Epilepsy Flashcards
What is the first line treatment for focal seizure
Lamotrigine or levetiracetam
What is the second line treatment for focal seizures
Carbamazepine, oxcarbazepine, zonisamide
What is the first line for tonic- clonic, myoclonic, atonic, tonic and absence with another type of seizure
Sodium valproate
What is the first line for abscence seizure on its own
Ethosuximide
What is the second line treatment for tonic clonic seizure
Lamotrigine/ levetiracetam
What is the second line for absence seizure alone
Sodium valproate
What is the second line treatment of absence seizure with another type of seizure
Lamotrigine and levetiracetam
What is the second line treatment for myoclonic seizures
Levietiracetam
What is the second line treatment for myoclonic seizures
Levietiracetam
What is the second line treatment for myoclonic seizures
Levietiracetam
What is the second line treatment for atonic seizures
Lamotrigine
What is the second line treatment for tonic seizures
Lamotrigine
What medicine is avoided in women who have child bearing potential
Sodium valproate
What is meant by status epilepticus
Seizures lasting longer than 5 minutes
Provide resuscitation and immediate emergency treatment
1- patients has an individualised emergency management plan that is immediately available
2- patients doesn’t have an individualised emergency management plan immediately available
What is the treatment plan for status epilepticus
Seizures lasting more than 5 minutes:
1- IV Lorazepam ( if resuscitation facilities are available)
2- buccaneers midazolam or rectal diazepam (if in community
Give a second dose if seizure doesn’t stop within 5-10 minutes of first dose
If seizure fails to respond after 2 benzodiazepams doses:
Levetiracetam, phenytoin, sodium valproate
If seizure fails to respond, try another second line. If still fails to respond then:
Phenobarbital or general anaesthesia
What are the 3 categories of anti-epileptic drugs
Category 1: ensure that the patient is maintained on the same brand
Carbamazepine, phenobarbital, phenytoin, primidone
Category 2: maintaining on specific brand should be based on clinical judgment with patients factor considered
Clobazam, clonazepam, Lamotrigine, oxcarbazepine, perampanel, rufinamide, topiramate, valproate, zonisamide
Category 3: unnecessary to ensure patients are maintained on specific brands
Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin
What are the interactions of carbamazepine, phenytoin and sodium valproate
Hepatotoxicity: Amiodarone, itraconazole, macrolides, alcohol
CYP enzyme:
INDUCERS (phenytoin, phenobarbital and carbamazepine)
INHIBITORS: (sodium valproate)
Drugs that lowers the seizure threshold: Tramadol, theophylline, quinolones
Carbamazepine: Hyponatraemic drug (SSRIs, Diuretics)
Phenytoin: anti-folates (methotrexate and trimethoprim )
What are the side effects of carbamazepine, phenytoin and sodium valproate
FOR ALL:
Depression and suicide
Hepatotoxicity
Hypersensitivity
Blood dyscrasia
Vitamin D deficiency (look for trigger words; bone pain)
Carbamazepine SE: hyponatraemia and Odema
Phenytoin SE: coarsening appearance and facial hair
Sodium valproate SE: pancreatitis and teratogenic (should be on pregnancy prevention programme)
What are the other side effects for the other anti-epileptic drugs?
Hypersensitivity: carbamazepine, phenobarbital, phenytoin and primidone, Lamotrigine
Skin rash: Lamotrigine- Steven Johnson syndrome
Blood dyscrasia: carbamazepine, valproate, ethosuximide, topiramate, phenytoin, Lamotrigine, zonisamide
Eye disorders: vigabatrin (reduced visual field) topiramate (secondary glaucoma)
Encephalopathy: Vigabatrin
Respiratory depression: gabapentin and pregabalin
What is the therapeutic range or carbamazepine and what are the toxic side effects
Therapeutic range : 4-12mg/l
Aligns of toxicity:
Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred vision
Arrhythmias
GI disturbances
What is the therapeutic range of phenytoin and what are the toxic side effects
Therapeutic range: 10-20mg/l
Toxic side effects:
Slurred speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double vision
What are the conditions of driving in epilepsy
If you have an epileptic fit you need to stop driving immediately and inform the DVLA
First unprovoked/single isolated- stop for 6 months
Established epilepsy: 1 year (or a pattern of seizures established for 1 year with no impact of consciousness
Medication change or withdrawal
shouldn’t drive for 6 months after last dose
Seizures occurs: licence revoked for 1 year, reinstated for after 6 months if treatment resumed and no further seizures occurred
What are the risk of epilepsy in pregnancy
Risk of harm to the mother and foetus from convulsive seizure outweighs the risk of continued therapy
Folic acid is given to reduce the risk of neural tube defects in first trimester
Vitamin k injection administered at birth to minimise risk of neonatal haemorrhage
Most risk: sodium valproate
Topiramate: cleft palate
What are the guidelines on Epilepsy and breast feeding
Encouraged to breast feed (combination therapy/risk factors (premature birth) give specialist advice
High prescience in milk : primidone, ethosuximide, Lamotrigine and zonisamide
Risk of drowsiness: primidone, phenobarbital and benzodiazepine
Withdrawals effects (mother stops breast feeding): phenobarbital, primidone, benzodiazepines and Lamotrigine
