Therapeutic Management Of Epilepsy Flashcards

1
Q

What are some drugs that commonly lower the seizure threshold?

A
  • Pethidine
  • Antidepressants
  • Clozapine
  • Penicillins, cephalosporins, amphotericin
  • Hormonal preparations
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2
Q

How is the risk of sudden unexpected death in epilepsy (SUDEP) minimised?

A
  • Optimising seizure control
  • Being aware of potential consequences of nocturnal seizures
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3
Q

What are the three classes of seizures and their subclasses?

A
  • Focal onset (one hemisphere) (aware/Impaired, motor/non-motor, focal to bilateral tonic-clonic)
  • Generalised onset (both sides of brain) (motor/non motor)
  • unknown onset (motor/non motor, unclassified)
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4
Q

What are the five main types of seizures?

A
  • Tonic-clinic seizures (classic seizures)
  • Absence seizures
  • Myoclonic seizures
  • Atonic seizures
  • Focal seizures
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5
Q

How is epilepsy diagnosed?

A
  • Eyewitness account, subjective symptoms (I.e. potential triggers - light sensitivity)
  • Physical exam
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6
Q

When is anti seizure medication usually initiated?

A

After a second epileptic seizure

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7
Q

What are examples of some category one antiepileptics (need to stick to one manufacturers product)

A

Carbamazepine, phenobarbital, phenytoin, primidone

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8
Q

What seizures are Carbamazepine used for and what is it’s dose?

A

Focal and tonic-clinic seizures

100-200mg BD for adults, lower for elderly, increase slowly at increments of 100-200mg every 2 weeks

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9
Q

What seizures is sodium valproate used for and what is its dose?

A

All forms of epilepsy

500mg In two divided doses, increasing by 200mg/day
MR formulation -> OD dosing

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10
Q

Under what circumstances can valproate be used in women and children of childbearing age?

A
  • conditions of pregnancy prevention programme are met
  • if other treatments are ineffective
  • judged by experienced specialist
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11
Q

What seizures is phenytoin indicated for and what are some effects?

A

Tonic-clinic and focal seizures

Hirsutism, gingival hyperplasia, acne aggregation

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12
Q

What seizures are phenobarbital used for and what is an important consideration for them?

A

All forms except typical absence seizures

Drug interactions as it’s a potent enzyme inducer

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13
Q

What seizures are lamotrigine used for, what is it’s dose what is a titration consideration?

A

Focal and Tonic-clinic seizures

Starting: 50mg (mono therapy), 25mg (add on therapy)
Maintenance: 400mg/day in two divided doses

Titrate slowly - skin rash risk

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14
Q

What seizures are Topiramate used for and what is it’s dose?

A

Focal and tonic-clinic seizures

200-600mg/day - titrate slowly

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15
Q

What seizures is levetiracetam used for and what is it’s dose?

A

Refractory focal epilepsy

Usual: 1500mg-3000mg/day (inc by 500mg every 1-2 weeks)
Starting: 500mg/day

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16
Q

What is status epilepticus?

A

Prolonged convulsive seizure lasting more than 5 minutes OR
recurrent seizures one after another without recovery

17
Q

What is the initial supportive management for status epilepticus?

A

Buccal midazolam, rectal diazepam, IV lorazepam

18
Q

What is important advice with withdrawal of antiepileptics?

A

Avoid abrupt withdrawal due to precipitation of severe rebound seizures, reduce dose gradually

19
Q

What is important advice with driving on antiepileptics?

A

Should not drive during medication changes or withdrawal, and for 6 months after last dose

20
Q

What types of anti epileptics can interact with contraceptives and oral emergency contraceptives?

A

Enzyme inducing

21
Q

Which antiepileptic interacts with oestrogen containing contraceptives?

A

Lamotrigine

22
Q

What supplementation and injection should pregnant women with epilepsy get?

A

Folic acid 5mg daily, vitamin K injection at birth (reduces risk of neonatal haemorrhage)