CNS-Epilepsy

Question 1

What are the rule of 3 in epilepsy treatment?

Answer 1

-Monotherapy: to reduce S/E as much as possible
-Start at the lowest dose and increase gradually
-Never withdraw abruptly, withdraw in 2-6 months.

Question 2

What are the antiepileptics which need to be prescribed by brand for the indication of epilepsy?

Answer 2

CPr3
Carbamazepine
Phenytoin
Primidone
Phenobarbital

Question 3

What are the two most common S/E or adverse effects of ALL anti-epileptics?

Answer 3

They all are teratogenic.
All of them cause suicidal thoughts (monitor mood changes)

Question 4

Most antiepileptics are given TWICE daily. What are the antiepileptics that can be given ONCE daily at bedtime?

Answer 4

LP3
Lamotrigine
Phenytoin
Phenobarbital
Perampanel

Question 5

How do you move to 2nd line therapy in epilepsy?

Answer 5

You don’t abruptly withdraw the first-line medication used. E.g. if the patient was using carbamazepine but it is not good at controlling the seizures, we want to move to a MONOTHERAPY with a second line e.g. Lamotrigine. You start lamotrigine while the patient is on Carbamazepine and then once the patient is stable, you start to gradually withdraw carbamazepine.

Question 6

What is category 1 of anti-epileptics?

Answer 6

Category 1 are anti-epileptics that must be prescribed by brand ONLY FOR EPILEPSY INDICATION. e.g. carbamazepine can be prescribed without a specific brand for bipolar disorder but for epilepsy, it must be the same brand as the brands vary in bioavailability.

Category 1 anti-epileptics are CPr3
Carbamazepine
phenytoin
phenobarbital
Primidone

Question 7

What is category 2 of anti-epileptics?

Answer 7

Does not have to be by brand, however, depends on the prescriber’s judgement e.g. some patients psychologically require to be put on the same brand as changes can trigger their epilepsy.

LC CTV
Lamotrigine
Clonazepam
Clobazam
Topiramate
Valproate

Question 8

Category 3 of anti-epileptics?

Answer 8

No need for any brand. Any other anti-epileptics apart from LC CTV (2) and CPr3 for category 1? E.g. Levetiracetam, Pregabalin, Gabapentin.

Question 9

What is antiepileptic hypersensitivity syndrome?

Answer 9

Happens with some anti-epileptics in the first 2 months of therapy.
Monitor these drugs very closely for 2 months.
Advice patients to report any signs of fever, rash, liver dysfunction, renal and pulmonary abnormalities and multi-organ failure.

Drugs that cause this syndrome are:
CPr3
Carbamazepine
Phenytoin
Primidone
Phenobarbital
+ Lamotrigine, Lacosamide, Rufinamide

Question 10

Suicidal thoughts? Which drugs cause suicidal thoughts?

Answer 10

ALL Anti-epileptics can cause suicidal thoughts within 1 week of starting therapy.

Monitor for any mood changes, suicidal or distressing thoughts and self harm in the first 2 months of therapy.