Neurology

Question 1

Brand name: Phenytoin

Answer 1

Dilantin

Question 2

Brand name: Carbamazepine

Answer 2

Tegretol

Question 3

Brand name: Valproic acid

Answer 3

Depakote

Question 4

Brand name: Levetiracetam

Answer 4

Keppra

Question 5

General therapeutic recommendations for treatment of epilepsy in pregnancy

Answer 5

Smallest effective dose, monotherapy preferableFolate supplementation of 4 mg daily

Question 6

History to document in the epileptic patient

Answer 6

Aura - present or absentSeizure description by eyewitness, including durationPostictal phase - description, durationExacerbating factorsBirth history, esp if seizure onset was neonatal or early childhoodHistory of febrile convulsions, CNS infections, or head trauma w/ LOCFamily history

Question 7

Fetal complications of epilepsy

Answer 7

Fetal lossPerinatal deathCongenital malformations (4-8%, or twice baseline risk)Low birth weightPrematurityDevelopmental delayChildhood epilepsy

Question 8

Preconception counseling of the epileptic patient

Answer 8

There is a small risk of having a child with a malformation because of the sz disorder or the drugs used in its treatment. This risk is probably about double that for the nonepileptic patient (4-8%, compared with 2-3% for the general population), but there is still more than 90% chance that she will have a normal child. Preconception folic acid (4 mg) may be considered to reduce the risk of major congenital malformations.

Question 9

Preconception counseling: when can an anticonvulsant be stopped, and when should the patient attempt conception

Answer 9

Consider neuro consultation regarding tapering off AEDs if the patient has been seizure free for > 2 years and has a nl EEG. The patient should be observed for 6-12 months off AED before attempting conception.

Question 10

Seizure freedom for at least __ months before pregnancy is associated with a high likelihood of remaining seizure-free during pregnancy

Answer 10

9 months

Question 11

Risk of epilepsy in offspring

Answer 11

2-3%

Question 12

Prenatal care of the epileptic patient

Answer 12

Folic acid 4 mg/dayAnatomic US at 11-13w to identify severe defectsAFP at 15-18w gestation for NTDsTargeted US at 16-20wFetal echo at 22w+/- growth US at 32wNeonates should receive 1 mg IM Vit K at birth

Question 13

Which anticonvulsants should have levels monitored during pregnancy?

Answer 13

LamotrigineCarbamazapinePhenytoinLevetiracetamOxcarbazepine

Question 14

Anticonvulsants that interfere with oral contraceptives

Answer 14

Enzyme-inducing AEDS:PhenytoinPhenobarbitalCarbemazepineTopiramate (>200 mg/day)Primidone

Question 15

Drugs that may interfere with absorption of anticonvulsants

Answer 15

Folic acid may lower plasma phenytoin levelAntacidsAntihistamines

Question 16

Does prenatal vitamin K in women with epilepsy reduce the risk of newborn hemorrhagic complications?

Answer 16

Evidence is inadequate to determine

Question 17

Postpartum considerations for mothers with epilepsy

Answer 17

Do not bathe child while home aloneAvoid stair climbing while carrying the babyPortable changing bad on floor should be usedAvoid using front or back carrierWomen taking enzyme-inducing anticonvulsants who desire OCPs should take one w/ >50 mcg of ethinyl estradiol

Question 18

Treatment of status epilepticus

Answer 18

IV diazepam (10-30 mg)IV lorazepam (4-8 mg)