CNS - EPILEPSY/SEIZURES Flashcards
Most anti-epileptic drugs are given BD except which ones and why?
- Phenobarbital, Lamotrigine, Phenytoin
- They all have long half lives
What are focal seizures?
- Seizures where a small part of the brain is affected
- Simple partial seizures = where you remain fully conscious throughout
- Complex partial seizures = Lose awareness and can’t remember what happened after seizure passed
What categories of seizures fall under generalised seizures?
- Absence seizures = patient looks blank
- Myoclonic seizures = arms, legs, or upper body jerk or twitch
- Clonic seizures = similar twitching to myoclonic seizures but jerks last longer. consciousness may occur
- Atonic seizures = all muscles suddenly relax, can result in a fall
- Tonic seizures = all muscles suddenly stiffen, can result in a fall
- Tonic-clonic seizures = 2 stages. Body initially becomes stiff and then arms and legs begin twitching
What is the treatment for Focal seizures with/without secondary generalisation?
- 1st line = Lamotrigine or Carbamazepine
- OR: Levitiracetam, Valporate, Oxcarbazepine
What is the treatment for tonic-clonic seizures?
- 1st line = Valporate or Carbamazepine
- OR: Lamotrigine
What is the treatment for absence seizures?
- 1st line = Valporate (if high risk of generalised tonic/clonic seizures) OR Ethosuximide
- OR: Lamotrigine
What is the treatment for myoclonic seizures?
- 1st Line = Valporate
- OR - Topiramate, Levetiracetam
What is the treatment for Atonic/Tonic seizures?
1st Line = Valporate
Which drugs are category 1 drugs?
- Carbamazepine, Phenytoin, Phenobarbital, Primidone
- Rx should contain brand name OR generic name + manufacturer
Which drugs are category 2 drugs?
Valporate, Lamotrigine, Clonazepam, Topiramate
Which drugs are category 3 drugs?
Levetiracetam, Gabapentin, Pregablin, Ethosuximide
What can happen if you withdraw anti-epileptics abruptly?
can precipitate rebound seizures
How would you withdraw anti-epileptics if the pt was on combination therapy?
You would withdraw them one at a time
How long must a patient be seizure-free for in order to drive?
1 YEAR
If a patient’s dose is changed, how long do they have to wait until they can drive?
6 months with no further seizures
What are the exceptions to driving if a patient has a history of SLEEP seizures?
- Allowed to drive if they have had no awake seizures for 1 year from first sleep seizure
- Allowed to drive if there is an established pattern of sleep seizures for 3 years if they have had previous awake seizures
When would patients with epilepsy be on a driving ban?
- During medication changes or withdrawal
- 6 months after last dose
- 6 months for first unprovoked epileptic seizure or single isolated seizure (5 year ban for large goods or passenger carrying vehicles)
Which anti-epileptic holds the highest risk of causing teratogenicity?
Valporate
Which anti-epileptic in particular needs to be dose adjusted due to the reduced albumin levels is pregnancy?
Phenytoin - dose tends to be reduced
With which 2 anti-epileptics is it important to monitor foetal growth?
- Topiramate
- Levetiracetam
What can be taken to reduce neural tube defect in pregnancy?
- Folic acid
- Take before conception and until week 12 of pregnancy
What can minimise the risk of neonatal haemorrohage?
vit k injection
Women are encouraged to breastfeed if they are on monotherapy. What should be monitored in the infant if this is happening?
- weight gain
- feeding difficulties
- drowsiness
Which anti-epileptics can be present in high amounts in breast milk?
- Zosinamide
- Ethosuxamide
- Lamotrigine
- Primidone
