Epilepsy

Question 1

Epilepsy: focal seizures:
First line is what (Ls)

Answer 1

First line : Lamotrigine or levetiracetam (2Ls)

Question 2

Second line:
- focal cozzzzz

Answer 2

Carbamazepine, oxcarbazepine and zonisamide (Coz)

Question 3

Generalised seizures:
(Names) think waterrrr tamat

Answer 3

• Toinic clinic
  
  • Absence(with another type of seizure)
  • Myoclonic
  • Atonic
  • Tonic

Question 4

Generalised seizures - treatment - WHAT DO WE USE FIRST LINE? THEN??? OR??

Answer 4

We use sodium valoprate as the first line, then lamotrigine or levetiracetam as the second line

Question 5

For Absence on its own with nothing else what can we give??( E + S)

Answer 5

we would use use Ethosuximide and sodium valoprate

Question 6

Women - should always take what in terms of treatment if of child bearing age?

Answer 6

Women to always take second line if at child bearing age

Question 7

MHRA Update- for Sodium valproate??? And topimirate??

Answer 7

Full pack dispensing required for sodium valoprate. Valoprate must not be started in new patients (Male or female) aged 55 or under , unless two specialists independently consider and document that there is no other effective treatment available
- Topimirate is also contraindicated in pregnancies now and women of child bearing age can use unless conditions of pregnancy prevention are fulfilled
- Male patients who may father children should use effective contraception whilst on valoprate and for at least 3 months after valoprate

Question 8

Status epilepticus is a seizure that will last….
How long?
What do we need to provide? What are the two likelihoods for the plans put in place by th patient

Answer 8

• Seizure lasting longer than 5 mins
  
  • Provide immediate resuscitation and immediate emergency treatment:

1)Patient has an individualised emergency management plan in place that is immediately available
2)Patient doesn’t have an individualised emergency management plan immediately available

Question 9

Seizures lasting longer than 5 mins:
We give what IV? If resus available vs if in community

Answer 9

• IV lorazepam (if resuscitation facilities are available)
  
  • Buccal midazolam or rectal diazepam(if in community)

Question 10

Give second dose in seizures if …. How long does it last ?
Or if what fails so we give what? What if second line doesn’t work what are the 2 options?

Answer 10

seizure doesn’t stop within 5-10 mins

- If seizure fails to respond after 2 benzodiazepine doses:
- Levetiracetam,phenytoin, sodium valoprate 

If seizure fails to respond, try second line - if still not working then give phenobarbital or general anaesthetic

Question 11

Category 1

Answer 11

Category 1:
Ensure patients are maintained on a specific brand
Carbamazepine,phenobarbital,phenytoin and primodine
Has to be the same brand

Question 12

Anti-epileptic interactions:
(Carbamazepine? Phenytoin? Sodium valproate?) have a risk of what so interact with drugs that are what toxic? What about being inducers and inhibitors? Which drugs lower seizure threshold? Carbamazepine specifically and phenytoin is a what so interacts with what?

Answer 12

Carbamazepine,phenytoin and sodium valoprate:
Hepatoxicity: Amiodarine,Itraconazole,Macrolides,alcohol
CYP enzyme:inducers(phenytoin,phenobarbital,carbamazepine),inhibitors(sodium valoprate)
Drugs that lower seizure thresholds: Tramadol,theophyllines,quinolones

Carbamazepines: Hyponatraemic drugs(SSRI,Diuretics)
Phenytoin: Anti-folates(methotrexate,trimethoprim)

Question 13

Anti epileptic side effects:
Carb/phenytoin and valproate can all cause what?
What’s blood dyspraxia??? What doe we give patients complaining of bone pain?

Answer 13

Carbamazepine,phenytoin and sodium valproate
- Depression and suicude
- Hepatotoxic it’s
- Hypersensitivity
- Bloody dyspraxia
Vitamin D deficiency- pt is complaining of bone pain = vit D

Question 14

Carbamazepine- can cause????

Answer 14

Hyponatraemia and oedema

Question 15

Phenytoin can cause?

Answer 15

coursing appearance and facial hair

Question 16

Cyp450 is linked to what?

Answer 16

hepatotoxicty

Question 17

Hypersensitivity- is caused by which 5 anti epileptics?(NOT valproate!!!!)

Answer 17

Carbamazepine,phenobarbital,phenytoin,primidone,lamotrigine

Question 18

Skin rash: is caused by? What is the syndrome also known as??

Answer 18

lamotrigine - Stevens Johnson syndrome
Blood Dyscrasia -

Question 19

Blood Dyscrasia is caused by which anti-epileptics - C.VET PLEZ

Answer 19

carbamazepine,valoprate,ethosuximide,topiramate,phenytoin
Lamotrigine and zonisamide(C.VET PLZ)

Question 20

Eye disorder: What causes reduced visual fields? What causes a secondary glaucoma??? What causes encephalopathy? What causes resp depression???

Answer 20

Vigabatrin(reduced visual field)topiramate(secondary glaucoma)
Encephalopathy: vigabatrin
Resp depression: Gabapentin,pregablin

Question 21

CARBAMAZEPINE:
What is the therapeutic range? What are the signs of toxicity?

Answer 21

Therapeutic range 4-12mg/L
Signs of toxicity -
Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred vision
Arrhythmias
GI disturbances

Question 22

Phenytoin: 10-20 mg.L
Signs of toxicity?

Answer 22

SIGNS
Slurred speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double vision

Question 23

Epilepsy and Driving- what are the steps taken?

Answer 23

• Driver must stop immediately and inform DVLA - if a fit
  
  • If first unprovoked or single isolated - stop driving for 6 months - if you have another one within -established epilepsy but no impact on consciousness - 1 year fit free o start driving again
  • If nothing then its okay continue during
  • Med change/withdrawal
  • Should not drive for 6 months after last does - meds taken off slowly
    Reduced meds and reduction causes a seizure, license gets revoked for a year and then reinstated after 6 months if the treatment resumed and no further seizures occur

Question 24

Pregnancy- there is a risk of what from convulsions? Which outweigh what? What is given fro neural defects in the first trimester?what vitamin is given at birth to minimise what? Most risky med ? What can topimiarte cause

Answer 24

• Risk of harm to the mother and foetus from convulsion seizures outweighs the risk of continued therapy
  
  • Folic acid given reduces the risk of neural tube defect in the first trimester
  • Vitamin K - phitomenadoin injection administered at birth to minimise risk of neonatal haemorrhage
  • Most risk: Sodium valproate PPP
  • Topiramate - Cleft palate

Question 25

Breast feeding- encouraged to do what if on just one med? Combo therapy could mean??
Which are highly present in milk??? (PLEZ)
Which cause risk of drowsiness? (Bapp)
Which cause withdrawal effects?? (Lapp- b)

Answer 25

• Encouraged to breastfeed if on one medication - combo therapy = premature birth - need specialist advice
  
  • High presence in milk; primodine, ethosuximide,lamotrigine,zonisamide
  • Risk of drowsiness: primodine,phenobarbital and bdz
  • Withdrawal effects(mother suddenly stops breastfeeding - phenobarbital,primodine,bdz,lamotrigine

Question 26

Category 2

Answer 26

Category 2:
Maintain specific brands should be based on clinical judgment with patient factors considered
Clobazam,clonazepam,lamotrigine,oxcarbazepine,perampanel,rufinamide,topimirate,valoprate,zonisamide

Question 27

Category 3

Answer 27

Category 3:
Unnecessary to keep the same brand
Brivaracetam,ethosuximide,sgabapentin,lacosamide,levetiracetam,pregabalin,tiagabine,vigabatrin