Epilepsy

Question 1

What are the 5 generalised seizure types?

Answer 1

1. Tonic-clonic
2. Absence
3. Tonic/atonic
4. Myoclonic
5. Status epilepticus

Question 2

What are tonic-clonic seizures characterised by?

Answer 2

Loss of consciousness, stiffness, jerking, deep sleep

Question 3

What are absence seizures characterised by?

Answer 3

Staring and behaviour arrest

Question 4

What are tonic/atonic seizures characterised by?

Answer 4

Muscle stiffness/loss of control

Question 5

What are myoclonic seizures characterised by?

Answer 5

Sudden brief muscle contractions

Question 6

What are status epilepticus seizures characterised by?

Answer 6

> 5m uncontrolled seizure activity

Question 7

What is the classification of seizures?

Answer 7

Partial and generalised seizures

Question 8

What is involved in a partial seizure?

Answer 8

One hemisphere

Question 9

What is involved in a generalised seizure?

Answer 9

Both hemispheres

Question 10

What are the types of partial seizures?

Answer 10

Simple and complex

Question 11

What is a simple partial seizure?

Answer 11

Conscious

Question 12

What is a complex partial seizure?

Answer 12

Unconscious

Question 13

What are epilepsy syndromes characterised by?

Answer 13

By repeated seizures

Question 14

What are seizures characterised by?

Answer 14

Sudden bursts of electrical activity in the brain causing changes in muscle tone, behaviour and awareness

Question 15

How is epilepsy diagnosed?

Answer 15

EEGs (seizure type) and MRI (organic causes)

Question 16

What are the main drugs that can be used to treat epilepsy?

Answer 16

1. Lamotrigine
2. Sodium valproate
3. Diazepam
4. Levetiracetam

Question 17

What other drugs can also be used to treat epilepsy?

Answer 17

1. Carbamazepine
2. Topiramate
3. Ethosuximide
4. Phenytoin

Question 18

What is the mechanism of action of lamotrigine?

Answer 18

1. Blocks voltage-gated Na+ channel on presynaptic glutamatergic neurons
2. Prevents Na+ influx
3. Prevent depolarization
4. Decreased glutamate excitotoxicity

Question 19

How would you reduce the frequency of skin reactions with regards to lamotrigine?

Answer 19

Introduce lamotrigine gradually and titrate up dose

Question 20

What are the drug-drug interactions for lamotrigine?

Answer 20

1. Safe in pregnancy, present in but not harmful for breastfeeding child
2. COCP induced UDPGA, increases lamotrigine metabolism, less seizure control

Question 21

What are the side effects of lamotrigine?

Answer 21

1. Maculo-papular rash (10%)
2. Drowsiness
3. Steven-Johnson’s syndrome (1 in 1000)
4. Suicidal thoughts (rare)

Question 22

What is the mechanism of action of levetiracetam?

Answer 22

1. Inhibits SV2A on excitatory presynaptic neuronal vesicles
2. Prevents vesicle exocytosis
3. Decreased glutamate secretion presynaptically
4. Deceased glutamate excitotoxicity

Question 23

What are the drug-drug interactions for levetiracetam?

Answer 23

1. None - no CYP450 enzyme interaction

2. Requires good renal function

Question 24

What are the side effects of levetiracetam?

Answer 24

1. Dizziness, headache
2. Somnolence
3. Fatigue