//CNS//

Question 1

What is the dosage frequency of anti epileptics determined by?

Answer 1

Plasma half-life
Should be kept as low as possible to encourage adherence
But with large doses, frequency may have to increase to avoid ADRs

Question 2

Which anti-epileptics have once a day (at bedtime) dosing?

Answer 2

Lamotrigine
Perampanel
Phenobarbital
Phenytoin

Question 3

What is the frequency of dosing for most antiepileptics when given at their usual dose?

Answer 3

Twice a day

Question 4

What is epilepsy defined as?

Answer 4

1) at least 2 unprovoked seizures occurring more than 24 hrs apart
2) 1 unprovoked seizure and probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures, ovvuring over the next 10 years
3) diagnosis of an epilepsy syndrome

Question 5

What is a seizure?

Answer 5

The transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

Question 6

What is status epilepticus?

Answer 6

Prolonged convulsive seizure for 5 minutes or longer, or recurrent seizures one after the other without recovery in between

Question 7

What is the prevalence of epilepsy in the Uk?

Answer 7

5-10 cases per 1000

Question 8

What population group is epilepsy more common in?

Answer 8

People with learning difficulties

Question 9

What proportion of those with epilepsy have an identified cause?

Answer 9

Cause of epilepsy is only identified in 1/3 of those with the disease

Question 10

What clinical features indicate TONIC seizure

Answer 10

Short lived , less than 1 min
Abrupt
Generalised muscle stiffening with rapid recovery

Question 11

What clinical features indicate generalised TONIC CLONIC seizure

Answer 11

Generalised stiffening
Subsequent rhythmic jerking of the limbs
Urinary incontinence
Tongue biting

Question 12

What clinical features indicate ABSENCE seizure?

Answer 12

Behavioural arrest
Brief sudden lapses of consciousness
More common in children than adults - may look like they are staring blankly into space

Question 13

What clinical features indicate ATONIC seizure?

Answer 13

Sudden onset of loss of muscle tone

Question 14

What clinical features indicate MYOCLONIC seizure?

Answer 14

Brief shock like involuntary single or multiple jerks

Question 15

How to respond if a pt is having a seizure?

Answer 15

• Protect the person from injury - check airaways, recovery position after seizure stops
• If tonic clonic is prolonged or recurrent —> emergency buccaneers midazolam 1st line in community according to pre-arranged protocol
• Emergency admission to hospital if seizures do not respond promptly

Question 16

How often to epileptics need a review - and what would be addressed during this review?

Answer 16

Once a year

• seizure control, ADRs, compliance, appropriate Rx
• impact of epilepsy on work, education, leisure activities - how to manage risks
• entitlement to drive
• carers’ skills in managing seizures
• contraception - PPP

Question 17

Which antiepileptics are classed as category 1 by the MHRA and what does this mean?

Answer 17

Phenytoin, carbamazepine, phenobarbital, primidone

—> pt needs to be maintained on a specific manufacturer’s product

Question 18

What are first-line options for FOCAL seizures?

Answer 18

Carbamazepine

Lamotrigine

Question 19

What is first-line for generalised TONIC CLONIC seizures?

Answer 19

Sodium valproate unless woman of childbearing potential - in which case lamotrigine

Question 20

What is first-line for absence seizures?

Answer 20

Ethosuximide
Sodium valproate unless woman of childbearing potential - in which case lamotrigine

Sodium valp should be first line if high risk of generalised tonic clonic

Question 21

What is first-line for MYOCLONIC seizures?

Answer 21

Sodium valproate unless woman of childbearing potential - in which case topiramate and levetiracetam