Seizures & Epilepsy

Question 1

Meds that lower seizure threshold

Answer 1

◦ Bupropion
◦ TCAs
◦ Tramadol
◦ Amphetamines
◦ Isoniazid
◦ Venlafaxine

Question 2

Types of seizures

Answer 2

Focal (with intact or impaired awareness) - presentation varies depending on what area of brain is affected
Generalized Tonic Clonic - stereotypical
Absence - non motor
Myoclonic - involuntary muscle contractions
Atonic - drop attack
Febrile - long term tx not recommended

Question 3

Seizure/Epilepsy tx principles

Answer 3

Monotx when possible, then try switching to alt 1st line, and if still not controlled then add on adjuct

Question 4

What’s the one synergistic antiepileptic drug combo?

Answer 4

Valproic acid and lamotrigine

Question 5

Pregnancy & epilepsy considerations

Answer 5

Avoid valproic acid,

may use lamotrigine, levitiracetam, oxcarbazepine

Question 6

Generalized tonic-clonic seizure tx

Answer 6

First-Line*
• Valproic Acid
• Lamotrigine
• Carbamazepine
• Oxcarbazepine
Adjunctive
• Clobazam
• Levetiracetam
• Topiramate

Question 7

Focal seizure tx

Answer 7

First-Line*
• Carbamazepine
• Lamotrigine
• Levetiracetam
• Oxcarbazepine
• Valproic Acid
Adjunctive
• Clobazam
• Gabapentin
• Topiramate

Question 8

Tx for Absence, atonic, myoclonic:

Answer 8

Absence
• Ethosuximide
• Valproic Acid
• Lamotrigine
Atonic
• Valproic Acid
Myoclonic
•  Sodium valproate
• Levetiracetam
• Topiramate

Question 9

Antiepileptic Drug side effects are related to

Answer 9

dose related and occur initially or with dose increases so titrate!

Question 10

Antiepileptic Drug CNS side effects

Answer 10

CNS Side Effects
 Dizziness, sedation, headache, ataxia, diplopia
 Aggression, irritability (with clobazam, levetiracetam, phenobarbital)
 Impaired memory (phenobarbital, carbamazepine)
 Impaired speech and cognition (topiramate)
–> consider reducing dose or slower release formulations

Question 11

Antiepileptic Drug GI side effects

Answer 11

• GI Side Effects
 Nausea, vomiting, stomach upset
 Weight loss (topiramate); weight gain (valproate, gabapentin, vigabatrin)

Question 12

Increase risk of contraceptive failure with:

Answer 12

 Carbamazepine
 Oxcarbazepine
 Lamotrigine*
 Phenobarbital
 Phenytoin
 Topiramate
Use E doses >50mcg and barrier

Question 13

Decreased levels when contraceptives used

Answer 13

lamotrigine (up to 50% decrease)

Question 14

TDM used for

Answer 14

◦ Carbamazepine
◦ Phenobarbital
◦ Phenytoin
◦ Valproic Acid

Question 15

Monitoring

Answer 15

CBC, LFTs, weight gain, visual changes, poor coordination/memory, sedation, tremor, bone density, rash (d/c)

Question 16

When can Antiepileptic Drugs be stopped?

Answer 16

Seizure-free for ≥2 years on stable dose of AED(s) - may slowly wean off over months

Question 17

Status epilepticus definition

Answer 17

Seizures > 5 mins or clusters of 3 or more seizures within 30 min

Question 18

Epilepsy Non-pharms

Answer 18

Avoid sleep deprivation, minimize alcohol use, avoid marijuana, photostimulation. Other risk factors stress, head injury, fever, infection, electrolyte imbalance, hormonal changes.

Question 19

Rare idiosyncratic AED S/E

Answer 19

Mucocutaneous reactions, blood dyscrasias, hepatotoxicity, pancreatitis

Question 20

Other uses for antiepileptic drugs

Answer 20

Migraine - valproate, topiramate

Bipolar Disorder - valproate, lamotrigine