Neuro - Non-emergency management of epilepsy + drugs Flashcards
What is the treatment of choice for tonic-clonic seizures?
- 1st line: Na Valproate
- 2nd line: Lamotrigine
What is the treatment of choice for absent seizures?
- 1st line: Na Valproate or ethosuximide
- 2nd line: lamotrigine
What is the treatment of choice for tonic, atonic or myoclonic seizures?
- 1st line: Na Valproate
- 2nd line: levetiracetam
What is the treatment of choice for focal seizures?
- 1st line: lamotrigine
- 2nd line: carbamazepine
What are important considerations for epileptic women of childbearing age?
- Avoid valproate - take lamotrigine instead
- Must be taking 5mg of folic acid OD if of child-bearing age
- Carbamazepine and phenytoin are enzyme inducers and decrease efficacy of COCP - need to discuss with neurologist and may have to double pack
What are important SEs of Valproate? What counselling must you provide?
- Must counsel regarding its teratogenicity (background rate is 1%, NaValproate increases it to 9% and if you add another AEP then its 25% risk)
- Valproate induces metabolism of vit D - need regular checks
SEs (spell ALPROATE)
- Appetite and weight increased
- Liver failure: monitor LFTs every 6/12
- Pancreatits
- Reversible hair loss
- Oedema
- Ataxia
- Teratogenicity, tremor, thrombocytopenia
- Encephalopathy (raised ammonia)
What are important SEs of lamotrigine?
- Skin rash and Steven-Johnson syndrome within first 8 weeks
- Rash may be associated with hypersensitivity reaction (fever, raised LFT)
- Diplopia
What are important SEs of carbamazepine?
- Leukopenia
- Skin reactions
- Diplopia
- SIADH/hyponatraemia
What are important SEs of phenytoin?
- Gingival hypertrophy
- Hirsutism
- Diplopia and tremor
- Cerebellar sx
- Peripheral sensory neuropathy
Which EAPs are enzyme inducers and/or inhibitors?
Inducers
-carbamazepine, phenytoin and barbiturates (need double dose of COCP)
Inhibitors
-Na Valproate
