Epilepsy CG137

Question 1

What imaging to diagnose epilepsy?

Answer 1

MRI, especially in those who have first fit <2yo or in adulthood, who have focal onset, or refractive epilepsy

Question 2

What investigations to diagnose epilepsy?

Answer 2

EEG, MRI (CT if MRI not available), U+Es, BM, Ca2+, ECG in adults and considered in children, refer for neuropsychological assessment

Question 3

What pharm tx for focal seizures?

Answer 3

first line: carbamazepine or lamotrigine monotherapy

Question 4

What pharm tx for newly diagnosed generalised tonic-clonic seizures?

Answer 4

first line: sodium valproate (not for women for childbearing age) second line: lamotrigine (may exacerbate myoclonic seizures)

Question 5

What pharm tx of absence seizures?

Answer 5

First line: ethosuxamide or sodium valproate

Question 6

What pharm tx of myoclonic seizures?

Answer 6

First line: sodium valproate

Question 7

What pharm tx of tonic or atonic seizures?

Answer 7

First line: sodium valproate

Question 8

What pharm tx of infantile spasms?

Answer 8

First line: prednisolone or tetracosatide or vigabatrin

Question 9

What pharm tx of Dravet syndrome?

Answer 9

First line: sodium valproate or topiramate

Question 10

What pharm tx of Lennox-Gastaut syndrome?

Answer 10

Sodium valproate

Question 11

What pharm tx of benign epilepsy with centrotemporal spikes?

Answer 11

Firs tline: carbamazepine or lamotrigine

Question 12

What pharm tx of idiopathic generalised epilepsy?

Answer 12

First line: sodium valproate (c/i in child-bearing age) Second line: lamotrigine (but can exacerabte myoclonic seizures)

Question 13

What pharm tx of juvenile myoclonic epilepsy?

Answer 13

First line: sodium valproate Second line: lamotrigine

Question 14

How can adherence to treatment be optimised?

Answer 14

• educating children and families on condition and rationale of treatment - reducing stigma - using simple medication regimes - positive relationships between HCP and child and family

Question 15

What blood tests for those on AEDs?

Answer 15

• no regular blood tests for adults nor children - but every 2-5 years FBC, U+E, LFTs, bone profile for those taking enzyme-inducing drugs. - clotting screen before surgery for those on sodium valproate

Question 16

Can the COCP or minipill be taken with AEDs?

Answer 16

COCP yes with caution (lamotrigine particularly), POP cannot be taken as becomes ineffective.

Question 17

What are the differential diagnoses in adults for epilpetic presentations?

Answer 17

Question 18

What are the differential diagnoses for epileptic presentations in children?

Answer 18