Epilepsy

Question 1

Partial Seizures

Answer 1

Seizures that begin at discrete and relatively limited focus

Question 2

Simple partial seizures

Answer 2

• limited spread
• uncomplicated
• affects only limited aspects of neural function
• consciousness and memory undisturbed

Question 3

Complex partial seizure

Answer 3

• alteration of consciousness follows initial simple seizure
• typically appear confused and preoccupied
• automatisms (purposeless and automatic behaviors: lip smacking, sucking, fumbling with clothing)
• seizures are stereotypic

Question 4

Generalized seizures

Answer 4

cannot be linked to single foci, involves entire cerebrum
- Absence seizures (petit mal)
- simple absence seizure (an epilepsy of childhood and adolescence)

Question 5

Tonic-clonic seizures

Answer 5

• Grand Mal
• maximal seizure response of brain in which all systems can be recruited into paroxysmal discharge

Question 6

3 phases of tonic-clonic seizures

Answer 6

1.) initial tonic phase (10-20s)
2.) clonic phase (1/2-2min)
3.) terminal phase (5min)

Question 7

Levetiracetam use

Answer 7

most seizure types

Question 8

Levetiracetam dosing

Answer 8

IR: 500mg BID -> inc Q2weeks by 500mg/dose -> max dose 1.5g BID

ER: 1g QD -> inc Q2weeks by 1 g/dose -> max 3 g

Question 9

Levetiracetam ADE

Answer 9

generally well tolerated
some weight gain

Question 10

Oxcarbamazepine use

Answer 10

adjunctive therapy in treatment of partial seizures in kids 6 and older

Question 11

Oxcarbamazepine dose

Answer 11

• 5 mg/kg/day
• inc weekly by 5 mg/kg/day
• target 30-50 mg/kg/day
• BID dosing

Question 12

Oxcarbamazepine ADE

Answer 12

CNS
- drowsiness
- h/a
- dizziness
GI
-N/V
Rash

Question 13

Oxcarbamazepine monitoring parameters

Answer 13

sodium
hepatic function

Question 14

Lamotrigine use

Answer 14

partial onset seizures
absence seizures
GTC
juvenile myoclonic epilepsy
Lennox-Gastaut Syndrome

Question 15

Lamotrigine dose

Answer 15

children 2-12 yo:
- start 0.5 mg/kg/day div BID x 2 weeks
- inc by 1 mg/kg/day x 2 weeks
-typical maintenance 5-15 mg/kg/day
-max 400mg/day

Question 16

Lamotrigine ADE

Answer 16

SJS

Question 17

Gabapentin use

Answer 17

partial seizures
monotherapy or addon

useful for co-morbid neuropathic pain / bipolar disorder

Question 18

Gabapentin dose

Answer 18

start 30 mg/kg/d
max 1800 mg/d
TID dosing

Question 19

Gabapentin ADE

Answer 19

drowsiness
dizziness
ataxia (involuntary movement)
weight gain

Question 20

Phenytoin use

Answer 20

generalized seizures

Question 21

Phenytoin dose

Answer 21

200-400 mg/d

Question 22

Phenytoin concentration dependent ADE

Answer 22

nystagmus (rapid eye movement)
double vision
blurred vision
incoordination
drowsiness/dizziness
h/a

Question 23

Phenytoin idiosyncratic ADE

Answer 23

aplastic anemia
granulocytopenia
hepatotoxicity
rash
exfoliative dermatitis
SJS
lupus-like rxn

Question 24

Phenytoin chronic ADE

Answer 24

gum hypertrophy
acne
hirsutism
peripheral neuropathy
chronic cerebellar damage
megaloblastic anemia
osteoporosis
fetal vitamin K depletion

Question 25

Valproate dose

Answer 25

15 mg/kg/d in 2-3 div doses ->

increase in 5-10 mg/kg/day increments weekly

max 60 mg/kg/d

Question 26

Valproate ADE

Answer 26

N/V/D + abdominal cramps (minimized by slow titration)
inc LFTs
drowsiness
ataxia
hair loss
weight gain
asymptomatic hyperammonemia
liver failure

Question 27

Carbamazepine use

Answer 27

partial seizures
secondary generalized seizures

Question 28

Carbamazepine ADE

Answer 28

dizziness/drowsiness
h/a
double vision
N/V
hyponatremia
transient leukopenia

Question 29

Carbamazepine monitoring

Answer 29

baseline CBC
LFTs
serum levels weekly during 1st month