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Neurology > Epilepsy management > Flashcards

Epilepsy management Flashcards

1
Q

what is a helpful adjunct in diagnosing epilepsy?

A

EEG

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2
Q

some patients with epilepsy might have a ———– EEG

A

normal

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3
Q

if neuroimaging is to request to diagnose epilepsy it usually is?

A

MRI

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4
Q

when is MRI used to diagnose epilepsy?

A

epilepsy before the age of 2, those who have any suggestion of a focal onset on history/examination or those in whom seizures continue despite use of first-line medication

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5
Q

what is the first step of epilepsy treatment?

A

establish diagnosis and epilepsy type

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6
Q

what is the second step of epilepsy treatment?

A

use only one drug at a time

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7
Q

initial titration should be to ——- maintenance doses and ——-/———- titration should in ———, ———- doses

A

low
upward/downward
slow
stepped

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8
Q

what is the first line treatment of tonic clonic seizures?

A

sodium valproate if unsuitable –> Lamotrigine

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9
Q

what is the second line treatment of tonic-clonic seizures?

A

levetiracetam
topiramate
clobazam

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10
Q

what is the first-line treatment of absence seizures?

A

ethosuximide

sodium valproate

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11
Q

what is the firsst-line treatment for myoclonic seziures?

A

sodium valproate

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12
Q

what is the second line treatment for myoclonic seizures?

A

levetiracetam

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13
Q

what is the first line treatment for focal seizures?

A

lamotrigine

carbamazepine

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14
Q

what is the firsst-line treatment for unclassified seizures?

A

sodium valproate

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15
Q

what is the sescond line treatment for unclassified seizures?

A

lamotrigine

topiramate

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16
Q

what is the mode of action of carbamazepine?

A

sodium channel inactivation

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17
Q

what are the adverse effects of carbamazepine? 5)

A

diplopia, ataxia, blood dysrasias, teratogenic, hyponatraemia

18
Q

carbamazepine can be used in

A

trigeminal neuralgia as well as first line for focal seizures

19
Q

what is the mode of action of phenytoin?

A

sodium channel inactivation

20
Q

what are the adverse effects of phenytoin? (10)

A

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megalobastic anaemia, teratogenic

21
Q

what teratogenic effects does phenytoin cause?

A

cleft palate and cardiac defects

22
Q

phenytoin can be used as?

A

seizure prophylaxis as well

23
Q

what is the mode of action of lamotrigine?

A

blocks voltage gated sodium gated channels

24
Q

what are adversse effects of lamotrigine?

A

rash and steven johnson syndrome

25
Q

which anti-epileptic drug caan be useed in pregnancy?

A

lamotrigine

26
Q

lamotrigine may exacerbate

A

myoclonic seizures

27
Q

what is the mode of action of ethosuximide?

A

blocks thalamic T-type calcium channels

28
Q

what are the adverse effects of ethosuximide? (5)

A

GI upset, fatigue, headache, urticaria, stevens-johnson syndrome

29
Q

ethosuximide is used first-line in?

A

absence seizures

30
Q

what is the mode of action of sodium valproate?

A

sodium channel inactivation with increased GABA concentration

31
Q

what are the adverse effects of sodium valproate? 95)

A

GI upset, liver failure, neural tube defectss, tremor, weight gain

32
Q

what are the neural tube defects caused by sodium valproate?

A

spina bifida

33
Q

what should be aware of when using valproate?

A

be aware in women or girls of childbearing age

34
Q

what is status epilepticus?

A

a convulsive seizure which continues for a prolonged period (longer than five minutes) or when convulsive seizures occur one after the other with no recovery in between

35
Q

what is the treatment for status epilepticus? in the community

A

buccal or rectal midazolam - 1st line in the community

36
Q

what is the treatment of status epilepticus in hospitals or if IV acceesss is already established?

A

IV lorazepam

37
Q

if seizures continue in sstatus epilepticus?

A

administer IV phenobarbital or phenytoin as second line treatment

38
Q

DVLA regulation regarding group 1 vehicles:

if seizure occurs when awake?

A

stop driving for 1 year

39
Q

DVLA regulation regarding group 1 vehicles:

if seizure occurs when asleep?

A

can drive but only if there is no awake attack for 3 years

40
Q

DVLA regulation regarding group 1 vehicles:

if seizure occurs when awake but doesnt affect consciousness?

A

will still qualify got license if these are the only type of attack you’ve ever had and the first one was 12 months ago

41
Q

DVLA regulation regarding group 2 vehicles:

one-off sseizure?

A

stop driving for 5 years

42
Q

DVLA regulation regarding group 2 vehicles:

more than 1 seizure/diagnosis of epilepsy?

A

must be seeizure and medication free for 10 years

Neurology (10 decks)

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