Epilepsy

Question 1

Drugs that can precipitate epileptic seizures

Answer 1

Tramadol - can induce in previously stable patients

Question 2

Driving and Epilepsy

Answer 2

1st seizure - 6 months car, 6 years for HGV / PCV
Epilepsy - 1 year car, or 3 years if seizure during sleep.
10 years off medication for HGV / PCV

Question 3

Generalised Seizures

Answer 3

Generalised seizures involving the corticothalamic circuitry. Can start from focal point.

Question 4

Epilepsy Classification

Answer 4

Epileptic Seizures

Epileptic Syndromes

Question 5

Epileptic Seizures

Answer 5

Generalised

Partial (focal site of origin)

Question 6

Epilepsy Syndromes

Answer 6

Type of seizure
Age
Aetiology

Question 7

Partial Seizures

Answer 7

Simple - without impaired consciousness

Complex - with impaired consciousness

Question 8

Generalised Seizures

Answer 8

Abscence
Myoclonic
Atonic - rare, seen in kids
Tonic
Tonic clonic (primary generalised)

Question 9

Generalised Epilepsy

Answer 9

Most have genetic predisposition
Present in childhood and adolescence
Spike-wave abnormality on EEG
Tonic clonic, absence, myoclonic, clonic, tonic and atonic

Question 10

Primary Generalised Epilepsy

Answer 10

Often present in childhood or teens
Sodium Valproate treatment of choice
Lamotrigine alternative
e.g. Juvenile Myoclonic Epilepsy

Question 11

Juvenile Myoclonic Epilepsy

Answer 11

Early morning jerks
Generalised seizure
RF: Sleep deprivation, flashing lights

Question 12

Focal Onset Epilepsy

Answer 12

Underlying structural problem
Focal onset - can then generalise
Any age
Frequent: complex partial seizures with hippocampal sclerosis
Carbamazepine or lamotrigine

Question 13

Focal Onset Epilepsy

Answer 13

Underlying structural problem
Focal onset - can then generalise
Any age
Frequent: complex partial seizures with hippocampal sclerosis
Carbamazepine or lamotrigine

Question 14

Partial Seizure treatment

Answer 14

Carbamazepine
Lamotrigine - takes three months to work
Levetiracetam

Question 15

Generalised Seizure - Absence treatment

Answer 15

Sodium Valproate

Ethosuximide

Question 16

Generalised Seizure - Myoclonic treatment

Answer 16

Sodium Valproate
Levetiracetam
Clonazepam

Question 17

Generalised Seizure - Atonic, tonic, generalised tonic clonic treatment

Answer 17

Sodium Valproate

Levetiracetam

Question 18

Phenytoin

Answer 18

Acute management only - Status epilepticus

SE: Gum hypertrophy

Question 19

Sodium Valproate

Answer 19

‘domestos’ of anticonvulsants

SE: Weight gain, teratogenic, hair loss, fatigue

Question 20

Carbamazepine

Answer 20

Focal onset seizure treatment

Can make primary generalised seizures worse - do not use.

Question 21

Lamotrigine

Answer 21

Well tolerated in generalised and focal seizures

Takes long time to titrate up - 3 months

Question 22

Topiramate

Answer 22

SE: weight loss, sedation, fatigue

Reasonably effective but not well tolerated

Question 23

When to prescribe drugs?

Answer 23

Patient has epilepsy
Single seizure but has high risk of recurrence
Only if patient wants drugs - SE and benefit weighing

Question 24

Ladies and Anti-convulsants

Answer 24

Alter efficacy of COC
Lamotrigine efficacy is reduced by COC.
Folic acid for conception (high dose 3 months) + vit K.