Epilepsy

Question 1

What is epilepsy?

Answer 1

Electrical imbalance that causes epileptic seizures

Question 2

List drugs that are taken once daily(at bed time)

Answer 2

LP3
Lamotrigine
Phenytoin
Phenobarbital
Perampanel

Question 3

Why are some drugs taken once daily?

Answer 3

They have longer action/ long half life

Question 4

What is the criteria of category 1 drugs

Answer 4

Needs to be given on specific brands (only for epilepsy)

Question 5

List drugs on Category 1

Answer 5

CP3

• carbamazepine (Tegretol, carbagen)
• phenytoin
• phenobarbital
• primidone

All cause hypersensitivity syndrome

Question 6

What is category 2 drugs?

Answer 6

Need for continuity depends on patient and doctors

Question 7

List drugs under category 2v

Answer 7

Sodium valproate
Lamotrigine
Clobazam
Clonazepam
Topiramate

Question 8

What are category 3 drugs?

Answer 8

No need to maintain brands unless pt wants it for confusion, dosing error etc

Question 9

List category 3 drugs?

Answer 9

Gabapentin
Pregabin
Levetiracetam
Tiagabine
Brivaracetam
Ethosuximide
Vigabatrine

Question 10

List drugs that cause anti epileptic hypersensitivity syndrome

Answer 10

CP3
Lamotrigine
Lacosimide
Rufinamide

Question 11

List symptoms of AE HS?

Answer 11

Fever
Rash
Liver dysfunction
Renal & pulmonary abnormalities
Multi organ failure

Question 12

When do you monitor patient for HS and how long does symptoms start?

Answer 12

First 2 months of starting meds

1 to 8 weeks

Question 13

What is the MHRA warning when taking AE drugs?

Answer 13

Suicidal thoughts and behavior within 1 week of starting

Question 14

Benzodiazepines withdrawal period is how long?

Answer 14

6 months or longer

Question 15

What are the DVLA rules?

Answer 15

-Stop driving immediately and inform dvla if driver has seizures

• if you have unprovoked (unknown) seizures or isolated one - stop driving for 6 months

-established seizures - can drive if there is no harm

• if there is a change of meds or withdrawal don’t drive for 6 months after last dose
• if seizure occurs during that change- hold license for 1 year

Question 16

What happens when you take AE drugs during pregnancy?

Answer 16

Increased risk of teratogenicity especially during 1st trimester

Question 17

Which drugs has the highest risk during pregnancy and what is the requirement?

Answer 17

Sodium valproate

Must not be used in women of childbearing unless they meet the PpP criteria and no other options

Question 18

Which drug carries increased risk of congenital malformations and what does it cause?

Answer 18

Topiramate - causes Cleft Palate

Question 19

Which vitamin should you give at birth yo minimize risk of neonatal haemorrhage?

Answer 19

Vitamin K

Question 20

List drugs that causes drowsiness in breastfeeding?

Answer 20

Phenobarbital
Primidone
Benzodiazepines
Lamotrigine

Question 21

What are the two types of seizures

Answer 21

Generalized and focal seizures

Question 22

What is the first line treatment for all generalized seizure?

Answer 22

Sodium valproate

Question 23

List the four types of generalized seizures?

Answer 23

Tonic clonic
Absence
Myoclonic
Atonic&tonic

Question 24

List the drugs that can’t completely be used in the types of generalized seizures except Tonic-clonic seizure?

Answer 24

Carbamezapine
Vigabatrin

Exacerbates symptoms

Question 25

What is the drugs used for absence seizure?

Answer 25

First line - Sodium valproate or ethosuximide Alternative- Lamotrigine (SEAL)

Question 26

Describe absence seizure?

Answer 26

Mainly in Childress Brief loss of consciousness, resolves in few seconds No convulsions

Question 27

Describe tonic clonic seizure

Answer 27

Body stiffens Loss of consciousness Body shakes (convulses) Loss of bladder/bowel movement

Question 28

Treatment of tonic clonic seizure

Answer 28

Sodium valproate or carbamazepine/lanotrigine

Question 29

Describe myoclonic seizures?

Answer 29

Jerking Muscle contraction - Arm/elbow

Question 30

List the treatment for myoclonic?

Answer 30

(SALT) Sodium valproate - first line Levetiracetam, Topiramate- alternative

Question 31

Describe tonic-atonic seizure

Answer 31

Brief loss of consciousness Stiff Fall to ground

Question 32

Treatment for tonic-atonic?

Answer 32

(SLART) Sodium valproate or Lamotrigine - first line Rufinamide, Topiramate- alternative

Question 33

List treatment of focal seizure?

Answer 33

Carbamazepine Lamotrigine (Cal)

Question 34

Describe focal seizures

Answer 34

One part of brain

Question 35

List the two types of focal seizures and explain them

Answer 35

Simple focal seizures- muscle jerk in one arm or leg, no loss of consciousness Complex focal seizure- consciousness affected

Question 36

What is status epilepticus?

Answer 36

Seizure that last more than 5 minutes or multiple seizure within 30 mins

Question 37

What is the treatment of status epilepticus

Answer 37

Diazepam rectal solution Or Midazolam oromucosal soln

Question 38

First seizure - impaired consciousness (Group 1- cars and motor cycles), how long should you avoid driving?

Answer 38

Do not drive for six months

Question 39

Epileptic seizure - impaired consciousness (Group 1)?

Answer 39

Don’t drive for 1 year

Question 40

No loss of consciousness seizure?

Answer 40

Seek DVLA advice

Question 41

First seizure (group two-buses and lorries)

Answer 41

Don’t drive for 5 years

Question 42

More than one seizure (group 2)

Answer 42

Don’t drive for 10 years

Question 43

When do you withdraw med after pt is seizure free?

Answer 43

Min 2 years