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Neurology- Clinical > Epilepsy - Management > Flashcards

Epilepsy - Management Flashcards

1
Q

The sudden development of very frequent attacks of seizures in a patient with previously well controlled epilepsy is unusual. What are some causes for this?

A

Pregnancy, stopping and swapping medications, new CNS pathology, psychogenic non-epileptic attacks

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2
Q

Which type of epilepsy is most likely to have a genetic predisposition?

A

Generalised

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3
Q

What will generalised epilepsy show on an EEG?

A

Generalised spike-wave abnormalities

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4
Q

When does juvenile myoclonic epilepsy typically present?

A

In the teens

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5
Q

What are some features of juvenile myoclonic epilepsy?

A

Early morning jerks, daytime generalised seizures (tonic clonic and absence)

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6
Q

What are some factors which can trigger seizures in juvenile myoclonic epilepsy?

A

Flashing lights (photosensitivity) and sleep deprivation

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7
Q

What are the outcomes of juvenile myoclonic epilepsy?

A

Remission is rare, and without medication the risk of recurrence is high

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8
Q

What is the first line treatment of choice for the vast majority of cases of generalised epilepsy?

A

Sodium valproate

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9
Q

What is the most important thing to be aware of about sodium valproate? What should be done about this?

A

This is teratogenic, any females taking this medication should be counselled about this and given appropriate contraception

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10
Q

Who should sodium valproate always be avoided in unless absolutely necessary?

A

Young females of reproductive age

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11
Q

Apart from the teratogenicity, what are some other side effects of sodium valproate?

A

Weight gain, hair loss and fatigue

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12
Q

What is the most common 2nd 1st line drug for generalised epilepsy?

A

Lamotrigine

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13
Q

What are the downsides to using lamotrigine?

A

Can sometimes make clonus worse and can precipitate Stevens-Johnsons Syndrome if given quickly at a high dose

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14
Q

How must lamotrigine be started?

A

Titrated up slowly

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15
Q

Which anti-epileptic medication is well-tolerated in both generalised and focal epilepsies?

A

Lamotrigine

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16
Q

When is levetiracetam used?

A

2nd line treatment for generalised epilepsy

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17
Q

Levetiracetam is a popular drug why?

A

It has few interactions with other medications and is usually well tolerated

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18
Q

At high doses, levetiracetam can cause what?

A

Moodswings

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19
Q

What are some side effects of topiramate, another 2nd line drug for generalised epilepsy?

A

Sedation, dysphagia and weight loss

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20
Q

Which anti-epileptic drugs is used for acute management only and requires a rapid loading dose?

A

Phenytoin

21
Q

After sodium valproate, the next drug in line for generalised epilepsy is lamotrigine. The exception to this is absence seizures when the next drug in line would be what?

A

Ethosuximide

22
Q

How do most anti-epileptic drugs work?

A

Block voltage gated Na+ channels which decrease pre-synaptic excitability and the ability of action potentials to spread

23
Q

How does sodium valproate work?

A

Enhances the action of GABA (an inhibitory neurotransmitter)

24
Q

What medication should never be given in generalised epilepsy and why?

A

Carbamazepine - can precipitate status

25
Q

The treatment plan for focal epilepsy also includes secondary generalised epilepsy - true/false?

A

True!!

26
Q

Name a specific example of a type of focal epilepsy?

A

Complex partial seizures with hippocampal sclerosis

27
Q

Complex partial seizures with hippocampal sclerosis can be caused by what?

A

Febrile seizures in the past

28
Q

What are the two treatment options for focal seizures?

A

Carbamazepine and lamotrigine

29
Q

Carbamazepine is only used to treat which type of epilepsy?

A

Focal

30
Q

Lamotrigine should not be used in combination with what other drug? Why?

A

Sodium valproate - increases risk of SJS

31
Q

Using carbamazepine can make what less effective?

A

Chemotherapy

32
Q

Can valproate be used as a treatment for focal epilepsy?

A

Yes, but is it not used first line because of side effects when other options work as well

33
Q

Why is topiramate not used first line in focal epilepsy?

A

Can cause psychosis and massive weight loss

34
Q

What are the outcomes of treating epilepsy with anti-epileptics?

A

55% of patients will be seizure free on monotherapy, another 10% on polytherapy and another 35% will be drug resistant

35
Q

How should anti-epileptic drugs be stopped and why?

A

Titrate down slowly, never stop suddenly to avoid rebound seizures

36
Q

When should anti-epileptic drugs be given?

A

When a person is diagnosed with epilepsy OR when there has been a single seizure but there is high risk of recurrence (e.g. brain tumour, head injury, genetic predisposition)

37
Q

Are anti-epileptics usually given after a first seizure?

A

No

38
Q

What is the role of anti-epileptic drugs?

A

Make the patient less likely to have more seizures in the future

39
Q

Name some anti-epileptic drugs which are hepatic enzyme inducers (i.e. increase speed of metabolism)?

A

Carbamazepine, phenobarbitol, phenytoin, topiramate

40
Q

Enzyme inducing anti-epileptic drugs alter the efficacy of what medication?

A

Combined oral contraceptive pill

41
Q

Can patients with epilepsy, taking enzyme inducing AEDs be prescribed the combined oral contraceptive pill?

A

Yes, but it should be given at a higher dose than normal

42
Q

What methods of contraception should someone on an enzyme inducing anti-epileptic drug not use?

A

Progesterone only pill, progesterone implants

43
Q

Can patients using enzyme inducing AEDs use the depot provera injections for contraception?

A

Yes, but it will need more frequent dosing

44
Q

What are the rules regarding the morning after pill and enzyme inducing anti-epileptic drugs?

A

The standard dose of the morning after pill will not be adequate and so the dose will need to be increased. This means these patients won’t be able to go to the pharmacy to get it, they will need to go to their GP or a sexual health clinic

45
Q

Before getting pregnant, females with epilepsy should get what?

A

Pre-pregnancy counselling to balance the risks of uncontrolled seizures against the teratogenicity of their medications

46
Q

If a woman has a lot of fits while pregnant this can be dangerous and cause what?

A

Miscarriage, early birth and pre-eclampsia

47
Q

When a woman with epilepsy is pregnant, what supplements should they take?

A

5mg folic acid and also vitamin K

48
Q

What are some lifestyle changes that can be used in the treatment of epilepsy?

A

Abstain from/decrease smoking and alcohol consumption and also sleep deprivation should be avoided

Neurology- Clinical (31 decks)

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