Epilepsy

Question 1

What are the three main types of generalised epilepsy?

Answer 1

Tonic-clonic (grand-mal)
Absence (petit-mal)
Myoclonic

Question 2

What are the symptoms of Tonic-clonic seizures?

Answer 2

Loss of consciousness w/ full fit

Often w/o warning

Question 3

What are the symptoms of Absence seizures?

Answer 3

Patient goes blank/staring for 10secs

Often in children

Question 4

What are the symptoms of Myoclonic seizures?

Answer 4

Abrupt, shock-like jerks

Affects whole body/limbs

Question 5

What is the main aim of Epilepsy treatment?

Answer 5

To control seizures with the lowest possible dose and the fewest side effects

Question 6

What other pathologies can cause/present as seizures?

Answer 6

Cerebral tumours
Cerebrovascular accident
Alcohol withdrawal
Hyper/hypoglycaemia
Syphilis
Drugs

Question 7

What is the drug therapy for most generalised seizures?

Answer 7

1st line - Valproate/Carbamazepine/Lamotrigine
2nd line - Levitiracetam
MONOTHERAPY

Question 8

What is the drug therapy for absence seizures?

Answer 8

1st line - Ethosuximide
2nd line - Valproate/Lamotrigine
MONOTHERAPY

Question 9

How does Valproate work?

Answer 9

Potentiates GABA

Causes Na channel blockade

Question 10

What are the side effects of Valproate?

Answer 10

Sedation
Weight gain
Tremor
Birth defects
Liver damage
Thrombocytopenia

Question 11

How does Carbamazepine work?

Answer 11

Use-dependent blockade of Na-channels

Question 12

What are the side effects of Carbamazepine?

Answer 12

Rashes
Dizziness
Double vision
Inducer of metabolism/many interactions
Birth defects

Question 13

How does Phenytoin work?

Answer 13

Voltage-dependent blockade of Na-channels

Question 14

What are the side effects of Phenytoin?

Answer 14

Increased gum growth
Nystagmus
Birth defects

Question 15

What sort of kinetics does Phenytoin have?

Answer 15

Zero-order

Disproportionate increases in plasma conc on increasing dose - MONITOR

Question 16

How does Lamotrigine work?

Answer 16

Use-dependent blockade of Na-channels

Reduces glutamate release

Question 17

What is the main side effect of Lamotrigine?

Answer 17

Bone marrow toxicity
-rash/flu like illness
Aplastic anaemia

Question 18

What haematological effects can occur during treatment with anti-epileptic drugs?

Answer 18

Leucopenia -fever/sore throat/rash/mouth ulcers
Aplastic anaemia - Lamotrigine
Thrombocytopenia - Valproate
MONITOR FBC

Question 19

What hepatological effects can occur during treatment with anti-epileptic drugs?

Answer 19

Hepatic function altered - Carbamazepine/Valproate

MONITOR LFT/INR

Question 20

What skin effects can occur during treatment with anti-epileptic drugs?

Answer 20

Rashes

Stevens-Johnson/TEN - Carbamazepine, Lamotrigine, Phenytoin, Valproate

Question 21

How should pregnant patients be advised regarding treatment?

Answer 21

Withdraw from drugs prior to conception if possible
Treatment is preferable to hypoxic seizures
Reduced control during pregnancy
Take folic acid to prevent NTD
Give Vit K1 in T3

Question 22

What interactions are common with anti-epileptic drugs?

Answer 22

Phenytoin, Carbamazepine, Phenobarbitone are inducers

Failure of oral contraceptives

Question 23

What drug is considered 1st line for treatment during pregnancy?

Answer 23

Lamotrigine - limited teratogenesis

Question 24

What is Status Epilepticus?

Answer 24

Continuous seizures for 30 mins OR

2 fits w/o recovery between them

Question 25

What is the treatment for Status Epilepticus?

Answer 25

Lorazepam i.v. OR
Diazepam i.v./rectal OR
Clonazepam OR
Phenytoin i.v. OR
General anaesthesia (propofol)

Question 26

What are the main issues surrounding anti-epileptic treatment?

Answer 26

Driving (permitted if seizure free for 1 year)
Withdrawal (consider if seizure free for 2-4 years)
Pregnancy
Side effects