Epilepsy management Flashcards
what is a helpful adjunct in diagnosing epilepsy?
EEG
some patients with epilepsy might have a ———– EEG
normal
if neuroimaging is to request to diagnose epilepsy it usually is?
MRI
when is MRI used to diagnose epilepsy?
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
what is the first step of epilepsy treatment?
establish diagnosis and epilepsy type
what is the second step of epilepsy treatment?
use only one drug at a time
initial titration should be to ——- maintenance doses and ——-/———- titration should in ———, ———- doses
low
upward/downward
slow
stepped
what is the first line treatment of tonic clonic seizures?
sodium valproate if unsuitable –> Lamotrigine
what is the second line treatment of tonic-clonic seizures?
levetiracetam
topiramate
clobazam
what is the first-line treatment of absence seizures?
ethosuximide
sodium valproate
what is the firsst-line treatment for myoclonic seziures?
sodium valproate
what is the second line treatment for myoclonic seizures?
levetiracetam
what is the first line treatment for focal seizures?
lamotrigine
carbamazepine
what is the firsst-line treatment for unclassified seizures?
sodium valproate
what is the sescond line treatment for unclassified seizures?
lamotrigine
topiramate
what is the mode of action of carbamazepine?
sodium channel inactivation
what are the adverse effects of carbamazepine? 5)
diplopia, ataxia, blood dysrasias, teratogenic, hyponatraemia
carbamazepine can be used in
trigeminal neuralgia as well as first line for focal seizures
what is the mode of action of phenytoin?
sodium channel inactivation
what are the adverse effects of phenytoin? (10)
nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megalobastic anaemia, teratogenic
what teratogenic effects does phenytoin cause?
cleft palate and cardiac defects
phenytoin can be used as?
seizure prophylaxis as well
what is the mode of action of lamotrigine?
blocks voltage gated sodium gated channels
what are adversse effects of lamotrigine?
rash and steven johnson syndrome
which anti-epileptic drug caan be useed in pregnancy?
lamotrigine
lamotrigine may exacerbate
myoclonic seizures
what is the mode of action of ethosuximide?
blocks thalamic T-type calcium channels
what are the adverse effects of ethosuximide? (5)
GI upset, fatigue, headache, urticaria, stevens-johnson syndrome
ethosuximide is used first-line in?
absence seizures
what is the mode of action of sodium valproate?
sodium channel inactivation with increased GABA concentration
what are the adverse effects of sodium valproate? 95)
GI upset, liver failure, neural tube defectss, tremor, weight gain
what are the neural tube defects caused by sodium valproate?
spina bifida
what should be aware of when using valproate?
be aware in women or girls of childbearing age
what is status epilepticus?
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
what is the treatment for status epilepticus? in the community
buccal or rectal midazolam - 1st line in the community
what is the treatment of status epilepticus in hospitals or if IV acceesss is already established?
IV lorazepam
if seizures continue in sstatus epilepticus?
administer IV phenobarbital or phenytoin as second line treatment
DVLA regulation regarding group 1 vehicles:
if seizure occurs when awake?
stop driving for 1 year
DVLA regulation regarding group 1 vehicles:
if seizure occurs when asleep?
can drive but only if there is no awake attack for 3 years
DVLA regulation regarding group 1 vehicles:
if seizure occurs when awake but doesnt affect consciousness?
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
DVLA regulation regarding group 2 vehicles:
one-off sseizure?
stop driving for 5 years
DVLA regulation regarding group 2 vehicles:
more than 1 seizure/diagnosis of epilepsy?
must be seeizure and medication free for 10 years
