Epilepsy - 1 Flashcards
(23 cards)
Which antiepileptics have long half lives and therefore can be given ON?
LP3
lamotrigine
perampanel
phenobarbital
phenytoin
Which anti-epileptics are part of the pregnancy prevention programme?
sodium valproate, valproic acid
topiramate
congenital malformations
neurodevelopmental disorders
For which anti-epileptics must patient be maintained on the same brand?
3P + C
phenobarbital
phenytoin
primidone
carbamazepine
What is the MHRA warning for all anti-epileptics?
risk of suicidal thoughts and behaviour
- all may be associated with a small increased risk of suicidal thoughts and behaviour
- symptoms may occur as early as 1 week after starting treatment
seek medical advice if any mood changes, distressing thoughts, or feelings about suicide or self-harming develop
What is antiepileptic hypersensitivity syndrome?
potentially fatal syndrome associated with some antiepileptic drugs
3P+C, ROLL
- carbamazepine, phenobarbital, phenytoin, primidone
- rufinamide, oxcarbazepine, lacosamide, lamotrigine
symptoms usually start between 1 and 8 weeks of exposure
- fever, rash, and lymphadenopathy
- liver dysfunction, haematological, renal, and pulmonary abnormalities, vasculitis, and multi-organ failure
- withdraw and do not restart
What are the rules for driving with epilepsy?
1st seizure: stop driving and inform DVLA, cannot drive for 6 mths, must be assessed before driving
established seizures: can drive if seizure free for 1 yrs, no history of unprovoked seizures, compliant with treatment and follow up
seizure while asleep are not permitted to drive for one year from the date of each seizure, unless:
- pattern of sleep seizures occurring only ever while asleep has been established over the course of at least one year from the date of the first sleep seizure
- established pattern of purely asleep seizures can be demonstrated over the course of three years if the patient has previously had seizures whilst awake
When should patient not drive?
medication changes
withdrawal of AED + 6mths post last dose
if a seizure occurs
- license revoked for 1 year or 6mths if treatment restarted
How should AED withdrawal occur?
can be considered 2 years post last seizure
withdraw one at a time
avoid abrupt withdrawal
- can precipitate seizures
- especially with barbiturates and benzodiazepines: takes longer for these
Which AEDs are safer in pregnancy?
lamotrigine
levetiracetam
What supplements are needed for patients on AEDs in pregnancy? What supplement is needed for the baby upon birth?
folic acid: 5mg OD until week 12 of pregnancy to prevent neural tube defects
vitamin K injection: to minimise risk of neonatal haemorrhage
What type of contraception is required if a patient is on AEDs?
highly effective contraception
- male and female sterilisation
- long-acting reversible contraceptives: copper intra-uterine device, levonorgestrel intra-uterine device, and progestogen-only implant
2 complementary forms including a barrier method.
women need it if they or their partner is taking the AED
What conditions must be met to prescribe sodium valproate/valproic acid?
male or female <55yrs: need two specialists to prescribe it
annual reviews
meet all PPP conditions
sign risk acknowledgement forms
patient guide and alert card: every dispense
full pack dispensing
highly effective contraception: during + 3 mths after
How do AEDs affect breastfeeding?
monitors infants for: sedation, feeding difficulties, adequate weight gain, and developmental milestones
- especially for: primidone, phenobarbital, and benzodiazepines, higher risk of drowsiness
Which AEDs can be transferred into breastmilk?
ZELP
zonisamide
ethosuximide
lamotrigine
primidone
Which AEDs can affect hormonal contraception?
lamotrigine: COC can affects its levels and vice versa
enzyme inducers: carbamazepine, phenobarbital, phenytoin, primidone, perampanel (if >12mg OD), rufinamide, topiramate
enzyme inhibitors: sodium valproate
What is the first and second line treatment of tonic-clonic seizures?
if unable to have kids
1st: sodium valproate
2nd: lamotrigine or levetiracetam (unlicensed)
able to have kids
1st: lamotrigine or levetiracetam
tonic-clonic: increase in muscle tone (fall) then jerking of limbs
What is the first and second line treatment of absence seizures?
1st: ethosuximide
unable to have kids
2nd: sodium valproate
able to have kids
2nd: lamotrigine or levetiracetam (unlicensed)
absence: typical (brief, non-motor), atypical (longer, motor symptoms)
What is the first and second line treatment of myoclonic seizures?
if unable to have kids
1st: sodium valproate
2nd: levetiracetam
able to have kids
1st: levetiracetam
myoclonic: jerks of muscle groups, often upon waking
Which AEDs are not recommended in absence, myoclonic seizures, atonic/tonic?
carbamazepine, oxcarbamazepine
gabapentin, pregabalin, tiagabine, vigabatrine
phenobarbital, phenytoin (only absence or myoclonic)
can exacerbate seizures
What is the first and second line treatment of atonic or tonic seizures?
if unable to have kids
1st: sodium valproate
2nd: lamotrigine
able to have kids
1st: lamotrigine
atonic: loss of muscle tone (fall)
tonic: increase in muscle tone (fall)
What is the first and second line treatment for focal seizures?
LL
1st: lamotrigine or levetiracetam
2nd: carbamazepine, oxcarbazepine, or zonisamide
focal: seizure starts on one side of the brain, aware vs unaware
Which AEDs can accumulate in infants due to slow metabolism?
phenobarbital
lamotrigine
Which AEDs inhibit sucking reflex in infants?
phenobarbital
primidone
