Management of Epilepsy

Question 1

What investigations do you want to in epilepsy?

Answer 1

• EEG ± MRI
• Bloods - AED levels, metabolic screen, drug screen
• ± LP, blood cultures

Question 2

How do you confirm epilepsy diagnosis?

Answer 2

At least 2 seizures

Question 3

How do you treat focal (partial) seizures?

Answer 3

1. Carbamazepine OR lamotrigine

2. Levetiracetam, oxcarbazepine or sodium valproate

Question 4

How do you treat generalised tonic-clonic seizures?

Answer 4

1. Sodium valproate OR lamotrigine

2. Carbamazepine, clobazam, levetiracetam or topiramate

Question 5

How do you treat absence seizures?

Answer 5

1. Sodium valproate OR ethosuximide

2. Lamotrigine

Question 6

How do you treat myoclonic seizures?

Answer 6

1. Sodium valproate

2. Levetiracetam or topiramate (AVOID carbamazepine and oxcarbazepine)

Question 7

How do you treat tonic or atonic seizures?

Answer 7

Sodium valproate OR lamotrigine

Question 8

When could a pt stop AEDs?

Answer 8

If seizure-free for > 2 years

Question 9

What are other possible interventions in epilepsy?

Answer 9

• Psychological e.g. CBT (only with medication)
• Neurosurgical resection - if single epileptogenic focus
• Vagal nerve stimulation, DBS

Question 10

What increases risk of sudden unexpected death in epilepsy (SUDEP)?

Answer 10

• Uncontrolled epilepsy

- Nocturnal seizure-associated apnoea or asystole

Question 11

What is the issue with AEDs and contraception?

Answer 11

• Enzyme-inducing AEDs (carbamazepine, oxcarbazepine) make progesterone-only contraception unreliable
• Oestrogen-containing contraceptives lower lamotrigine levels - an increased dose may be needed to achieve seizure control