Epilepsy

Question 1

Epilepsy

Answer 1

sudden surge of electrical activity of neurons in brain

Question 2

non-epileptic seizures causes

Answer 2

1. Organic (hypoglycaemia, fever)
2. Psychogenic (mental/emotional) e.g. distressing thoughts

Question 3

List of drugs used to tx seizures

Answer 3

1. Barbiturates: Phenobarbital (LONG-HALF LIFE), Primidone, thiopental
2. Benzodiazepines; Clobazam, Clonazepam, Lorazepam, Midazolam
3. Carbamazepine
4. Ethosuximide
5. Gabapentin, Pregablin
6. Lacosamide
7. Lamotrigine (LONG half-life)
8. Perampanel (Long half -life)
9. Phenytoin (LONG half-life)
10. Sodium valproate
11. Topiramate

Question 4

Partial (focal) seizures w or w/o secondary generalisation TX steps

Answer 4

1st = Lamotrigine or Carbamazepine

2nd = Levetiracetam, Valproate, Oxacarbazepine

Question 5

generalised Tonic-clonic seizures tx

Answer 5

1st line = Valproate or Lamotrigine
2nd = Carbamazepine

Question 6

generalised Absence seizures tx

Answer 6

1st line = Ethosuximide or Valproate (if high risk of generalised tonic-clonic seizure)
2nd = Lamotrigine

Question 7

generalised Myclonic seizures

Answer 7

1st line = Valproate
2nd = Topiramate, Leventiracetam

Question 8

generalised Atonic / Tonic seizures

Answer 8

1st line = Valproate

Question 9

Epilepsy MHRA alert

Answer 9

Potential harm when switching between different manufacturers for certain drugs

Question 10

Category 1 of anti-epileptic

Answer 10

~ Phenytoin, carbamazepine, phenobarbital + primidone

Advised to keep same brand

Question 11

Category 2 of anti-epileptic

Answer 11

~ Valproate, lamotrigine, clonazepam, topiramate

Based on clinical judgement and patient consultation

Question 12

Category 3 of anti-epileptic

Answer 12

~ Levetiracetam, Gabapentin, Pregablin, Ethosuximide

NOT need same brand

Question 13

EP drugs withdrawals

Answer 13

~ gradually reduce dose under specialist
~ avoid abrupt withdrawal, can participate severe rebound seizures

Question 14

Epilepsy driving

Answer 14

~ inform DVLA
~ can drive motor vehicle (not large goods)
~ if 1y seizure free

Question 15

Seizures while sleep & driving

Answer 15

• if hx of no awake seizure for 1y from first one
• establised pattern of sleep seizures for 3y if previous awake seizure

Question 16

EP and driving bans

Answer 16

• during medication changes or withdrawals
• 6 motnhs after last dose
• 6 months for 1st unprovoked seizure or single seizure
• 5y ban for large good/passenger vehicle

Question 17

Anti-epileptics in pregnancy

Answer 17

• increased risk of teratogenicity
• highest = valproate
• increased risk with = carbamazepine, Phenytoin (Antifolate), phenobarbital, primidone, lamotrigine
• Cleft palate with topiramate