Epilepsy

Question 1

describe how you would manage a patient with status epileptics.

Answer 1

ABCD

• check airway
• check blood glucose
• oxygen

1st line - barbiturate

• prehospital: rectal diazepam
• in hospital: IV lorazepam (can be repeated after 10-20 mins)

2nd line if not responding
- phenytoin or phenobarbital infusion

if no response within 45 mins –> general anaesthesia

Question 2

1st and 2nd line treatment for focal seizure ?

Answer 2

1st line: carbamazepine or lamotrigine

2nd line: levetiracetam or na valproate

Question 3

1st line and 2nd line treatment for generalised seizure ?

Answer 3

1st line: sodium valproate

2nd line: lamotrigine or carbemazepam

Question 4

1st line treatment for absence seizure ?

Answer 4

na valproate or ethosuximide

Question 5

1st and 2nd line treatment for myoclonic seizures ?

Answer 5

1st line: na valproate

2nd line: lamotrigine or clonazepam

Question 6

what anti epileptic is safest to use during pregnancy ?

Answer 6

lamotrigine

Question 7

side effects of carbamazepine?

Answer 7

P450 inducer 
aagranulocytosis, leukopenia 
SJS 
hyponatraemia (SIADH)
rash
diplopia, nystagmus
drowsiness, confusion 
ataxia

Question 8

side effects of sodium valproate ?

Answer 8

P450 inhibitor 
teratogenic (neural tube defects)
thrombocytopenia 
weight gain 
hair loss 
tremor 
ataxia
hepatotoxicity 
pancreatitis 
hyperammonemic encephalopathy

Question 9

side effects of lamotrigine ?

Answer 9

SJS

Question 10

during status epileptics, after how long should would you give the 2nd dose of lorazepam ?

Answer 10

10-20 minutes

Question 11

when would you start antiepileptics after the patient has only 1 seizure ?

Answer 11

patient has neurological deficit
brain imaging shows structural abnormality
EEG shows definite epileptic activity
patient or their family/carers consider the risk of having a further seizure unacceptable