Neurology and psychiatry

Question 1

What are indications of carbamazepine?

Answer 1

Most commonly used in treatment of epilepsy, esp partial seizures (1st line). Other uses:

• trigeminal neuralgia
• bipolar disroder.

Question 2

What are adverse effects of Carbamazepine?

Answer 2

• P450 enzyme inducer
• dizziness and ataxia
• drowsiness
• headache
• visual disturbance (diplopia)
• steven-johnson syndrome
• leucopenia and agranulocytosis
• hyponatraemia secondary to SiADH

Question 3

What are the common indication and side effects of Topiramate?

Answer 3

Indication: an antiepileptic adn is used alone or as adjunctive treatment in general tonic-clonic seizures. Also used as migraine prophylaxis.

Adverse effects: 
- reduced appetite and weight loss
- dizziness
paraesthesia
- lethargy and poor concentration
- acute myopia and secondary angle-closure glaucoma. 

• associated with risk of foetal malformations.

Note on contraception + topiramate:

• Injections (depo-provera) and IUS are not affected.
• Implants + topiramate (UKMEC 2)
• COCP and POP with topiramate (UKMEC 3)

Question 4

What are the rules around driving (car/motorcycle) and epilepsy/seizure?

Answer 4

• First unprovoked/isolated seizure - 6 months off, given that there is no structural abnormality of brain on imaging or any epileptiform activity on EEG.
  a) if the above conditions are not met, then no driving for 12 months.
• pts who are established to have epilepsy or those with multiple unprovoked seizure:
  a) may qualify for driving licence if seizure free for 12 months.
  b) if there has been no seizure for 5 yrs (with meds if needed), a ‘till 70 licence is usually restored’.
• For those weaning off epilepsy meds - shouldn’t driving while weaning off and for up to 6 months from last dose.

Question 5

What are driving rules following syncope?

Answer 5

• Simple vasovagal (faint) - no restriction
• single syncope episode, explained and treated - 4 weeks off.
• single episode, unexplained - 6 months off
• 2 or more episodes: 12 months off.

Question 6

what’s DVLA/driving rule following stroke/TIA?

Answer 6

1 month off driving, may not need to inform DVLA if no residual neurological deficit.

Question 7

What are the DVLA rules followign multiple TIAs over short period of time?

Answer 7

3 months off drivign and inform DVLA.

Question 8

What are DVLA rules following a craniotomy e.g. for meningioma?

Answer 8

1 year off driving (if benign meningioma, no seizure history, licence can be reconsidered 6 months after surgery if remains seizure free).

Question 9

What are DVLA rules around chronic neurological disorders e.g. MS, MND?

Answer 9

inform DVLA, complete PK1 (application for driving licence holders state of health).

Question 10

What are commonly used drugs for generalised tonic-clonic seizures?

Answer 10

• Sodium valproate (1st line)

- 2nd line - lamotrigine, carbamazepine.

Question 11

Commonly used drugs for absence seizures (petit mal)?

Answer 11

• Sodium valproate or ethosuximide.

Question 12

Commonly used drugs for myoclonic seizures?

Answer 12

• 1st line - sodium valproate.

- 2nd line - clonazepam, lamotrigine.

Question 13

Commonly used drugs for focal seizrues?

Answer 13

• carbamazepine or lamotrigine

- 2nd line: levetiracetam or sodium valproate.

Question 14

What are the time onset of alcohol withdarwal?

Answer 14

• Symptoms start at 6-12 hrs
• Seizures : 36hrs
• Delirium tremens: 72hrs.

Question 15

What are the good prognosis features of MS?

Answer 15

• female sex
• young age of onset (20s or 30s)
• Relapsing-remitting disease
• sensory symptoms only
• long interval between first two relapses
• complete recovery between relapses.