Epilepsy

Question 1

What are the 3 types of seizures and where do they affect the brain?

Answer 1

• Focal - seizure starts in one side of the brain
• Generalized – affects both sides of brain
• Status epilepticus Uninterrupted seizure activity (life threatening condition)

Question 2

What are the seizure characteristics?

Answer 2

Tonic-Clonic – increased muscle tone and jerking (Most common)
Absence – suddenly stop (appear to be daydreaming)
Myoclonic- single repetitive jerking 1 or more muscle group
Atonic – drop attack loss of muscle tone
Tonic – immediate increase of muscle tone
Clonic – repetitive jerks

Question 3

Which antiepileptics will need specific brands ?

Answer 3

Category 1: Carbamazepine, phenobarbital, phenytoin, primidone –
GP ensure pt is maintained on a specific manufacturer’s product.

Question 4

Which antiepileptics may need specific brands?

Answer 4

Category 2: Clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, topiramate, valproate, zonisamide,
need for continued same brand depends on clinical judgement and pt preference

Question 5

Which antiepileptics dont need speicific brands

Answer 5

Category 3: Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin -usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product.

Question 6

What seizures is carbamazepine used for?

Answer 6

Tonic-clonic, focal seizures and complex focal seizures

responds poorly to absence, atonic and tonic seizures

Question 7

What are the SE of carbamazepine?

Answer 7

Sedation, Dizziness, drowsiness
Mental disturbances
headache
Water retention, weight increased
Nausea, vomiting, hyponatraemia

Question 8

What form of carbamazepine should be given?

Answer 8

controlled- release

Question 9

How should the dose of carbamazepine be increased?

Answer 9

Increases in dose at a rate of 200 mg every 1-2 weeks may be required to achieve a stable seizure threshold
Stable carbamazepine concentrations occur usually within 2-3 weeks after commencement of treatment

Question 10

What are common interactions of carbamazepine?

Answer 10

> Phenytoin/phenobarbital – increases carbamazepine clearance
Warfarin levels are decreased
Erythromycin, cimetidine, propoxyphene, and CCB decrease the metabolism of carbamazepine
!!! Carbamazepine can reduce effectiveness birth control, could lead to unexpected pregnancies !!!
it accelerates elimination of many benzodiazepines and decreases their action

Question 11

What are the common SE of valproate?

Answer 11

• Nausea
• gastric irritation
• diarrhoea
• weight gain
• hyperammonaemia
• thrombocytopenia
• transient hair loss.

Question 12

What seizures is valproate used for?

Answer 12

• First-line treatment to children, young people, and adults with newly diagnosed generalised tonic-clonic seizures and used in absence seizures.
• Often used in infantile epilepsy due to low toxicity and lack of sedative action.

Question 13

Is valproate suitable for childbearing or potential women?

Answer 13

• Hepatotoxicity
• Pancreatitis
• Risk of teratogenesis - spina bifida, organ and limb malformation

Question 14

what types of seizures is lamotrigine used for?

Answer 14

o Partial seizures
o Primary and secondary tonic-clonic seizures
o Seizures associated with Lennox-Gastaut syndrome (childhood epileptic encephalopathy)

Question 15

what are the SE of lamotrigine?

Answer 15

• Aggression, agitation, irritability
• Arthralgia – (pains in a joint)
• Diarrhoea
• Dizziness, drowsiness
• dry mouth
• fatigue
• headache

Question 16

What is the treatment guidelines for absence seizures in children?

Answer 16

Ethusuximide - in girls
ethusuximide or valproate for boys
then combine with lamotrigine
specialist will initiate:clobazam, clonazepam, levetiracetam, topiramate or zonisamide.

Question 17

What advice should be given for topiramate?

Answer 17

Advise that topiramate can impair the effectiveness of hormonal contraceptives.

Question 18

What is the treatment for status epilepticus?

Answer 18

Community- diazepam or midazolam may be given.
If the seizure stops, recovery position and airway kept clear throughout.
In hospital - IV lorazepam. If initial benzodiazepine treatment does not control the seizures, phenytoin, fosphenytoin or phenobarbital should be used. If this is not effective, anaesthetic with full intensive care may be required.

Question 19

How is diazepam administered for status epilepticus?

Answer 19

Diazepam- as a rectal solution. The drug is absorbed quickly and although this route of administration may be thought of as unpleasant by some, it is very effective when the oral route cannot be used (medication must not be given orally during a seizure as there is a high risk of choking).

Question 20

How is midazolam administered for status epilepticus

Answer 20

Midazolam is given as oromucosal solution – this is a small volume of liquid which is given into the buccal cavity (into the space between the gum and cheek).

Question 21

What does the DVLA recommend about driving and epilepsy?

Answer 21

• pts shouldn’t drive during any medication changes and for 6 months after their dose change
• if a seizure occurs due to a prescribed change the driving license will be revoked for 1 year
• relicensing may be considered earlier if treatment has been reinstated for 6 months and no further seizures have occurred.

Question 22

What is the treatment for focal seizures?

Answer 22

• Carbamazepine
• Lamotrigine
• Gabapentin
• Pregabalin
  Oxcarbazepine, sodium valproate and levetiracetam may be used if first line are unsuitable or not tolerated

Question 23

What is the treatment for tonic-clonic seizures?

Answer 23

• Sodium Valproate
• Carbamazepine
• Lamotrigine

Question 24

Can tramadol be used for pts with epilepsy?

Answer 24

no - lowers seizure threshold