IC6-7 Seizures and epilepsy

Question 1

4 main etiology of acute symptomatic seizures

Answer 1

1. Metabolic
2. Drugs/toxic substances
3. Structural
4. CNS infection

Question 2

Metabolic etiology of acute symptomatic seizures

Answer 2

Na: hyponatremia
Ca: hypocalcemia
Mg: hypomagnesemia
Glucose: hypoglycemia

Question 3

Drugs/toxic substances etiology of acute symptomatic seizures

Answer 3

Benzodiazepine withdrawals
Alcohol
illicit drugs

Question 4

Structural etiology of acute symptomatic seizures

Answer 4

Trauma
Stroke

Question 5

CNS infection etiology of acute symptomatic seizure

Answer 5

Febrile illness
CNS infection

Question 6

Drug induced seizures

Answer 6

Antibiotics: beta lactams, carbapenems, cefepime, levofloxacin, erythromycin
Analgesics: NSAIDS, tramdol
Antipsychotics + lithium
Antidepressants: TCA, SSRI, bupropion

Question 7

Clinical presentation of focal onset seizures

Answer 7

Clonic movements like jerking
Dysarthria: speech arrest
Numbness, tingling, visual disturbances, rising epigastric sensation
Flashbacks: deja vu, hallucinations
Fear, anger, irritation

Question 8

Clinical presentation of Tonic clonic seizures

Answer 8

Tonic: stiff posture, loss of consciousness, decreased breathing

Clonic: Jerking of limbs

Cyanosis of nail bed, incontinence, biting of tongue,

Question 9

Clinical presentation of absence seizure

Answer 9

Lapse in awareness, more common in children

Question 10

Clinical presentation of atonic seizure

Answer 10

Lose all postural tone, collapse to ground
Common in Lennox Gastaut syndrome

Question 11

Lab test for epilepsy

Answer 11

Scalp EEG epileptiform discharges confirms diagnosis of epilepsy, but not all have abnormal EEG

Question 12

Non pharm treatment of epilepsy

Answer 12

Ketogenic diet to prevetn seizures: low carb, high fat

Seizure dairy: trigger, frequency, duration, ADR from antiseizure medications

Question 13

Indications for carbamazepine

Answer 13

GTC, Focal seizures

Question 14

ADR of Carbamazepine

Answer 14

CNS: Dizziness, visual disturbances, nystagmus
Hepatotoxic
Blood dyscrasias
Hyponatremia
Osteoporosis
Peripheral neuropathy

Question 15

PG testing for carbamazepine

Answer 15

HLA B* 15:02
SJS/TEN
Cross reactive with aromatic ASM: phenytoin, phenobarbital, lamotrigine

Question 16

Monitoring for carbamazepine

Answer 16

LFT
Full blood count
Serum sodium
Bone mineral density

Question 17

DDI of carbamazepine

Answer 17

Inducer of 1A2, 2C9, 2C19, 3A4, UGT

Question 18

Indication for sodium valproate

Answer 18

All types of seizures

Question 19

ADR of valproate

Answer 19

Hepatotoxicity
Blood dyscrasias
Pancreatitis
Alopecia
Reversible weight gain
Teratogenic

Question 20

Monitoring for valproate

Answer 20

LFT
Full blood count

Question 21

DDI of valproate

Answer 21

Inhibitor of 2C9, UGT, epoxide hydrolase

Question 22

Indication for phenytoin

Answer 22

GTC, Focal seizures

Question 23

ADR of phenytoin

Answer 23

Hepatoxicity
Blood dyscrasias
Dyskinesia
Gum hyperplasia
Hirsutism
Osteoporosis
Peripheral neuropathy

Question 24

Monitoring for phenytoin

Answer 24

LFT
Full blood count
TDM

Question 25

DDI for phenytoin

Answer 25

Inducer of 2C9, 2C19, 3A4, UGT Bioavailability reduces with enteral feed, space apart by 2h

Question 26

ADR of phenobarbital

Answer 26

Sedation, drowsiness Nystagmus, ataxia, dysarthria, osteomalacia

Question 27

Indication for lamotrigine

Answer 27

Absence, GTC, Focal seizures

Question 28

DDI of lamotrigine

Answer 28

Oral contraceptives lower conc of lamotrigine Inducer of UGT

Question 29

ADR of lamotrigine

Answer 29

CNS: dizziness, somnolence, headache Cross reactive with carbamazepine: SJS/TEN Suicide ideation

Question 30

Which ASM is safe in pregnancy

Answer 30

Lamotrigine and levetiracetam

Question 31

Indication for levetiracetam

Answer 31

GTC, Focal seizures

Question 32

DDI for levetiracetam

Answer 32

No DDI

Question 33

ADR of levetiracetam

Answer 33

CNS: coordination difficulty, dizziness Irritability, aggression

Question 34

Indication for topiramate

Answer 34

Myoclonic, GTC, Focal seizures

Question 35

DDI for topiramate

Answer 35

Inducer of 3A4

Question 36

ADR of topiramate

Answer 36

Cognitive dysfunction: speech, memory, psychomotor slowing CNS, N/v Anorexia, weight loss Glaucoma Renal stones Suicide ideation