Neurology - Anti-epileptics

Question 1

What advice should patients be given following a seizure?

Answer 1

Advise against driving, swimming or operating heavy machinery until Dx is established

Question 2

Treatment for tonic clonic seizures

Answer 2

Valproate - 1st line

Lamotrigine - 2nd line

Question 3

Treatment for absence seizures

Answer 3

Valproate or ethosuximide - 1st line

Lamotrigine - 2nd line

Question 4

Treatment of tonic, atonic or myoclonic seizures

Answer 4

Valproate - 1st line

Levetiracetam - 2nd line

Question 5

What anti-convulsants should be avoided when treating tonic, atonic and myoclonic seizures?

Answer 5

Carbamazepine

Oxcarbazepine

Question 6

How are focal seizures with secondary generalisation treated?

Answer 6

Carbamazepine - 1st line

Lamotrigine - 2nd line

Question 7

What anti-convulasants affect liver enzymes?

Answer 7

Inducers: CBZ, phenytoin, and barbiturates (e.g. phenobarbitol)
Inhibitors: Valproate

Question 8

Side effects of valproate

Answer 8

“vALPROATE”

• Appetite incr. - weight gain
• Liver failure - monitor LFTs over first 6 months
• Pancreatitis
• Reversible hair loss
• Oedema
• Ataxia
• Teratogenicity, Tremor, Thrombocytopaenia
• Encephalopathy (increased blood ammonia)

Question 9

What anti-convulsants are better in pregnancy?

Answer 9

Avoid valproate (teratogenic)
Take lamotrigine or CBZ instead
Give 5mg folic acid daily if child bearing age and vit K (if PHE)
Contraception - CBZ and PHE are enzyme inducers so reduce effectiveness of OCP

Question 10

What 2 anti-convulsants are not present in breast milk and therefore safer to use?

Answer 10

CBZ

Valproate

Question 11

Causes of refractory epilepsy

Answer 11

Poor compliance
Pseudoseizures or non epileptic attack disorders
Underlying structural brain lesion
Excess alcohol/ illicit drug use

Question 12

Non pharmacological treatment of epilepsy

Answer 12

Neurosurgical resection - single epileptogenic focus

Vagal nerve stimulation - decrease seizure frequency and severity in 33%

Question 13

What are the side effects of carbamazepine?

Answer 13

1. ) Leukopenia
2. ) Skin reactions
3. ) Dipolpia
4. ) SIADH - hyponatraemia

As a general rule carbamazepine is 1st line for most patients with partial seizures.

Question 14

Side effects of phenytoin

Answer 14

1. ) Gingival hypertrophy
2. ) Hirsuitism
3. ) Cerebellar syn.
   - Ataxia
   - Nystagmus
4. ) Peripheral sensory neuropathy
5. ) Diplopia
6. ) Tremor

Question 15

Driving advice in epilepsy

Answer 15

Patient must report their condition to DVLA
Isolated seizure - 6 month “off driving period”, requires specialist assessment and no abnormality
Risk of further seizures - 12 month “off driving period”

Patients with hx of epilepsy must be seizure free for 1 year

Question 16

What is the main side effect associated with lamotrigine?

Answer 16

Stevens-Johnson syndrome