective?
A: Second-line adjunctive options include brivaracetam, cenobamate, eslicarbazepine acetate, perampanel, pregabalin, or sodium valproate (in males or females unable to have children).
Q: Which drugs are considered third-line options for adjunctive treatment in focal seizures?
A: Third-line adjunctive options include phenobarbital, phenytoin, tiagabine, or vigabatrin.
Flashcards for Seizure Treatment
Q1: What is the first-line monotherapy for generalised tonic-clonic seizures in males and females unable to have children?
A: Sodium valproate.
Q2: What are the alternative second-line options if sodium valproate is ineffective for generalised tonic-clonic seizures?
A: Lamotrigine or levetiracetam (for males, and females unable to have children).
Q3: What are the first-line monotherapy options for females able to have children experiencing generalised tonic-clonic seizures?
A: Lamotrigine or levetiracetam (if sodium valproate is unsuitable or unsuccessful).
Q4: In absence seizures, what is the recommended first-line treatment?
A: Ethosuximide.
Q5: What is the suggested second-line treatment for absence seizures if ethosuximide doesn’t work?
A: Sodium valproate (in specific cases), lamotrigine, or levetiracetam.
Q6: What is the first-line treatment for myoclonic seizures in males and females unable to have children?
A: Sodium valproate.
Q7: In females able to have children with myoclonic seizures, what is the first-line monotherapy option?
A: Levetiracetam.
Q8: What are the second-line options for myoclonic seizures if treatment with levetiracetam fails?
A: Brivaracetam, clobazam, clonazepam, lamotrigine, phenobarbital, piracetam, topiramate, or zonisamide.
Q9: For atonic or tonic seizures in males and females unable to have children, what is the first-line treatment?
A: Sodium valproate.
Q10: What is the first-line monotherapy option for females able to have children with atonic or tonic seizures?
A: Lamotrigine.
Q11: What are the second-line options for atonic or tonic seizures if lamotrigine is ineffective?
A: Lamotrigine, clobazam, rufinamide, or topiramate.
Q12: What should be avoided in certain types of seizures due to the risk of exacerbating the condition?
A: Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, or vigabatrin.
Flashcards for Seizure Treatment
Q1: What is the first-line monotherapy for generalised tonic-clonic seizures in males and females unable to have children?
A: Sodium valproate.
Q2: What are the alternative second-line options if sodium valproate is ineffective for generalised tonic-clonic seizures?
A: Lamotrigine or levetiracetam (for males, and females unable to have children).
Q3: What are the first-line monotherapy options for females able to have children experiencing generalised tonic-clonic seizures?
A: Lamotrigine or levetiracetam (if sodium valproate is unsuitable or unsuccessful).
Q4: In absence seizures, what is the recommended first-line treatment?
A: Ethosuximide.
Q5: What is the suggested second-line treatment for absence seizures if ethosuximide doesn’t work?
A: Sodium valproate (in specific cases), lamotrigine, or levetiracetam.
Q6: What is the first-line treatment for myoclonic seizures in males and females unable to have children?
A: Sodium valproate.
Q7: In females able to have children with myoclonic seizures, what is the first-line monotherapy option?
A: Levetiracetam.
Q8: What are the second-line options for myoclonic seizures if treatment with levetiracetam fails?
A: Brivaracetam, clobazam, clonazepam, lamotrigine, phenobarbital, piracetam, topiramate, or zonisamide.
Q9: For atonic or tonic seizures in males and females unable to have children, what is the first-line treatment?
A: Sodium valproate.
Q10: What is the first-line monotherapy option for females able to have children with atonic or tonic seizures?
A: Lamotrigine.
Q11: What are the second-line options for atonic or tonic seizures if lamotrigine is ineffective?
A: Lamotrigine, clobazam, rufinamide, or topiramate.
Q12: What should be avoided in certain types of seizures due to the risk of exacerbating the condition?
A: Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, or vigabatrin.
Q1: What characterizes epilepsy syndromes?
A: Epilepsy syndromes are categorized based on features like seizure type, age of onset, and EEG characteristics.
Q2: What does a likely drug-resistant epilepsy syndrome indicate?
A: Failure of adequate trials of two antiepileptic drugs to achieve sustained seizure freedom.
Q3: What should be the course of action for patients with likely drug-resistant epilepsy syndromes?
A: Referral to a tertiary epilepsy service for specialized evaluation and management.
Q4: Where can further guidance on epilepsy syndromes be found?
A: The NICE guideline: Epilepsies in children, young people, and adults (see Useful resources).
Q1: What characterizes epilepsy syndromes?
A: Epilepsy syndromes are categorized based on features like seizure type, age of onset, and EEG characteristics.
Q2: What does a likely drug-resistant epilepsy syndrome indicate?
A: Failure of adequate trials of two antiepileptic drugs to achieve sustained seizure freedom.
Q3: What should be the course of action for patients with likely drug-resistant epilepsy syndromes?
A: Referral to a tertiary epilepsy service for specialized evaluation and management.
Q4: Where can further guidance on epilepsy syndromes be found?
A: The NICE guideline: Epilepsies in children, young people, and adults (see Useful resources).
Q1: Who should be involved in decisions regarding the treatment of Dravet syndrome?
A: A neurologist with expertise in epilepsy.
Q2: What is the first-line treatment option for all patients with Dravet syndrome?
A: Sodium valproate, including females, considering the severity of the syndrome and limited effective options.
Q3: If monotherapy with sodium valproate is unsuccessful, what adjunctive therapy might be considered as first-line?
A: Triple therapy with sodium valproate, clobazam, and stiripentol.
Q4: In certain cases, what second-line adjunctive treatment might be considered for Dravet syndrome?
A: Cannabidiol with clobazam.
Q5: What other adjunctive treatments might be considered under specialist supervision if initial therapies fail?
A: Options include fenfluramine, topiramate, levetiracetam [unlicensed use], or potassium bromide [unlicensed], under specialist guidance.
Q6: Which drugs should be avoided in patients with Dravet syndrome as they might exacerbate seizures?
A: Carbamazepine, gabapentin, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, pregabalin, tiagabine, and vigabatrin.
Q1: Who should be involved in decisions regarding the treatment of Dravet syndrome?
A: A neurologist with expertise in epilepsy.
Q2: What is the first-line treatment option for all patients with Dravet syndrome?
A: Sodium valproate, including females, considering the severity of the syndrome and limited effective options.
Q3: If monotherapy with sodium valproate is unsuccessful, what adjunctive therapy might be considered as first-line?
A: Triple therapy with sodium valproate, clobazam, and stiripentol.
Q4: In certain cases, what second-line adjunctive treatment might be considered for Dravet syndrome?
A: Cannabidiol with clobazam.
Q5: What other adjunctive treatments might be considered under specialist supervision if initial therapies fail?
A: Options include fenfluramine, topiramate, levetiracetam [unlicensed use], or potassium bromide [unlicensed], under specialist guidance.
Q6: Which drugs should be avoided in patients with Dravet syndrome as they might exacerbate seizures?
A: Carbamazepine, gabapentin, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, pregabalin, tiagabine, and vigabatrin.
Flashcards for Lennox-Gastaut Syndrome
Q1: Who should be involved in decisions regarding the treatment of Lennox-Gastaut syndrome?
A: A neurologist with expertise in epilepsy.
Q2: What is the first-line treatment option for all patients with Lennox-Gastaut syndrome?
A: Sodium valproate, including females, considering the syndrome’s severity and limited effective options.
Q3: If monotherapy with sodium valproate is unsuccessful, what might be considered as second-line monotherapy or adjunctive treatment?
A: Lamotrigine.
Q4: What are the third-line adjunctive treatment options for Lennox-Gastaut syndrome?
A: Cannabidiol with clobazam (in certain patients), clobazam, rufinamide, or topiramate.
Q5: What adjunctive therapy might be considered under specialist supervision if all other treatments fail?
A: Felbamate [unlicensed].
Q6: Which drugs should be avoided in patients with Lennox-Gastaut syndrome as they might exacerbate seizures?
A: Carbamazepine, gabapentin, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, pregabalin, tiagabine, and vigabatrin.
Flashcards for Lennox-Gastaut Syndrome
Q1: Who should be involved in decisions regarding the treatment of Lennox-Gastaut syndrome?
A: A neurologist with expertise in epilepsy.
Q2: What is the first-line treatment option for all patients with Lennox-Gastaut syndrome?
A: Sodium valproate, including females, considering the syndrome’s severity and limited effective options.
Q3: If monotherapy with sodium valproate is unsuccessful, what might be considered as second-line monotherapy or adjunctive treatment?
A: Lamotrigine.
Q4: What are the third-line adjunctive treatment options for Lennox-Gastaut syndrome?
A: Cannabidiol with clobazam (in certain patients), clobazam, rufinamide, or topiramate.
Q5: What adjunctive therapy might be considered under specialist supervision if all other treatments fail?
A: Felbamate [unlicensed].
Q6: Which drugs should be avoided in patients with Lennox-Gastaut syndrome as they might exacerbate seizures?
A: Carbamazepine, gabapentin, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, pregabalin, tiagabine, and vigabatrin.
Flashcards for Seizure Management
Q1: How are repeated or cluster seizures, prolonged convulsive seizures, and convulsive status epilepticus managed?
A: As a medical emergency.
Q2: What defines repeated or cluster seizures?
A: Typically, 3 or more self-terminating seizures in 24 hours.
Q3: How are prolonged convulsive seizures managed if there’s no individualized emergency plan available?
A: Urgent consideration of benzodiazepine treatment (e.g., clobazam or midazolam).
Q4: What action is advised for convulsive seizures lasting 5 minutes or more?
A: Follow recommendations for managing convulsive status epilepticus.
Q5: In the absence of an individualized emergency plan, what should be done for concern about seizure recurrence?
A: Agreed emergency management plan creation for potential recurrence.
Q6: When should expert guidance be sought regarding repeated or cluster seizures?
A: When the patient experiences further episodes.
Flashcards for Seizure Management
Q1: How are repeated or cluster seizures, prolonged convulsive seizures, and convulsive status epilepticus managed?
A: As a medical emergency.
Q2: What defines repeated or cluster seizures?
A: Typically, 3 or more self-terminating seizures in 24 hours.
Q3: How are prolonged convulsive seizures managed if there’s no individualized emergency plan available?
A: Urgent consideration of benzodiazepine treatment (e.g., clobazam or midazolam).
Q4: What action is advised for convulsive seizures lasting 5 minutes or more?
A: Follow recommendations for managing convulsive status epilepticus.
Q5: In the absence of an individualized emergency plan, what should be done for concern about seizure recurrence?
A: Agreed emergency management plan creation for potential recurrence.
Q6: When should expert guidance be sought regarding repeated or cluster seizures?
A: When the patient experiences further episodes.
Flashcards for Managing Convulsive Status Epilepticus
Q1: What immediate measures are recommended to manage convulsive status epilepticus?
A: Positioning to avoid injury, respiratory support, blood pressure maintenance, and correction of hypoglycemia. Consider parenteral thiamine for alcohol abuse or pyridoxine for pyridoxine deficiency.
Q2: What should be done if an individualized emergency management plan isn’t available for status epilepticus in the community?
A: Urgent treatment with buccal midazolam or rectal diazepam.
Q3: Which benzodiazepine can be used if intravenous access and resuscitation facilities are available?
A: Intravenous lorazepam.
Q4: What action should be taken if there’s no response to the first dose of a benzodiazepine?
A: Call emergency services or seek expert advice. Follow the patient’s emergency plan or administer a second benzodiazepine dose if the seizure persists after 5–10 minutes.
Q5: If two doses of benzodiazepines are ineffective, what are the second-line treatment options for convulsive status epilepticus?
A: Levetiracetam [unlicensed use], phenytoin, or sodium valproate.
Q6: If second-line treatments fail, what can be considered under expert advice?
A: Phenobarbital or general anaesthesia as third-line treatments.
Q7: What action should be taken for concern about potential recurrence of status epilepticus?
A: Agree on an emergency management plan with the patient if not already established.
Flashcards for Managing Convulsive Status Epilepticus
Q1: What immediate measures are recommended to manage convulsive status epilepticus?
A: Positioning to avoid injury, respiratory support, blood pressure maintenance, and correction of hypoglycemia. Consider parenteral thiamine for alcohol abuse or pyridoxine for pyridoxine deficiency.
Q2: What should be done if an individualized emergency management plan isn’t available for status epilepticus in the community?
A: Urgent treatment with buccal midazolam or rectal diazepam.
Q3: Which benzodiazepine can be used if intravenous access and resuscitation facilities are available?
A: Intravenous lorazepam.
Q4: What action should be taken if there’s no response to the first dose of a benzodiazepine?
A: Call emergency services or seek expert advice. Follow the patient’s emergency plan or administer a second benzodiazepine dose if the seizure persists after 5–10 minutes.
Q5: If two doses of benzodiazepines are ineffective, what are the second-line treatment options for convulsive status epilepticus?
A: Levetiracetam [unlicensed use], phenytoin, or sodium valproate.
Q6: If second-line treatments fail, what can be considered under expert advice?
A: Phenobarbital or general anaesthesia as third-line treatments.
Q7: What action should be taken for concern about potential recurrence of status epilepticus?
A: Agree on an emergency management plan with the patient if not already established.
Flashcards for Non-Convulsive Status Epilepticus and Febrile Convulsions
Q1: How should non-convulsive status epilepticus with incomplete loss of awareness be managed?
A: Continue or restart usual oral antiepileptic therapy.
Q2: What action is recommended if patients fail to respond to oral antiepileptic therapy or have complete lack of awareness in non-convulsive status epilepticus?
A: Consider treating them similarly to convulsive status epilepticus, though anesthesia is rarely necessary.
Q3: What treatment is advised for brief febrile convulsions?
A: Brief febrile convulsions typically require no specific treatment. Antipyretic medication like paracetamol may be used to reduce fever, but evidence for its effectiveness is lacking.
Q4: How should prolonged or recurrent febrile convulsions without recovery be managed?
A: Treat actively, similar to convulsive status epilepticus, seeking medical attention for prolonged or recurrent febrile convulsions.
Q5: Is long-term anticonvulsant prophylaxis commonly recommended for febrile convulsions?
A: No, it’s rarely indicated except in specific cases.
Flashcards for Non-Convulsive Status Epilepticus and Febrile Convulsions
Q1: How should non-convulsive status epilepticus with incomplete loss of awareness be managed?
A: Continue or restart usual oral antiepileptic therapy.
Q2: What action is recommended if patients fail to respond to oral antiepileptic therapy or have complete lack of awareness in non-convulsive status epilepticus?
A: Consider treating them similarly to convulsive status epilepticus, though anesthesia is rarely necessary.
Q3: What treatment is advised for brief febrile convulsions?
A: Brief febrile convulsions typically require no specific treatment. Antipyretic medication like paracetamol may be used to reduce fever, but evidence for its effectiveness is lacking.
Q4: How should prolonged or recurrent febrile convulsions without recovery be managed?
A: Treat actively, similar to convulsive status epilepticus, seeking medical attention for prolonged or recurrent febrile convulsions.
Q5: Is long-term anticonvulsant prophylaxis commonly recommended for febrile convulsions?
A: No, it’s rarely indicated except in specific cases.
