Epilepsy

Question 1

What is the 1st and 2nd line treatment for Tonic-Clonic seizures?

Answer 1

1st Line: Sodium Valproate

2nd Line: Lamotrigine / Levetiracetam

Question 2

What are the 1st and 2nd line treatments for Focal Seizures?

Answer 2

1st Line: Lamotrigine or Levetiracetam

2nd Line: Carbmazepine, Oxcarbazepine, Zonisamide

Question 3

What is the 1st and 2nd line treatment for Absence seizures on their own?

Answer 3

1st Line : Ethosuximide

2nd Line: Sodium Valproate

Question 4

What is the 1st and 2nd line treatment for Absence seizures along side other types of seizures?

Answer 4

1st Line: Sodium Valproate

2nd Line: Lamotrigine/ Levetiracetam

Question 5

What is the 1st and 2nd line treatment for Myoclonic seizures?

Answer 5

1st Line: Sodium Valproate

2nd Line: Levetiracetam

Question 6

What are the 1st and 2nd line treatments for Atonic and Tonic seizures?

Answer 6

1st Line: Sodium Valproate

2nd Line: Lamotrigine

Question 7

What are the contraception conditions for a male on Sodium Valproate?

Answer 7

Male patients who may father children should use effective contraception during valproate treatment and for at least 3 months after stopping.

Question 8

What is the 1st Line treatment for Status Epilepticus?

Answer 8

If resuscitation facilities are available e.g hospital - IV Lorazepam

If not available e.g community - Buccal Midazolam or Rectal Diazepam

Question 9

What are the conditions for Sodium Valpraote to be started in patients under 55?

Answer 9

Two specialists must independently consider and document that there is no other effective or tolerated treatment

Question 10

If a patients Status Epilepticus seizure does not stop within 5-10mins of first dose of treatment what should be done?

Answer 10

Give second dose

If seizure fails to respond after 2 doses, second line options are:

Levetiracetam (FL), Phenytoin, Sodium Valproate
If seizure fails to respond try a different second line option.

If still not responding, third line options:

Phenobarbital or General Anaesthesia

Question 11

What are Category 1 Anti-Epileptic Drugs and what do they mean?

Answer 11

Carbamazepine, Phenobarbital, Phenytoin, Primidone (CP3)

Patients must be maintained on a specific brand throughout treatment of these drugs.

Question 12

What are interactions that occur with Carbamazepine, Phenytoin and Sodium Valproate?

Answer 12

Hepatoxicity with Amiodaron, Itraconazole, Macrolides and Alcohol

Carbamazepine, Phenytoin and Phenobarbital are CYP inducers.

Sodium Valproate - CYP inhibitor

Interact with drugs that lower seizure threshold: Tramadol, Theophylline, Quinolones

Question 13

What specific interactions occur with Carbamazepine?

Answer 13

Hyponatraemia - SSRI, Diuretics

Question 14

What specific interactions occur with Phenytoin?

Answer 14

Anti-folate reaction - Methotrexate, Trimethoprim

Question 15

What side effects occur with Carbamazepine, Phenytoin and Sodium Valproate?

Answer 15

Depression + Suicide (behavioural changes)
Hepatoxicity
Hypersensitivity
Blood Dyscrasia
Vitamin D Deficiency (disguised as bone pain)

Question 16

What are specific side effects that occur with Carbamazepine?

Answer 16

Hyponatraemia and Oedema

Question 17

What are specific side effects that occur with Phenytoin?

Answer 17

Coarsening Appearance and Facial Hair

Question 18

What are specific side effects that occur with Sodium Valproate?

Answer 18

Pancreatitis + Teratogenic effects

Question 19

Which Anti-Epileptic drugs can cause Hypersensitivity as a side effect?

Answer 19

Carbamazepine. Phenobarbital, Phenytoin, Primidone, Lamotrigine (CP3L)

Question 20

Which Anti-Epileptic drug can causes Stevens-Johnsons Syndrome as a side effect?

Answer 20

Lamotrigine

Question 21

Which Anti-Epileptic drugs cause Blood Dyscrasia as a side effect?

Answer 21

Carbamazepine, Valproate, Ethosuximide, Topiramate, Phenytoin, Lamotrigine, Zonisamide (C.VET.PLZ)

Question 22

Which Anti-Epileptic drugs can cause Eye Disorders as a side effect?

Answer 22

Vigabatrin - reduced visual field
Topiramate - secondary glaucoma

Question 23

Which Anti-Epileptic drug can cause Encephalopathy as a side effect?

Answer 23

Vigabatrin

Question 24

Which Anti-Epileptic drugs can cause Respiratory Depression as a side effect?

Answer 24

Gabapentin and Pregabalin

Question 26

What is the therapeutic range for Carbamazepine and what are the signs of toxicity?

Answer 26

4-12mg/L Hyponatraemia Ataxia Nystagmus Drowsiness Blurred Vision Arrhythmias Gastrointestinal Distrubances (HANDBAG)

Question 27

What is the therapeutic range for Phenytoin and what are the signs of toxicity?

Answer 27

10-20mg/L (same as theophylline) Slurred Speech Nystagmus Ataxia Confusion Hyperglycaemia Double Vision (SNACHD)

Question 28

How long must a person stop driving for if they have their first unprovoked or single isolated seizure?

Answer 28

6 Months

Question 29

How long must a person stop driving for is they have established epilepsy (multiple seizures)?

Answer 29

Must have no seizures for 1 year before starting to drive again.

Question 30

If a patients epilepsy medication has been changed or stopped how long can they not drive for?

Answer 30

6 months after change in dose or last dose

Question 31

If a patient has a seizure after their anti-epileptic medication has been changed or stopped how long is their license revoked for?

Answer 31

License is revoked for 1 year. If no seizures occur in 6 months then patient can start driving again.

Question 32

If a pregant epileptic patient queries that they heard ant-epileptic drugs are not safe for the baby what advise should you provide?

Answer 32

The risk of harm to mother and fetus from convulsive seizures outweighs the risk of continued therapy. Therefore the patient should continue to take their anti-epileptic medication.

Question 33

What medication is given to pregnant women to prevent neural tube defects caused by anti-epileptic drugs?

Answer 33

Folic Acid 5mg OD in first trimester

Question 34

Why is a Vitamin K injection administered at birth to pregnant epileptic women?

Answer 34

Minimises the risk of neonatal haemorrhage

Question 35

Other than Sodium Valproate, what other Anti-Epileptic medication is contraindicated in pregnancy and women of childbearing potential unless on pregnancy prevention programme?

Answer 35

Topiramate

Question 36

What is the advice for patients taking Anti-Epileptic medication who are breastfeeding?

Answer 36

If only on one medication Encouraged to breastfeed If on combination therapy or other risk factors present such as pre-mature birth: Seek advice before breastfeeding

Question 37

Which Anti-Epileptic drugs have a high presence in breast milk?

Answer 37

Primidone, Lamotrigine, Ethosuximide and Zonisamide (PELZ)

Question 38

Which Anti-Epileptic drugs have a risk of drowsiness whilst breastfeeding?

Answer 38

Primidone, Phenobarbital and Benzodiazepines

Question 39

Which Anti-Epileptic drugs have withdrawal effects (mother suddenly stops breast-feeding)?

Answer 39

Phenobarbital, Primidone, Benzodiazepines and Lamotrigine