Therapeutic Management Of Epilepsy Flashcards
What are some drugs that commonly lower the seizure threshold?
- Pethidine
- Antidepressants
- Clozapine
- Penicillins, cephalosporins, amphotericin
- Hormonal preparations
How is the risk of sudden unexpected death in epilepsy (SUDEP) minimised?
- Optimising seizure control
- Being aware of potential consequences of nocturnal seizures
What are the three classes of seizures and their subclasses?
- 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)
What are the five main types of seizures?
- Tonic-clinic seizures (classic seizures)
- Absence seizures
- Myoclonic seizures
- Atonic seizures
- Focal seizures
How is epilepsy diagnosed?
- Eyewitness account, subjective symptoms (I.e. potential triggers - light sensitivity)
- Physical exam
When is anti seizure medication usually initiated?
After a second epileptic seizure
What are examples of some category one antiepileptics (need to stick to one manufacturers product)
Carbamazepine, phenobarbital, phenytoin, primidone
What seizures are Carbamazepine used for and what is it’s dose?
Focal and tonic-clinic seizures
100-200mg BD for adults, lower for elderly, increase slowly at increments of 100-200mg every 2 weeks
What seizures is sodium valproate used for and what is its dose?
All forms of epilepsy
500mg In two divided doses, increasing by 200mg/day
MR formulation -> OD dosing
Under what circumstances can valproate be used in women and children of childbearing age?
- conditions of pregnancy prevention programme are met
- if other treatments are ineffective
- judged by experienced specialist
What seizures is phenytoin indicated for and what are some effects?
Tonic-clinic and focal seizures
Hirsutism, gingival hyperplasia, acne aggregation
What seizures are phenobarbital used for and what is an important consideration for them?
All forms except typical absence seizures
Drug interactions as it’s a potent enzyme inducer
What seizures are lamotrigine used for, what is it’s dose what is a titration consideration?
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
What seizures are Topiramate used for and what is it’s dose?
Focal and tonic-clinic seizures
200-600mg/day - titrate slowly
What seizures is levetiracetam used for and what is it’s dose?
Refractory focal epilepsy
Usual: 1500mg-3000mg/day (inc by 500mg every 1-2 weeks)
Starting: 500mg/day
What is status epilepticus?
Prolonged convulsive seizure lasting more than 5 minutes OR
recurrent seizures one after another without recovery
What is the initial supportive management for status epilepticus?
Buccal midazolam, rectal diazepam, IV lorazepam
What is important advice with withdrawal of antiepileptics?
Avoid abrupt withdrawal due to precipitation of severe rebound seizures, reduce dose gradually
What is important advice with driving on antiepileptics?
Should not drive during medication changes or withdrawal, and for 6 months after last dose
What types of anti epileptics can interact with contraceptives and oral emergency contraceptives?
Enzyme inducing
Which antiepileptic interacts with oestrogen containing contraceptives?
Lamotrigine
What supplementation and injection should pregnant women with epilepsy get?
Folic acid 5mg daily, vitamin K injection at birth (reduces risk of neonatal haemorrhage)
