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Stage 3 Case 2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What further information may be required for epilepsy case?

A

History of presenting complaint
Past medical
Family history

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2
Q

What investigations may be carried out for epilepsy?

A

Electroencephalograph (EEG)
Electrocardiogram (ECG)
Imaging (MRI)
Blood tests (FBC, U&Es, Blood glucose)

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3
Q

What is considered for treatment of epilepsy?

A

Type of epilepsy
Age (pregnancy)
Side effects
Co-morbidities

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4
Q

Education about epilepsy

A 
Information about epilepsy
 Lifestyle factors impacted by seizures
 Driving regulations
 Home safety adaptations
 Sports and physical activity
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5
Q

Initiating anti-epileptic drug

A

Monotherapy Preferred
Star low dose
1-2 daily for adherence
Wean if changing

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6
Q

Why is combination of anti-epileptics avoided?

A

Increased risk of adverse effects and interactions

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7
Q

Generalised tonic-clonic seizures first line drugs

A

Carbamazepine
Lamotrigine
Oxcarbazepine
Sodium valproate

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8
Q

Tonic or atonic seizures first line drugs

A

Sodium valproate

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9
Q

Absence seizures first line drugs

A

Ethosuximide
Lamotrigine
Sodium valproate

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10
Q

Myoclonic seizures first line drugs

A

Levetiracetam
Sodium valproate
Topiramate

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11
Q

Generalised tonic-clonic seizures adjunctive drugs

A 
Clobazam
 Lamotrigine
 Levetiracetam
 Sodium valproate
 Topiramate
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12
Q

Tonic or atonic seizures adjunctive drugs

A

Lamotrigine

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13
Q

Absence seizures adjunctive drugs

A

Ethosuximide
Lamotrigine
Sodium valproate

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14
Q

Myoclonic seizures adjunctive drugs

A

Levetiracetam
Sodium valproate
Topiramate

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15
Q

Why is Sodium valproate commonly prescribed?

A

It has a broad spectrum and able to have action on arrange of different seizures.

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16
Q

Side effects of sodium valproate

A

•Aggression, anaemia, drowsiness/ confusion, tremor, nausea & diarrhoea

  • Weight gain: progressive and significant
  • Increase in seizures
  • Menstrual disturbances
  • Transient hair loss
  • Rarely: hepatotoxicity, thrombocytopenia, pancreatitis
17
Q

Monitoring with sodium valproate

A

LFTs, FBC and BMI

18
Q

Interaction with sodium valproate

A
  • Broad enzyme inhibitor - CYPs, UGTs, epoxide hydrolase
  • Inc plasma level of interacting drugs
  • Inc risk of toxicity
  • Other AEDs especially Lamotrigine, Phenytoin (highly protein bound)
  • Other drugs: TCA’s, olanzapine
  • Effect on valproate levels: COCs, carbapenems
19
Q

How does oral contraceptives affect sodium valproate?

A

Reduce the sodium valproate due to CYP450 so dose will need to be increased.

20
Q

What is sodium valproate contra-indicated in?

A

Childbearing potential, pregnancy and children (females). Appropriate contraception and counselling required.

21
Q

Lamotrigine side effects

A
  • Generally well tolerated
  • Blurred vision, agitation, arthralgia, ataxia, back pain, diarrhoea, drowsiness, dry mouth, headache, insomnia, nausea & vomiting, tremor
22
Q

Lamotrigine skin reactions

A

Severe reactions can occur usually within first 8 weeks.
Greater risk in children, patients with previous allergies, patients on combination treatment and with high starting dose / rapid titration

23
Q

Carbamazepine use

A

Effective for focal seizures; primary clonic and secondarily generalised tonic clonic seizures

24
Q

What can Carbamazepine worsen

A

Absence and myoclonic seizures

25
Q

Carbamazepine side effects

A

Lots

CNS active so CNS side effects.

26
Q

Carbamazepine monitoring

A

FBC, U&Es prior to initiation and periodically

27
Q

What enzyme does carbamazepine induce?

A

Potent CYP3A4 inducer (auto inducer), So interactions associated with other CYP3A4 inducers and inhibitors.

28
Q

What is Oxcarbazepine

A

Structural derivative of carbamazepine to avoid metabolites causing side effects and interactions

29
Q

What does Oxcarbazepine do with hormonal contraceptives?

A

Loss of effectiveness of hormonal contraceptive

30
Q

Levtiracetam (Kepra) use

A

Monotherapy OR adjunctive therapy for focal seizures with or without secondary generalisation

31
Q

Levtiracetam (Kepra) side effects

A

Well tolerated: drowsiness, headache, Gi effects, mood alterations including anxiety

32
Q

Risk of suicidal thoughts and behaviour and AEDs

A

All AEDs associated with a small increased risk of suicidal thoughts and behaviour. Seek adive.

33
Q

Supply of AEDs Category 1

A

– Maintain on a specific manufacturer’s product.

– E.g. - Phenytoin, Carbamazepine, Phenobarbital, Primidone

34
Q

Supply of AEDs Category 2

A

– Use of same brand based on clinical judgement and consultation with patient
– E,g, - Valproate, Lamotrigine, Oxcarbazepine, Eslicarbazepine, Zonisamide, Topiramate

35
Q

Supply of AEDs Category 3

A

– Usually unnecessary to keep specific brand

– E.g. - Levetiracetam, Tiagabine, Gabapentin, Pregabalin

36
Q

Lifestyle advice

A

Maintain a balanced diet
Exercise regularly
Good sleep hygiene
Driving advice

37
Q

Lifestyle advice: Maintain a balanced diet

A

– Some people may have food “triggers”
– Avoid excessive alcohol intake
– Avoid dehydration

38
Q

Lifestyle advice: Exercise regularly

A

– People with epilepsy tend to exercise less than others
– Exercise has been shown to reduce seizures
– Associated with protective effects against common co-morbidities

Stage 3 Case 2 (7 decks)

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