Seizures/ epilepsy

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Question 23

suggest starting antiepileptics when ?

Answer 23

after the first seizure AND any of the following :

neurological deficit

brain imaging shows a structural abnormality

the EEG shows unequivocal epileptic activity

the patient or their family or carers consider the risk of having a further seizure unacceptable

Question 24

MX of Generalised tonic-clonic seizures

Answer 24

males: sodium valproate

females: lamotrigine or levetiracetam

Question 25

mx OF FOCAL SEIZURES

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first line: levetiracetam if not try lamotrigine

second line: carbamazepine, oxcarbazepine or zonisamide

Question 26

mx of absence seizures ?

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first line: ethosuximide

second line :
male: sodium valproate
female: lamotrigine OR levetiracetam

Question 27

CONTRAINDICATED IN ABSENCE SEZIURES ?

Answer 27

carbamazepine may exacerbate absence seizures

Question 28

Mx of myoclonic seizures ?

Answer 28

males: sodium valproate

females: levetiracetam

Question 29

Mx of atonic siezures

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males: sodium valproate
females: lamotrigine

Question 30

what tends to increase myoclonic seizures ?

Answer 30

feels they become worse when he is tired, stressed or has consumed alcohol the night before

often stimulus sensitive.

Question 31

e. Focal cortical myoclonus is the most common form of myoclonus and is usually caused by an underlying lesion of the

Answer 31

sensori-motor cortex, which produces hyperexcitability (e.g. vascular, inflammatory or neoplastic

Question 32

Other uses of Carbamazepine include ?

Answer 32

trigeminal neuralgia
bipolar disorder

Question 33

Carbamazepine is known to exhibit

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autoinduction, hence when patients start carbamazepine they may see a return of seizures after 3-4 weeks of treatment

Question 34

some adverse effects of carbamezapine ?

Answer 34

dizziness and ataxia

visual disturbances (especially diplopia)

Steven-Johnson syndrome - Stevens-Johnson syndrome is a rare condition arising from ‘over-reaction’ of the immune system to a trigger such as a mild infection or a medicine, leading to blistering and peeling of the skin and surfaces of the eyes, mouth and throat.

drowsiness

Question 35

carbamezapine effect on haematology ?

Answer 35

leucopenia and agranulocytosis

Question 36

carbamezapie secondary to syndrome of inappropriate ADH secretion causes?

Answer 36

hyponatraemia

Question 37

Carbamazepine Mechanism of action?

Answer 37

binds to sodium channels increases their refractory period

Question 38

least teratogenic of the antiepileptics?

Answer 38

lamotrigine: studies to date suggest the rate of congenital malformations may be low. The dose of lamotrigine may need to be increased in pregnancy

carbamazepine

Question 39

Breast feeding with anti epileptics ?

Answer 39

Breast feeding is acceptable with nearly all anti-epileptic drugs

Question 40

WHICH ANTIBIOTICS SHOULD NOT BE TAKEN WITH SEZIURE MEDICATIONS ?

Answer 40

Quinolones - cipro/levofloxacillin
lowers seizure threshold

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Question 43

when can anti epileptic mediations be stopped

Answer 43

seizure free for 2 years
with anti epileptics stopped over 2-3 months