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Management of epilepsy Flashcards

1
Q

define epilepsy

A

Neurological condition which affects the brain

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2
Q

Repeated seizures in epilepsy may cause tragic consequences. TRUE OR FALSE

A

TRUE

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3
Q

repeated seizure in epilepsy can be categorised as various sub types. what are the two subtypes

A

tonic clonic seizures
absence seizures
and myoclonic seizures
focal
generalised tonic clonic

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4
Q

Seizure activity may cause

A

-Progressive intellectual disability
-Sudden unexplained death in epilepsy (SUDEP)
-Status epilepticus ( a clinical activity in which seizure continues for long or multiple seizure occurs but no chance of recovery or conscious in between)
-Quality of life (complicated seizures)

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5
Q

Who can clinical diagnose and investigate epilepsy

A

Specialist medical practitioner with training and expertise in epilepsy

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6
Q

what investigations are required to confirm the diagnosis of epilepsy

A

-Clinical History
the detailed description of the event, an eyewitness to the attack (where possible)

-Electroencephalogram (EEG)/Video telemetry ( this should be performed only when clinical history suggests that that seizure is likely to be epileptic in origin)

-Neuroimaging - Magnetic Resonance Imaging (MRI)

-Biochemistry tests – e.g. serum electrolytes, glucose, calcium

-12-lead Electrocardiogram(ECG)

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7
Q

Aim of anti epileptic treatment is to keep the patients seizure free with fewest drugs. TRUE OR FALSE

A

TRUE

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8
Q

Prior/during the initiation of drug treatment, what must be checked?

A

Confirmed diagnosis
Types of epilepsy
Monotherapy
Slow titration/withdrawal
Monitor therapeutic levels
Be careful with changing drug regimens

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9
Q

Anti epilepsy drug should be prescribed based on seizure types. TRUE OR FALSE

A

TRUE

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10
Q

what are the Absence seizure AED for first line treatment?

A

ethosuximide, sodium valproate*

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11
Q

what are the Absence seizure AED for second line treatment?

A

lamotrigine

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12
Q

what are the Absence seizure AED for adjuvant treatment

A

ethosuximide , sodium valproate, lamotrigine

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13
Q

what are the Absence seizure AED for additional consideration on referral to sec/tert hospitals

A

clobazam, clonazepam, levetiracetam, topiramate, zonisamide

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14
Q

What are the absence seizure AED to avoid as ineffective or deteriorate

A

carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, vigabatrin

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15
Q

what are the focal seizure AED for first line treatment?

A

carbamazepine
lamotrigine

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16
Q

what are the focal seizure AED for second line treatment?

A

levetiracetam
oxcarbazepine
sodium valproate

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17
Q

what are the focal seizure AED for adjuvant treatment

A

carbamazepine, clobazam, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, topiramate

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18
Q

what are the focal seizure AED for additional consideration on referral to sec/tert hospitals

A

eslicarbazepine acetate, lacosamide, phenobarbital, phenytoin, pregabalin, tiagabine, vigabatrin and zonisamide

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19
Q

what are the generalised tonic clonic seizure AED for first line treatment?

A

Sodium valproate

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20
Q

what are the generalised tonic clonic seizure AED for second line treatment?

A

Lamotrigine
Carbamazepine (3rd)
Oxcarbazepine (3rd)

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21
Q

what are the generalised tonic clonic seizure AED for adjuvant treatment

A

clobazam, lamotrigine, levetiracetam, sodium valproate, topiramate

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22
Q

What are the generalised tonic clonic seizure AED to avoid as ineffective or deteriorate

A

If absence or myoclonic seizures, juvenile, myoclonic epilepsy is suspected,
carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, vigabatrin.

23
Q

what are the myoclonic seizure AED for first line treatment?

A

Sodium valproate

24
Q

what are the myoclonic seizure AED for second line treatment?

A

Levetiracetam, topiramate

25
what are the myoclonic seizure AED for adjuvant treatment
Levetiracetam, topiramate, sodium valproate
26
what are the myoclonic seizure AED for additional consideration on referral to sec/tert hospitals
Clobazam, clonazepam, piracetam, zonisamide
27
What are the myoclonic seizure AED to avoid as ineffective or deteriorate
Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, vigabatrin
28
what are the tonic or atonic seizure AED for first line treatment?
Sodium valproate
29
what are the tonic or atonic seizure AED for adjuvant treatment
Lamotrigine
30
what are the tonic or atonic seizure AED for additional consideration on referral to sec/tert hospitals
rufinamide, topiramate
31
What are the tonic or atonic seizure AED to avoid as ineffective or deteriorate
carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine, vigabatrin.
32
Carbamazepine
Hyponatremia via induction of SIADH Starting at a low dose with slow titration Formulation Tablet Modified-release tablet Oral suspension/solution Suppository - maximum 250mg QDS which is equivalent to 800mg daily orally, up to 7 days Dose equivalence and conversion 100mg tablet = 125mg suppository note sodium level should be measured before starting therapy, 2 weeks after initiation and every month for 2 months
33
Phenytoin
Dose equivalence and conversion 100mg capsule/IV = 92mg oral solution (Phenytoin sodim vs phenytoin base) How to give phenytoin via Intravenous administration? Dilute in 50-100ml Sodium Chloride 0.9% Give into a large vein through an in-line filter (0.22-0.5micron) – why? Maximum rate of 50mg/minute (lower to 25mg/minute if elderly or patients with heart disease)
34
Lamotrigine
Tolerability – reasonably well Adverse drug events Rash (in the first 8 weeks, if given too quickly) - this can be life threatening Blood disorders Drug-drug interactions With valproate: increased plasma concertation Enzyme inducing AEDs: decrease plasma concentration
35
Levetiracetam
Extremely well tolerated Effective in most types of epilepsy Usually recommended as 2nd line or adjuvant therapy Red-flag symptoms Skin rash (SJS), allergic reactions Caution/avoid in patient with; Renal impairment Depression, thoughts of harming/killing Pregnancy Formulation Tablets, liquid, granules, solution for infusion
36
Sodium valproate
Metabolic effects Monitor LFTs and FBC Teratogenicity Must NOT be used in females of childbearing potential unless Pregnancy Prevention Programme is in place, and only if used as a last option Dose equivalence and conversion PO = IV (doses are equivalent between formulations) Formulation Tablets – crushable, enteric-coated, modified-release Liquid Solution for IV injection
37
Sodium valproate
Metabolic effects Monitor LFTs and FBC Teratogenicity Must NOT be used in females of childbearing potential unless Pregnancy Prevention Programme is in place, and only if used as a last option Dose equivalence and conversion PO = IV (doses are equivalent between formulations) Formulation Tablets – crushable, enteric-coated, modified-release Liquid Solution for IV injection
38
what happens during the initiation of AED therapy
patients invited for consultation to discuss options 4 weeks of treatment in hospital followed by continuation in primary care
39
Why are patient referred back to the hospital during therapy in community care
Abnormal blood results uncontrolled seizures in community
40
Treatment regimens are decided in the epilepsy clinic TRUE OR FALSE
TRUE
41
What is done during Treatment regimens
Personalised care plan current seizure frequency Indication for new drug regime titration schedule potential side effects need for specific monitoring Changes in treatment to be communicated with GP
42
refer back to slide 14 and 15
43
what is status epilepticus
Prolonged seizure activity either For more than 30 minutes or A series of seizures without recovery in between Medical Emergency if Occurs during convulsive (tonic-clonic) seizure Urgent treatment is required at approximately 5 minutes after seizure started Or Repeated convulsive seizures (3 or more episodes) in community Non-convulsive status epilepticus
44
What class of drugs is the first line treatment for hospital convulsive status epilepticus
Benzodiazepine
45
List the drugs used in hospital for convulsive status epilepticus
IV lorazepam (1st) - 0.1mg/kg, repeat after 10 mins) IV diazepam Buccal midazolam (if IV access is not available) IV phenobarbital/phenytoin (2nd) - ?IV valproate/ levetiracetam
46
List the drugs used in hospital for refractory convulsive status epilepticus
IV midazolam, Propofol, Thiopental sodium With General anaesthesia
47
List the drugs used in community for status epilepticus
Buccal midazolam (1st) Rectal diazepam IV lorazepam (only if IV access/resus facilities are available) then Call an ambulance After another 5 mins of emergency drug intervention Unable to open airway/breathing
48
what are the Non-pharmacological interventions
Brain surgery -Resective surgery -Focal resection (e.g. temporal, extratemporal resection) -Lesionectomy - Functional procedures Vagal nerve stimulation (VNS) Dietary therapies - Ketogenic Diet
49
what does MHRA says on the use of AED in pregnancy
Lamotrigine (Lamictal) and levetiracetam (Keppra) are safer than other AEDs Carbamazepine, phenobarbital, phenytoin, topiramate increases the risk of physical birth abnormalities Phenobarbital or phenytoin increases the risk the child may have difficulties with learning and thinking ability, but NOT as high as for valproate Phenobarbital, topiramate, or zonisamide increases the risk of the baby being born smaller than expected Offer folic acid 5mg OD before possible pregnancy When use AED Offer monotherapy Start with the lowest effective dose Report any adverse drug effects via Yellow Card Scheme Drug level monitoring is required for Lamotrigine, Levetiracetam, Oxcarbazepine, phenytoin
50
Applying for drivers license is acceptable as long as the patient is how many months free from seizure
12 months
51
What are the conditions for applying for drivers license
12 months seizure free if you have had an awake seizure in the past, and in last 3 years you had only sleep seizures if you have never had an awake seizure and had only sleep seizure in the last 12 months
52
You must report to DVLA if you have a seizure, TRUE OR FALSE
TRUE
53
You must stop driving for 6 months if what?
changed treatment dose withdrawn from AEDs had a single episode of seizure
54
What do you avoid when you have epilepsy
Swimming alone bathing a baby on your own

integrated studies in mental health (20 decks)

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