Epilepsy

Question 1

DVLA guidance after
-1 seizure
-2 seizures/abnormal brain scan/abnormal EEG/epileptic seizure after remission

Answer 1

1st seizure - cannot drive for 6 months until they have been seen by a consultant neurologist

2nd seizure/abnormal brain scan/abnormal EEG/epileptic seizure after period of remission - cannot drive for 12 months

Question 2

Non epileptic causes of seizures

Answer 2

Acute head injury
Alcohol withdrawal
Febrile in children
Medication
Metabolic disturbance
Strokes

Question 3

Medications that may provoke seizures

Answer 3

Analgesic - NSAIDs, tramadol, nefopam

Antiemetics - cyclizine, propchlorperazine

Antipsychotics - clozapine, haloperidol

Antibiotics - quinolones

Antidepressants - SSRIs

COCP

Hypnotics, anxiolytics - BZ, Z-drugs

Alcohol, amphetamines, cocaine

Question 4

AEDs safe in pregnancy

Answer 4

Lamotrigine
Levetiracetam

Question 5

Missed AED doses management

Answer 5

ABRUPT WITHDRAWAL OF AEDS => HIGH RISK OF SE

Medications with similar modes of action cannot be considered equivalent

Cannot assume remission status

Give them dose as soon as possible

Question 6

AEDs and contraceptives

Answer 6

Effectiveness reduced if on OCP, implant

Devices and depot are unaffected

Question 7

AEDs and SE

Answer 7

Lamotrigine - SJS, TENs
Carbemazepine - SIADH

Question 8

AEDs and drug levels

Answer 8

Not routinely taken - concentration does not indicate toxicity
-done for phenytoin to guide treatment

Take drug levels if there are symptoms of toxicity

Question 9

Phenytoin toxicity

Answer 9

NV, ataxia, fine rapid nystagmus on lateral gaze

Dysarthria

Hypotension, apnoea, resp depression

Question 10

Switching between brands

Answer 10

Cat 1 - keep on same brand
-phenytoin, carbemazepine

Cat 2 - clinical judgement based on seizure frequency and treatment history
-lamotrigine, valproate

Cat 3 - can switch brands
-levetiracetam, lacosamide

Question 11

Status epilepticus
-definition
-refractory
-causes

Answer 11

Continuous seizure activity for 20-30mins

Longer duration => more likely to be refractory to treatment
-refractory to BZ, phenytoin

Abrupt withdrawal of AEDs
Alcohol withdrawal
CNS infection
Fever/infection
Malignancy
Medication change
Metabolic distubance
Trauma
Stroke

Question 12

Management of SE

Answer 12

Pre-hospital
Rectal diazepam - 10-20mg 2x 5-10mins apart or
Buccal midazolam - 10mg

Early status
IV loraz 0.1mg/kg - repeat after 5-10mins
IV diazepam
regular AED

Established status
IV levetiracetam/phenytoin/valproate - repeat after 5-10mins

Refractory status
Phenobarbitone or GA with
-IV propofol/midaz/thiopentone
Continue for 12-24hrs after last clinical or EEG seizure before tapering