Epilepsy

Question 1

What is the aim of anti epileptic treatment?

Answer 1

To prevent the occurrence of seizures

Question 2

What are the difference epilepsy?

Answer 2

Generalised seizures

• tonic clonic
• Absence seizures
• Myoclonic seizures
• Atonic and tonic seizures

Focal aware or Focal impaired awareness seizures with or without generalisation

Unknown

Question 3

Name the category 1 antiepiletics (4)

Answer 3

Carbmazepine
Phenobarbital
Phenytoin
Primidone

Question 4

Name the category 2 antiepileptics (10)

Answer 4

Clobazam
Clonazepam
Eslicarbazepine acetate
Lamotrigine 
Oxcarbazepine 
Perampanel
Rufinamide 
Topiramate
Valporate 
Zonisamide

Question 5

What is meant by a category 1 antiepileptic

Answer 5

These must be supplied by brand only

Question 6

What is meant by a category 2 antiepileptic

Answer 6

The supply of a particular brand should be based on clinical judgment

Question 7

What is a category 3 antiepileptic

Answer 7

It’s unnecessary to prescribe by brand

Question 8

What are the steps of management of epilepsy ?

Answer 8

. Monotherapy with first line
. Minotherapy with second line
. Monotherspy with a second drug (after checking the diagnosis)
. Use two (or more) antiepileptics

Question 9

What serious side affect is associated with carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone and rufinamide?

Answer 9

Antiepileptic hypersensitivity syndrome if it has happened with one of these cross sensitivity can occur

Question 10

When does a hypersensitivity reaction occur?

Answer 10

1 -8 weeks of exposure

Question 11

What are the symptoms of hypersensitivity?

Answer 11

Fever
Rash
Lymphadenopathy
Liver dysfunction 
Haemological, renal and pulmonary abnormalities 
Vasculitis 
Muti-organ failure

Question 12

Which antiepileptics are associated with a small increase risk of suicidal thoughts and behaviour?

Answer 12

All

Question 13

How soon can suicidal thoughts and behaviours start?

Answer 13

1 week after starting

Question 14

When must a person stop driving after having a seizure?

Answer 14

Immediately

Question 15

A patient who has had their first unprovoked seizure or a single seizure how long must they not drive for ?

Answer 15

6 months

Question 16

A patient with a established epilepsy how long must they be seizure free for till they can drive again?

Answer 16

1 year old with no history of unprovoked seizures

Question 17

How long does the DVLA recommend to wait till driving when changed or withdrawal antiepileptics?

Answer 17

6 months from the last dose

Question 18

What antiepileptics are recommended for focal seizures with or without secondary generalisation?

Answer 18

1st line
Carbamazipine
Lamotrigine

2nd line
Oxcarbazepine
Sodium valproate
Levetiracetam

Question 19

What antiepileptics are used for absence seizures?

Answer 19

1st line
Ethosuximide
Sodium valproate (best if there is a high risk of generalised seizures)

2nd line
Lamotrigine

Question 20

What antiepileptics are recommended for myoclonic seizures?

Answer 20

1st line
Sodium valproate

2nd line
Topiramate
Levetiracetam

Question 21

What antiepileptics are recommended for atonic and tonic seizure

Answer 21

Sodium valproate however antiepileptics respond poorly to antiepileptics

Question 21

What are the side effects of carbamazepine? (5)

Answer 21

GI upset 
Neurological effects (dizziness and ataxia)
Oedema 
Hyponaturaemia 
Hypersensitivity reaction

Question 21

What warnings are there with carbamazepine? (3)

Answer 21

Pregnancy
Prior antiepileptic hypersensitivity syndrome
Prescribed in caution hepatic, renal and cardiac disease

Question 22

What is the monitoring requirement for carbamazepine?

Answer 22

Plasma concentration for optimum response (4-12 mg/L) after 1-2 weeks but not routinely recommended

Question 23

What supplement is needed for immobilised for long periods of time when on carbamazepine?

Answer 23

Vitamin D

Question 24

What interactions occur with carbamazepine?

Answer 24

Reducing the plasma concentration on…
Warfarin
Oestrogen
Progesterone

It’s increased by
Macrolides
Lamotrigine

Drugs that lower seizure threshold

Question 25

What are the main side effects of Lamotrigine? (7)

Answer 25

Headaches
Drowsiness 
Irritability 
Blurred vision 
Dizziness 
GI symptoms 
Hypersensitivity reaction

Question 26

What are the predicable (dose related) side effect for carbamazepine? (6)

Answer 26

Diplopia, 
Drowsiness, 
Headache, 
Nausea,
Orofacial dyskinesia,
Arrhythmias

Question 27

What are unpredicable (non dose) related sode effect for carbamazepine? (6)

Answer 27

Photosensitivity 
Steven Johnson syndrome 
Agranulocytosis, 
Aplastic anemia,
Hepatotoxicity,
Teratogenicity

Question 28

What are the main interactions with Lamotrigine?

Answer 28

These reduce levels 
Carbamazepine 
Phenytoin 
Oestrogen 
Rifampicin 
Protease inhibitor 

These increase levels
Valproate

Question 29

What are the predicable (dose related) side effect for Lamotrigine? (6)

Answer 29

Headaches,
Drowsiness,
Diplopia,
Ataxia,
Tremor,
Insomnia,

Question 30

What are non predicable (non dose related) side effect for Lamotrigine? (7)

Answer 30

Rash,
Liver failure,
Steven-johnson syndrome,
Aplastic,
Anaemia,
Toxic epidermal necrolysis,
Panctopenia

Question 31

What are the predicable (dose related) side effects phenytoin? (7)

Answer 31

Ataxia,
Nystagmus,
Drowsiness, 
Diplopia,
Asterixis,
Orofacial dykinesia,
Folate deficiency

Question 32

What are non predicable (non dose relates) side effects phenytoin? (8)

Answer 32

Blood dyscrasis, 
Rash,
Dupuytren contracture,
Hepatotoxicity, 
Gingival hyperplasia,
Acne,
Coase facies,
Hirsutism,

Question 33

What are the warnings with carbamazepine? (5)

Answer 33

. Women planning pregnancy 
. Antiepileptic hypersensitivity syndrome 
. Hepatic disease
. Renal disease
. Cardiac disease

Question 34

What antiepileptic is the clear first line choice for trigeminal neuralgia ?

Answer 34

Carbamazepine

Question 35

What antiepileptic is used for bipolar?

Answer 35

Lamotrigine

Question 36

What major interactions does levetiracetam have?

Answer 36

MTX - It’s clearance is reduced