Epilepsy

Question 1

What does category 1 mean and what drugs are in this category

Answer 1

Needs to be prescribed by brand

Carbamazepine
Phenytoin
Phenobarbital
Primidone

Question 2

What does category 2 mean and what drugs are in this category

Answer 2

Prescribing by brand is based on clinical judgement

Valproate, lamotrigine, clonazepam, clobazam, topiramate

Question 3

What does category 3 mean and what drugs are in this category

Answer 3

Does not need to be prescribed by brand;

Pregabalin
Gabapentin
Levetiracetam
Brivacetam

Question 4

Why must you avoid abrupt withdrawal of anti-epileptic drugs?

Answer 4

Can cause rebound seizures
Should be reduced gradually

Question 5

How should anti epileptic drugs be withdrawn?

Answer 5

Gradually
In patients taking several, only one should be withdrawn at once

Question 6

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

Answer 6

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)

Question 7

PREGNANCY

Which anti epileptics are safest in pregnancy?

Answer 7

Lamotrigine
Levetiracetam

Question 8

PREGNANCY
What is the likelihood of the baby having no malformations if taking anti epileptics?

Answer 8

90%

Question 9

PREGNANCY

Which drugs are MOST dangerous in pregnancy?

Answer 9

Greatest risk;
valproate

Dose dependent;
carbamazepine, phenobarbital, topiramate.

phenytoin

Question 10

PREGNANCY;

What is recommended to be given along side anti epileptic and why?

Answer 10

Folate supplements

reduce risk of neural tube defects
folate supplementation

Question 11

BREASTFEEDING:

What should be advised and how should the baby be monitored?

Answer 11

Continue breastfeeding

Patients and family should be made aware of signs of toxicity

monitor for; sedation, feeding difficulties, adequate weight gain, and developmental milestones.

Question 12

BREASTFEEDING:
What drugs are associated with increased risk of drowsiness to baby?

Answer 12

Primidone, phenobarbital, and the benzodiazepines

Question 13

FOCAL SEIZURES:

What is first line for focal seizures with or without generalisation?

Answer 13

Lamotrigine or levetiracetam

second line;
carbamazepine
oxcarbazepine
zonisamide

Third line;
lacosamide

Question 14

GENERALISED SEIZURES:

What are the FOUR types?

Answer 14

Tonic-clonic
absence seizures
myoclonic seizures
atonic or tonic

Question 15

GENERALISED SEIZURES:

what is first line mono therapy for tonic-clonic seizures;
in males/females over 55?

females of child bearing potential?

Answer 15

sodium valproate
lamotrigine
levetiracetam

Question 16

GENERALISED SEIZURES:
What can exacerbate generalised seizures?

Tonic-clonic
absence seizures
myoclonic seizures
atonic or tonic

Answer 16

carbamazepine
gabapentin
pregabalin
vigabatrin

Question 17

GENERALISED SEIZURES:
What is treatment for absence seizures?

Answer 17

ethosuximide

sodium valproate

lamotrigine or levetiracetam

Question 18

GENERALISED SEIZURES:
what is treatment for myoclonic

Answer 18

sodium valproate first line

levetiracetam- second line

Question 19

GENERALISED SEIZURES:
what can exacerbate myoclonic seizures?

Answer 19

lamotrigine

Question 20

GENERALISED SEIZURES:

What is treatment for atonic/tonic seizures?

Answer 20

sodium valproate

Lamotrigine

Question 21

What is ONLY treatment for Lennox-gastaut syndrome for all patients and why ?

Answer 21

Sodium Valproate due to severity of syndrome and lack of evidence in others

lamotrigine can be used if not or cannabidiol with clobazam

Question 22

EPILEPSY;
What is repeated, cluster seizures and status epilepticus and what is treatment?

Answer 22

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)

Question 23

EPILEPSY:
What is first line treatment for convulsive status epilepticus?

Answer 23

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.

Question 24

EPILSEPY:
What is second line treatment if the first does not work?

Answer 24

second dose of benzodiazepines

then;
phenytoin and sodium valproate