Seizures

Question 1

Tonic-Clonic

Answer 1

1st line = Valproate / Carbamazepine

Alternative = Lamotrigine

Question 2

Absence

Answer 2

1st line = Ethosuximide / Valproate (high risk of generalised tonic-clonic seizure)
Alternative = Lamotrigine

Question 3

Myoclonic

Answer 3

1st line = Valproate

Alternative = Lamotrigine / Levetiracetam

Question 4

Atonic / Tonic

Answer 4

Childhood
Epilepsy syndromes or cerebral damage / mental retardation
Poor response to traditional drugs
1st line = Valpropate
Adj = Lamotrigine
3rd = consider Rufinamide or Topiramate (specialist)

*DO NOT GIVE CARBAMAZEPINE, OXYCARBAZEPINE, GABAPENTIN, PREGABALIN, TIAGABINE, VIGABATRIN

Question 5

Epilepsy Syndromes

Answer 5

1. Dravet Syndrome

2. Lennox-Gastaut Syndrome

Question 6

Dravet syndrome

Answer 6

Involve 3* specialist
1st line = Sodium Valproate / Topiramate (unlicenced)
2nd = Clobazam or Stiripentol as adj treatment
3rd = Cannabidol with clobazam

*AVOID CARBAMAZEPINE, GABAPENTIN, LAMOTRIGINE, OXCARBAZEPINE, PHENYTOIN, PREGABALIN, TIAGABINE, VIGABATRIN as they exacerbate myoclonic seizures