Epilepsy Management

Question 1

Who qualifies for epilepsy surgery?

Answer 1

• Resective surgery for partial seizures with single focus
• must be possible to define the focus accurately
• should be medically intractable
  -Risk of surgery less than benefits
• Other epilepsies may also respond to VNS

Question 2

Types of epilepsy surgeries

Answer 2

• Focal resection (eg temporal lobectomy, lesionectomy)
• Major resection (multilobar, hemisperectomy/otomy)
• Disconnection (multiple subpial transection, callosotomy)
• Functional (Vagus nerve stimulation, deep brain stimulation)

Question 3

Adverse effects of antiepileptic drugs

Answer 3

• changes in brain chemistry
• sedation
• educational difficulties
• Eg Levetiracitam and depression
• Topiramate and speech disturbance

Question 4

how might epilepsy surgery affect psychiatric state?

Answer 4

• Major life events (such as surgery) are associated with depression
• Anti-climax of still being at risk of seizures
• anxiety of no seizures
• potential lack of social benefit from too-late surgery

Question 5

Seizure management in tumour-associated epilepsy

Answer 5

-Treat after first seizure
-Avoid enzyme-inducing AEDs
-Peri-operative regimens
-Tumour treatment takes precedence
-Use AEDs from different groups

Question 6

what effect can ASM have longterm on bone health

Answer 6

not exclusively those with enzyme inducing effects, may be associated with reduction in bone density

Question 7

Which ASM is associated with decreased bone mineral density and increased risk of osteomalacia

Answer 7

carbamazepine, phenytoin, primidone and sodium valproate

Question 8

What increases your risk fracture

Answer 8

Postmenopausal = Osteoporosis

Question 9

Management of bone health in epilepsy

Answer 9

> Management should include being proactive about optimizing bone health in the long term,
especially in countries with low Vit D
consider vitamin D and calcium supplementation for people at risk
Bone density scanning where indicated in high risk groups based on gender, age, ASM used and duration, lifestyle and mobility and comorbidity
Apply fracture risk assessment where appropriate

Question 10

Pregnancy planning in women with epilepsy

Answer 10

-Folic acid preconception
-Anti-seizure medication reviewed/adjusted before conception to minimize teratogenic risk while keeping the mother (and later the unborn child safe)
-Pregnancy and fetus monitored to maximize safety including, monitoring anti-seizure medication levels for certain anti-seizure medications
-Small risk of seizures during labour
-Advice for postpartum

Question 11

Adverse drug effects on the fetus…

Answer 11

can present as fetal loss, intrauterine growth retardation, congenital malformations, impaired postnatal development, and behavioural problems

Question 12

To reduce risk of ASM

Answer 12

Adjust/ or change medication where there is a history of a previous malformation without compromising the safety of the mother

Question 13

higher risk of seizures among women treated with …

Answer 13

oxcarbazepine