Paeds: Epilepsy georgie

Question 1

AED for partial seizures

Answer 1

•	Carbamezapine (first libe treatment)
•	Sodium valporate
•	Lamotrigine 
•	Topiramate 
Levetiracetam

Question 2

AEDs for Generalized

Answer 2

• Sodium valporate (first line teatment)
• Lamotrigine
• Topiramate
Levetiracetam

Question 3

Complex partial

Prevalence

Answer 3

60%

Question 4

Prevalence Secondary generalized tonic-clonic

Answer 4

60%

Question 5

Prevalence Primary generalized tonic-clonic

Answer 5

30%

Question 6

Prevalence Generalized absence

Answer 6

5%

Question 7

Prevalence Generalized myoclonus

Answer 7

5%

Question 8

Simple partial Prevalence

Answer 8

rare

Question 9

West syndrome

age and comments

Answer 9

4-6 months
• Violent flexor spasms of the head, trunk and limbs followed by extension of the arms (so-called ‘salaam spasms’). Flexor spasms last 1–2 s, often multiple bursts of 20–30 spasms, often on waking, but may occur many times a day.
• Many causes; two-thirds have underlying neurological cause.
Most will subsequently lose skills and develop learning disability or epilepsy

Question 10

Management of west syndorme

Answer 10

• Treatment is with vigabatrin or corticosteroids good response in 30-40%
•

Question 11

Childhood absence syndrome

Answer 11

4-12 Years

• It is associated with brief interruptions of 3-5s in awareness, with minimal or no motor manifestation
• Accounts for 2% of epilepsy
• Prognosis is good, with 95% remission in adolescence; 5–10% may develop tonic-clonic seizures in adult life
•

Question 12

childhood absence syndrome management

Answer 12

It responds to sodium valporate or ethosuximide

Question 13

Juvenile myoclonic epilepsy age and presentation

Answer 13

• Associated with early morning myoclonic jerks
• Generalized tonic-clonic seizures occur in most
• Childhood absence seizures in 30%
• Precipitants: sleep deprivation, alcohol

Question 14

Juvenile myoclonic epilepsy management

Answer 14

Best response to sodium valproate

Question 15

Tonic-clonic generalised seizures first-line Rx

Answer 15

Valproate, carbamazepine

Question 16

Tonic-clonic generalised second line

Answer 16

Lamotrigine

Topiramate

Question 17

Absence generalised seizures first-line

Answer 17

Valproate, ethosuximide

Question 18

Absence generalized seizures second line

Answer 18

Lamotrigine

Question 19

Myoclonic generalised seizures first line

Answer 19

Valproate

Question 20

Focal seizures first line

Answer 20

Carbamazepine or valproate

Lamotrigine shown since to be most effective - but slow titration

Question 21

Focal seizures second line

Answer 21

Topiramate, levetricatam, oxcarbazepine, gabapentin, tiagabine, vigabatrin

Question 22

Treatment info for parents

Answer 22

-70% of epilepsy controlled on AED therapy
- of these 80% on monotherapy, 10-15% on two drugs
30% not controlled

Question 23

If the response is poor to AED

Answer 23

1. Switch to another 1st line AED as monotherapy
2. Add 2nd AED
3. Explore full range of doses
4. Avoid polytherapy
5. Surgery

Question 24

Valproate SE

Answer 24

weight gain
Hair loss
Rare idiosyncratic liver failure

Question 25

Carbamazepine/oxcarbazepine SE

Answer 25

Rash
Neutropenia
Hyponatraemia
Liver enzyma induction
Can interfere with other medication

Question 26

Vigabatrin SE

Answer 26

Restriction of visual fields, which has limited its use

Sedation

Question 27

Lamotrigine SE

Answer 27

Rash

Question 28

Ethosuximide SE

Answer 28

N and V

Question 29

Topiramate SE

Answer 29

Drowsiness, withdrawal and weight loss

Question 30

Gabapentin SE

Answer 30

Insomnia

Question 31

Levetiracetam SE

Answer 31

Sedation - rare

Question 32

Benzos SE

Answer 32

Sedation
tolerance to effect
Increased secretion

Question 33

Sudden death in epilepsy (SUDEP)

Answer 33

• Risk of SUDEP should be discussed with all patients (NICE)
• Not only patients with poorly controlled seizures are at risk.
• Mainly respiratory arrest (central hypoventilation)
• Risk highest in Generalized tonic-clonic seizures, also complex partial seizures of temporal origin (bradyarrythmia/ asystole)