Management of Epilepsy

Question 1

NICE neurological management pathway

Answer 1

1) Refer to specialist for diagnosis and decision to start treatment

2) Provide Information

3) Decision to treat
4) Ongoing treatment
5) Stopping treatment

Question 2

NICE guidelines on pharmacological treatment of epilepsy

Answer 2

1) Provide information (side effects etc.)

2) Drug treatment strategy should be individualised
3) Diagnosis of epilepsy needs to be critically evaluated with events continue
4) Consistent supply
5) Monotherapy
6) Start second drug if single ASM fails
7) Combination therapy when monotherapy fails
8) No sodium valproate for women

Question 3

Seizure-freedom after AED (%)

Answer 3

63% become seizure free

47% seizure free for >12 months with monotherapy

14% After changing to second drug

3% on polytherapy

Question 4

Monotherapy drug treatment of Focal (‘partial’) seizures:

Answer 4

Levetiracetam, lamotrigine, carbamazepine

Question 5

Monotherapy of generalised seizures:

Answer 5

In men: sodium valproate, lamotrgine, levetiracetam

In women: Lamotrigine, levetiracetam

For frequent absence seizures: Ethosuximide

Question 6

predictors for more likely seizure recurrence

Answer 6

• longer epielpsy duration before remission
  -shorter seizure-free interval before drug withfrawl
• younger age at onset of epilepsy
• history of febrile seizures
• higher number of seizures before remission
• absence of a self-limiting epilepsy syndrome
• developmental delay
• epileptiform abnormalitity on EEG before drug withdrawl

Question 7

Emergency treatment of seizure cluster or prolonged seizures

Answer 7

• benzodiazepines
• intranasal midazolam and diazepam
• lorazepam and intranasal lorazepam