Epilepsy Flashcards
What does category 1 mean and what drugs are in this category
Needs to be prescribed by brand
Carbamazepine
Phenytoin
Phenobarbital
Primidone
What does category 2 mean and what drugs are in this category
Prescribing by brand is based on clinical judgement
Valproate, lamotrigine, clonazepam, clobazam, topiramate
What does category 3 mean and what drugs are in this category
Does not need to be prescribed by brand;
Pregabalin
Gabapentin
Levetiracetam
Brivacetam
Why must you avoid abrupt withdrawal of anti-epileptic drugs?
Can cause rebound seizures
Should be reduced gradually
How should anti epileptic drugs be withdrawn?
Gradually
In patients taking several, only one should be withdrawn at once
DRIVING;
What must the patient do if they experience any of the following;
Experience a seizure
to continue driving following a seizure
Patients who have had a seizure whilst asleep
stop driving immediately
Prove they have not had a seizure free for at least a year
cannot drive for 1 year from date unless the seizures occur only ever asleep or pattern of purely asleep seizures can be demonstrated over course of three years (if had awake seizures before)
PREGNANCY
Which anti epileptics are safest in pregnancy?
Lamotrigine
Levetiracetam
PREGNANCY
What is the likelihood of the baby having no malformations if taking anti epileptics?
90%
PREGNANCY
Which drugs are MOST dangerous in pregnancy?
Greatest risk;
valproate
Dose dependent;
carbamazepine, phenobarbital, topiramate.
phenytoin
PREGNANCY;
What is recommended to be given along side anti epileptic and why?
Folate supplements
reduce risk of neural tube defects
folate supplementation
BREASTFEEDING:
What should be advised and how should the baby be monitored?
Continue breastfeeding
Patients and family should be made aware of signs of toxicity
monitor for; sedation, feeding difficulties, adequate weight gain, and developmental milestones.
BREASTFEEDING:
What drugs are associated with increased risk of drowsiness to baby?
Primidone, phenobarbital, and the benzodiazepines
FOCAL SEIZURES:
What is first line for focal seizures with or without generalisation?
Lamotrigine or levetiracetam
second line;
carbamazepine
oxcarbazepine
zonisamide
Third line;
lacosamide
GENERALISED SEIZURES:
What are the FOUR types?
Tonic-clonic
absence seizures
myoclonic seizures
atonic or tonic
GENERALISED SEIZURES:
what is first line mono therapy for tonic-clonic seizures;
in males/females over 55?
females of child bearing potential?
sodium valproate
lamotrigine
levetiracetam
GENERALISED SEIZURES:
What can exacerbate generalised seizures?
Tonic-clonic
absence seizures
myoclonic seizures
atonic or tonic
carbamazepine
gabapentin
pregabalin
vigabatrin
GENERALISED SEIZURES:
What is treatment for absence seizures?
ethosuximide
sodium valproate
lamotrigine or levetiracetam
GENERALISED SEIZURES:
what is treatment for myoclonic
sodium valproate first line
levetiracetam- second line
GENERALISED SEIZURES:
what can exacerbate myoclonic seizures?
lamotrigine
GENERALISED SEIZURES:
What is treatment for atonic/tonic seizures?
sodium valproate
Lamotrigine
What is ONLY treatment for Lennox-gastaut syndrome for all patients and why ?
Sodium Valproate due to severity of syndrome and lack of evidence in others
lamotrigine can be used if not or cannabidiol with clobazam
EPILEPSY;
What is repeated, cluster seizures and status epilepticus and what is treatment?
Repeated/cluster;
3 or more self-terminating seizures
prolonged seizures;(>2mins than normal), convulsive status epilepticus
considered a medical emergency
Treatment;
Patients medical emergency treatment plan should be followed if not benzodiazepine(clobazam/midazolam)
EPILEPSY:
What is first line treatment for convulsive status epilepticus?
Immediate measures;
positioning the patient to avoid injury
supporting respiration including the provision of oxygen,
maintaining blood pressure, and the correction of any hypoglycaemia.
Parenteral thiamine should be considered if alcohol abuse is suspected; pyridoxine hydrochloride should be given if the status epilepticus is caused by pyridoxine deficiency.
EPILSEPY:
What is second line treatment if the first does not work?
second dose of benzodiazepines
then;
phenytoin and sodium valproate
