Anti-Epileptics

Question 1

what is a seizure ?

Answer 1

a sudden irregular discharge of electrical activity in the brain
causing a physical manifestation such as sensory disturbance, unconsciousness
or convulsions

Question 2

what is a convulsion ?

Answer 2

uncontrolled shaking movements of the body due to rapid

and repeated contraction and relaxation of muscles

Question 3

what is an Aura ?

Answer 3

a perceptual disturbance experienced by some prior to a seizure,
e.g. strange light, unpleasant smell, confusing thoughts

Question 4

what is Epilepsy ?

Answer 4

neurological disorder marked by sudden recurrent episodes of
sensory disturbance, LOC or convulsions, associated with abnormal electrical
activity in the brain

Question 5

what is status epilepticus ?

Answer 5

epileptic seizures occurring continuously without

recovery of consciousness in between

Question 6

what is the difference between partial and generalised seizures ?

Answer 6

partial = in one part of the brain 
Generalised = electrical activity everywhere

Question 7

what is difference between partial simple/ complex seizures ?

Answer 7

simple = maintain consciousness 
complex = loss in consciouses

Question 8

what is the most common effected lobe in epilepsy and how does it present/Caused ?

Answer 8

Temporal

Aura- auditory hallucinations and rush of memories
10-20 yrs olds , fever or early injury to the brain

Question 9

what is seen in frontal lobe epilepsy ?

Answer 9

contralateral side affected

convulsions

Question 10

what is the Tonic clonic seizure?

Answer 10

generalised -

muscles tense and then convulsions

Question 11

What is a absence seizure ?

Answer 11

Daydreaming - may start a sentence and stop

Question 12

what is a myoclonic seizure ?

Answer 12

short shock like muscle jerks

Question 13

What is an Atonic seizure ?

Tonic?

Answer 13

Without tone - drops down

increased tone

Question 14

how do you take a history for seizure ?

what specifically would you ask ?

Answer 14

what happened:
before - PH, FH, Triggers , first sign
during- Description, Duration , ending 
after - headspace, tongue biting, incontience , neuro deficit 
take collateral histry

Question 15

what is primary epilepsy ?

Answer 15

cause is idiopathic

Question 16

what are vascular causes of epilepsy ?

Answer 16

stroke , TIA

Question 17

what are Infective causes of epilepsy ?

Answer 17

Abscess , meningitis

Question 18

What are Traumatic causes of epilepsy?

Answer 18

IC haemorrhage

Question 19

What are Autoimmune causes of epilepsy?

Answer 19

SLE

Question 20

What are Metabolic causes?

Answer 20

Hypoxia, electrolyte imbalance , Hypoglyceamia, thyroid

Question 21

What are Iatrogenic causes ?

Answer 21

Drugs, alcohol with-drawl

Question 22

What are neoplastic causes ?

Answer 22

SoLs

Question 23

what can EEG do ? also what can it cause ?

Answer 23

First unprovoked seizure = asses risk of recurrence

Photic stim and hyperventilation = induce a seizure

Question 24

what are don’t of a EEG?

Answer 24

If there’s high chance of syncope
Clinical presentation supports diagnosis of non-elieptic event
in isolation to make diagnosis

Question 25

what other EEGs can you do ?

Answer 25

repeat EEGs sleep EEGs Long term video or ambulatory

Question 26

What other investigations do for epilepsy ?

Answer 26

ECGs | MRI

Question 27

Name sodium channel blockers used as anti-epileptics

Answer 27

Carbamazepine, Lamotrigine, Phenytoin, sodium valproate (first line)

Question 28

name CCBs used in anti-elliptics | what type of seizures are they good for ?

Answer 28

Sodium Valproate, Ethosuximide absence

Question 29

how do barbiturates and benzo work? | give one example of each

Answer 29

potentiates GABA so enhances the effect at the synaptic junction Diazepam, Phenobarbital

Question 30

how does Vigabatrin work ?

Answer 30

inhibit GABA transminase in pre synaptic terminal leading to increase of GABA due to less breakdown

Question 31

how does Gabapentin work ?

Answer 31

increased ultalisation of glutamate which is precursor for GABA .

Question 32

how does Levetiracetam work?

Answer 32

binds to synaptic vesicles to inhibit pre synaptic Ca2+ activity stoping neurotransmitter release

Question 33

what are the principles of initiating anti-epileptics ?

Answer 33

start monothearpy and Triate up

Question 34

what anti-epileptics are CYP3A4 inducers ?

Answer 34

carbmazepine and pheytonin | increase COCP dosage

Question 35

what anti-epileptics are CYP3A4 inhibtors ?

Answer 35

sodium valproate

Question 36

what is first line in generalised or tonic / clonic seizures ?

Answer 36

Sodium valproate

Question 37

what are some ARDs of AED?

Answer 37

``` Dizziness , fatigue , diplopia (all) irritability weight loss / gain tics and insomnia language dysfunction ```

Question 38

how to change AEDs?

Answer 38

start initial dose and slowly titrate to middle dose whilst still on original and then slowly titrate down the first AED over 6 wks

Question 39

when should you stop AEDs? | what considerations should you think about ?

Answer 39

seizure free for 2 yrs since childhood , polypharmcy , myoclonic/clonic , EEG abnormal, undelrying brain damage

Question 40

how long can patient not drive after stopping AEDs? when is a patient with epilepsy allowed to drive again ? what about 1 off seizure

Answer 40

6 months 1 yr free of seizure 6 mothns

Question 41

how to stop AEDs? why? what about polypahrmcy ?

Answer 41

Taper off avoid withdrawl features= recurrent seizures and anxiety and restlessnes take one drug off at a time and leave 1 moth gaps

Question 42

how would you taper off Na channel blockers ?

Answer 42

reduce dose 10% every 2-4 wks

Question 43

how would you taper off Ca channel blockers and Benzos?

Answer 43

10% reduction every 4-8 wks

Question 44

what can be used in pregnancy ? what cant ? why?

Answer 44

carbamzepine sodium valproate = decrese in folate = neural tube defects

Question 45

what must you do on pregnant / child bearing women on sodium valproate ?

Answer 45

lowest dose possible , divide over day specialist monitoring folate supplements contraception if not pregnant

Question 46

what are side effects of phenytonin ?

Answer 46

congnetinal malformations - cleft lip/ palate heart defects Nausea , CNS dysfunction , coma due to

Question 47

what else is phenytonin used for ?

Answer 47

arrhythmias - cardiac depressant

Question 48

what is the pharmokinetics of phenytonin ? | what must you do ?

Answer 48

``` narrow thearputic window non linear trend monitor closely (3-4 days ) ```

Question 49

what drugs do you use for partial seizures ?

Answer 49

``` Lamotrigine Topirmate (CCB) Gabapentin Phenytonin Carbamazepine ```

Question 50

What drugs for general seizures ?

Answer 50

Phenobarbitol Sodium valproate Ethosuxamide Diazepam (1st line for status epilepticus )

Question 51

what is Initial mangement of seizures ?

Answer 51

ABCDE give benzo - Lorazepam or midazolam If pre hospital - PR or Buccal if hospital = IV access

Question 52

how to treat status elipticus ?

Answer 52

Benzo or phenytoin

Question 53

what too long considerations would you say to a patient in annual review ?

Answer 53

check compliance , seziure control SUDEP in poorly controlled increased risk of mental illness