EPILEPSY: MHRA/CHM + General info Flashcards
Category 1 AEDs
Patient must be maintained on a specific brand/generic drug manufacturer.
Carbamazepine
Phenobarbital
Phenytoin
Primidone
Category 2 AEDs
Patient maintained on a specific brand based on clinical judgement e.g. seizure frequency, treatment history
Clobazam
Clonazepam
Lamotrigine
Oxcarbazepine
Perampanel
Rufinamide
Topiramate
Valproate
Zonisamide
Category 3 AEDs
Patient does NOT need to be maintained on a specific brand
Brivaracetam
Leveiracetam
Ethosuximide
Gabapentin
Lacosamide
Pregabalin
Tiagabine
Vigabatrin
Diagnosing epilepsy
- Made by specialist
- History of epilepsy must be determined and eyewitness of attack where possible
- EEGS (Electroencephalogram)
- Neuroimaging (e.g. MRI or
CT) - Blood tests (e.g. Plasma electrolytes, glucose, calcium)
- 12-lead ECG
- Medical history (some drugs can lower seizure threshold e.g. quinolones)
Suicidal thoughts/behaviour
- Risk with all anti-epileptic drugs
- Can occur within 1 week of starting treatment
- Advise patients to report any mood changes, distressing thoughts/feelings about suicide or self-harm
- Seek help
- Do not stop/switch medication without professional advice
How soon can suicidal behaviour occur with AED use?
1 week
Report
Antiepileptic Hypersensitivity Syndrome (AHS)
- Occurs within 8 weeks of exposure to medication
- Discontinue immediately and seek specialist advice.
Occurs with all Category 1 drugs AND lamotrigine - Rash
- Fever
- Lymphadenopathy
Which AED can cause AHS
Occurs with all Category 1 drugs AND lamotrigine
Withdrawal
- Avoid abrupt withdrawal - can precipitate severe rebound seizures
- Gradually reduce dose under specialist supervision
- Withdraw one antiepileptic drug at a time
- Benzodiazepines and Barbiturates require longer to reduce dose.
Driving - when can you drive if you have epilepsy?
Can drive if:
* Seizure free for 1 year.
* Established seizure pattern with no influence on consciousness
* No history of unprovoked seizures.
* Seizure due to prescribed change or withdrawal
* History of no awake seizures for 1 year from first sleep seizure.
Driving with epilepsy: 1st unprovoked/ single isolated
Driver must stop immediately and inform the DVLA
must not drive for 6 months
Driving with epilepsy: established epilepsy
- 1 year (or pattern of seizures established for 1 year with no impact on consciousness)
Driving with epilepsy: seizure while asleep
Not permitted to drive for 1 yr
Driving with epilepsy: med change withdrawal
- Should not drive for 6 months after last dose
- Seizure occurs: license revoke for 1 year, reinstated after 6 months if treatment resumed and no further seizures occurred
