Epilepsy

Question 1

Name the 4 antiepileptics that can be given once daily at night due to their long half-lives

Answer 1

Parampanel, Lamotrigine, Phenobarbital, Phenytoin

Question 2

Which risk category does gabapentin fall into in terms of keeping with the same manufacturer when supplying antiepileptics?

Answer 2

Category 3- Not necessary to provide same manufacturer

Question 3

Which risk category does lamotrigine fall into in terms of keeping with the same manufacturer when supplying antiepileptics?

Answer 3

Category 2

Question 4

Which risk category does sodium valproate fall into in terms of keeping with the same manufacturer when supplying antiepileptics?

Answer 4

Category 2- Based on clinical judgement and patient circumstances

Question 5

Which risk catergory does carbamazepine, phenobarbital, phenytoin, and primidone fall into in terms of keeping with the same manufacturer when supplying antiepileptics?

Answer 5

Category 1- Manufacturer must be kept the same when supplying

Question 6

When are symptoms likley to develop in antiepilepsy hypersensitivity syndrome?

Answer 6

Between 1-8 weeks after exposure to drug

Question 7

Name the symptoms of antiepilepsy hypersensitivity syndrome

Answer 7

Rash, fever, and lymphadenopathy most likley to occur, but multi-organ failure can occur when serious

Question 8

How is antiepilepsy hypersensitivity syndrome treated?

Answer 8

Withdrawal of causative drug and no further re-occurence to drug

Question 9

When can withdrawal of antiepileptics be considered?

Answer 9

If seizure free after 2 years

Question 10

How are antiepileptics withdrawn?

Answer 10

Withdrawn over 3 months (benzodiazepines and barbiturates longer).
If on multiple epileptics, should be withdrawn one at a time.

Question 11

Which classes of antiepileptics are associated with severe rebound seizures?

Answer 11

Barbiturates and benzodiazepines

Question 12

How long does the DVLA recommend not driving for after an unprovoked epileptic seizure or a single isolated seizure?

Answer 12

6 months

Question 13

What criteria do people with epilepsy have to meet to be permitted to drive?

Answer 13

• seizure free for 1+ years OR
• confirmed history of seizures that do not effect level of conciousness/ ability to act.
• Must not have history of unprovoked seizures.

Question 14

How long is a person not permitted to drive for following a withdrawal of epilepsy treatment?

Answer 14

6 months after their last dose

Question 15

Which trimester is the highest risk of teratogenicity when using anti-epileptics?

Answer 15

first trimester

Question 16

Which 4 antiepileptics demonstrate the highest risk of major congenital abnormalities in the foetus?

Answer 16

Carbamazepine, phenytoin, topiramate, and phenobarbital

Question 17

Why is folic acid recommended in the 1st trimester for a pregnant patient taking antiepileptics?

Answer 17

To prevent neural tube defects

Question 18

Which 2 antiepileptics are particularly affected by physiological changes during pregnancy and post-partum?

Answer 18

Lamotrigine + phenytoin

Question 19

What assessment must a pregnanct patient have if experiencing seizures in the seconf trimester?

Answer 19

eclampsia assessment

Question 20

Which therapy reduces the risk of neonatal haemorrhage associated with antiepileptic use?

Answer 20

Vitamin K given at birth

Question 21

Which type of seizure may lamotrigine exacerbate?

Answer 21

myoclonic seizure

Question 22

First line therapy for focal seizures

Answer 22

Levetiracetam/ Lamotrigine

Question 23

First line therapy for in pregnancy for epilepsy

Answer 23

Lamotrigine

Question 24

Second-line therapy for focal seizures

Answer 24

carbamazepine, oxcarbamazepine, zonisamide

Question 25

Third-line therapy for focal seziures

Answer 25

Lacosamide

Question 26

Fourth line therapy for focal seizures

Answer 26

Adjunctive treatment with 1st, 2nd, and 3rd line agents + topiramate

Question 27

First line therapy for generalised tonic-clonic seizure

Answer 27

Sodium valproate if unable to have children

Question 28

Second-line therapy for generalised tonic-clonic seizure

Answer 28

Lamotrigine/Levetiracetam

Question 29

Third-line therapy for generalised tonic-clonic seizure

Answer 29

Adjunctive therapy with 1st, 2nd, 3rd line options + perampanel, clobazam, topiramate.

Question 30

First-line therapy for absence seizures

Answer 30

ethosuximide

Question 31

Second-line therapy for absence seizures

Answer 31

sodium valproate if unable to have children- as monotherapy or adjunct

Question 32

First-line therapy for myoclonic seizures

Answer 32

sodium valproate

Question 32

Third-line therapy for absence seizures

Answer 32

Levetiracetam or Lamotrigine as monotherapy or adjunct

Question 33

Second-line therapy for myoclonic seizures

Answer 33

Levetiracetam

Question 34

Why is lamotrigine not used in myoclonic seizures?

Answer 34

Can exacerbate the seizure

Question 35

First-line therapy for atonic or clonic seizures

Answer 35

sodium valproate

Question 36

Second-line therapy for atonic or clonic seizures

Answer 36

Lamotrigine

Question 37

What is first line therapy in epilepsy syndromes such as dravet and lennox-gastaut syndrome?

Answer 37

Sodium valproate irrespective of being female- due to seriousness of conditions

Question 38

How are febrile convulsions treated?

Answer 38

Anti-pyretics used to bring temp down Treated as status epilepticus if lasts 5+ minutes

Question 39

What is 1st line therapy in status epilepticus if patient does not have an emergency management plan in place?

Answer 39

buccal midazolam or rectal diazepam. Lorazepam if IV access and resuscitation equipment available (can give a second dose in 5-10 mins if no response)

Question 40

Second line options in status epilepticus?

Answer 40

phenytoin, levetriacetam, sodium valproate, phenobarbital

Question 41

Third-line option in status epilepticus?

Answer 41

general anaesthesia

Question 42

What is the definition of prolonged convulsive seizure?

Answer 42

seizure lasting 2+ minutes more than a patient's normal seizure

Question 43

What is the definition of repeated/ cluster seizures?

Answer 43

3+ seizures in 24 hours

Question 44

What condition is oral phenytoin contraindicated in?

Answer 44

Acute porphyrias

Question 45

What conditions is IV phenytoin contrainidicated in?

Answer 45

2nd/3rd degree heart block, stokes-adams syndromes, sino-atrial block, and sinus bradycardia

Question 46

What monitoring is needed when giving IV phenytoin?

Answer 46

ECG and BP monitoring

Question 47

How long a gap should there be between phenytoin and enteral feeds?

Answer 47

2 hours either side of dose

Question 48

What common side effects are associated with phenytoin?

Answer 48

vitamin d deficiency and electrolyte disturbances

Question 49

Why should IM phenytoin not be given?

Answer 49

Slow and erratic absorption

Question 50

What is the relationship between plasma drug concentrations and dose of phenytoin?

Answer 50

Non-linear

Question 51

What symptoms would raise red flags for a patient taking carbamazepine?

Answer 51

fever, rash, bleeding, bruising, mouth ulcers due to risk of leucopenia

Question 52

Name the contra-indications of carbamazepine

Answer 52

Acute porphyrias, AV conduction abnormalities, history of bone marrow suppression

Question 53

Which anti-epileptics are particualrly associated with a high risk of steven johnsons syndrome?

Answer 53

Carbamazepine, Levetriacetam, Phenytoin, Phenobarbital

Question 54

Which-anti-eplileptic should be withdrawn in cases of acute liver disease, or aggravated liver disease?

Answer 54

Carbamazepine

Question 55

Which anti-eplieptic has an increased risk of cutaneous adverse reactions with it's use?

Answer 55

Carbamazepine