FN: Epilepsy Investigation and Management

Question 1

General principles of epilepsy

Answer 1

1. After any seizure advise against driving, swimming, etc until a diagnosis is established
2. Dont diagnose epilepsy from a single seizure
3. Diagnosis should be made by a specialist
4. After Diagnosis, cannot drive until seizure-free for >1yr - 10 yrs for HGV (no meds)

Question 2

Investigations

Answer 2

1. basic bloods: FBC, U+Es, glucose
2. SE increased Prl 10min after fit (relative to baseline)
3. Se AED levels
4. Urine toxicology
5. ECG

Question 3

EEG

Answer 3

1. Use to support Dx (cannot exclude or prove)
2. Helps classification and prognosis
3. Use with hyperventilation and photic stimulation

Question 4

Neuroimaging used and shows

Answer 4

Typically MRI

1. Not routine for idiopathic generalised epilepsy

Question 5

MRI indications

Answer 5

Developed epilepsy as an adult
Any evidence of focal onset
Seizures continue despite 1st line Rx

Question 6

Tonic clonic seizure first line and 2nd line treatment

Answer 6

Valproate

Lamotrigine

Question 7

Abscenses 1st and 2nd line rx

Answer 7

Valproate/Ethosuximide

Lamotrigine

Question 8

tonic, atonic or myoclonic 1st and 2nd line Rx

Answer 8

Valproate

Levetiracetam

Question 9

Focal ± secondary generation 1st and 2nd line

Answer 9

Lamotrigine

CBZ

Question 10

In women/Pregnancy Rx

Answer 10

1. Avoid valproate: take lamotrigine (or CBBZ)
2. 5mg folic acid daily if child-bearing age
3. CBZ and PHE are enzyme inducers and decrease the efectiveness of the OCP

Question 11

Other Rx options apart from medical

Answer 11

Neurosurgical resection can be an option if a single epileptogenic focus is identified
Vagal nerve stimulation can reduced seizure freqeuncy and severity in 33%

Question 12

Side effects of Common AEDs - enzyme effects

Answer 12

Inducers: CBZ, PHE and barbiturates
Inhibitors: Valproate

Question 13

Lamotrigine SE

Answer 13

1. Skin rash - SJS: occurs w/i 1st 8 wks
2. Rash may be assoc. with hypersensitivity - fever, raised LFTs, DIC
3. diplopia, blurred vision
4. Levels affected by enzyme inhibitors/inducers

Question 14

Valproate

Answer 14

1. Appetite increased - increased wt.
2. Liver fialure: monitor LFTs over 1st 6mo
3. Pancreatitis
4. Reversible hair loss
5. Oedema
6. Ataxia
7. Teratogenicity, tremor, thrombocytopenia
8. Encephalopathy: due to raised ammonia

Question 15

Carbamazepie SE

Answer 15

Leukopenia
Skin reactions
Diplopia, blurred vision
SIADH - hyponatraemia

Question 16

Phenytoin SE

Answer 16

Gingival hypertrophy
Hirsutism
Cerebellar syn.
1. Ataxia
2. Nystagmus
3. Dysarthria

Peripheral sensory neuropathy
Diplopia
Tremor