Epilepsy in special populations

Question 1

Indipendent risk factors for epilepsy in elderly (4)

Answer 1

• Depression (sixfold increase in risk of unprovoked seizures
• Sleep apnea
• hypertension
• alzheimers (10% of AD patients)

Question 2

Risk of seizure recurrence in elderly after first unprovoked seizure

Answer 2

80%

Question 3

ASMs that can decrease effectiveness of oral contraceptives

Answer 3

“Rooftop Carbs, three for four pennies”
RUF - rufinimide
TOP - topirmate
Carb (3)
- carbamazepine
- oxcarbamazepine
- esclicarbazipine
4 (pennies)
- phenytoin
- phenobarbital
- Primidone
- Perampanel

Question 4

Teenager wants to start OCP, what medicine would you need to get levels on?

Answer 4

Lamotrigine (levels may reduce as much as 50% if on estrogen-containing contraceptive)

Question 5

Antiseizure medications that do NOT reduce effectiveness of contraceptives

Answer 5

“GET Lisa’s 3 Vests zipped”
G- gabapentin
E- Ethosuximide
T- Tiagabine
L(3) - levetiracetam, lamotrigine, lacosamide
V - valproate
Z- zonisamide

Question 6

Medications that are confirmed efficacious per ILAE:
Level A:
Level B:
Level C:
Level D:

Answer 6

Level A:
- Lamotrigine
- Gabapentin
Level B: None
Level C:
- Carbamazepine
Level D:
- Topiramate
- valproate

Question 7

Criteria for Social security benefits for Disability for convulsive epilepsy: (2)

Answer 7

• Seizure frequency of seizure frequency of >1 seizure per month despite taking prescribed treatment for 3+ months
• daytime episodes OR nocturnal episodes with significant residual interference

Question 8

Which medications transfer into breast milk at clinically significant amounts (2)

Answer 8

Primidone
levetiracetam

Question 9

Pregnancy and AEDs:
Low-risk (2)
Low-medium risk (2)
Medium risk (5)
High-medium risk (2)
High risk (2)

Answer 9

Low risk:
- Lamotrigine
- Levetiracetam
Low-medium risk
- Oxcarbazepine
- Carbamazepine
Medium
- Lacosamide
- Gabapentin
- CBD
- Perampanel
- Onfi
High
- Valproate
- Topiramate

Question 10

ASM that can cause cleft lip/palate (2)

Answer 10

• Topiramate
• Lamotrigine

Question 11

ASM least likely to cause problems with bone density

Answer 11

Lamotrigine