Epilepsy

Question 1

GABA

Answer 1

Major inhibitory neurotransmitter

Question 2

Amino Acid Glutamate

Answer 2

Major excitatory neurotransmitter

Question 3

Diagnosis

Answer 3

EEG
CT
MRI

Question 4

Advice: Driving

Answer 4

Stop driving
Inform DVLA
No allowed to drive for 6 months
Licensed might be collected depending on circumstances

Question 5

Advice: Pregnancy

Answer 5

Topiramate - avoid both pregnancy and childbearing potential females
Valproate - avoid both pregnancy and childbearing potential females unless Pregnancy Prevention Program criteria was met and other antiepileptics are not suitable
Lamotrigine and Levetiracetam - safer

Question 6

Generalised Tonic Clonic (ValpLamLev)

Answer 6

Sodium Valproate - 1st line
Lamotrigine / Levetiracetam - 2nd line and in pregnant women (Lam is always 1st line)
If taken with contraceptives - increase dose of Lam

Question 7

Generalised Absence Seizures (EtValpLamLev)

Answer 7

Ethosuximide - 1st line
Sodium Valproate
Lamotrigine
Levetiracetam

Question 8

Myoclonic Seizures (ValpLev)

Answer 8

Sodium Valproate
Levetiracetam

Question 9

Focal Seizures (LamLev)

Answer 9

Lamotrigine
Levetiracetam

Question 10

Atonic or Tonic Seizures (ValpLam)

Answer 10

Sodium Valproate
Lamotrigine

Question 11

Status Epilepticus

Answer 11

IV Lorazepam - initial treatment
IV Clonazepam or Diazepam - alternative
Rectal Diazepam or oromucosal Midazolam - if IV access is difficult
Infusion of Phenytoin or Phosphenytoin or Phenobarbital - if Lorazepam failed to control seizures

Question 12

Cannabis and Epilepsy

Answer 12

Epidyolex
Epidyolex + Clobazam - for people with Dravet and Lennox-Gastaut syndrome

Question 13

Monitoring

Answer 13

TDM
Diary of seizures
S/E - drowsiness, dizziness, nausea

Question 14

Monitoring: Phenytoin

Answer 14

Blood or skin disorders - FBC, rash (if present)
Ataxia, nystagmus, slurred speech - dose related

Question 15

Monitoring: Sodium Valproate

Answer 15

Hepatotoxicity - LFT
Blood disorders - FBC, risk of infection or bleeding
Weight gain, appetite stimulation, tremor, thinning and loss of hair - dose related

Question 16

Monitoring: Carbamazepine

Answer 16

Drowsiness, hyponatraemia, neutropenia - dose related
Bone marrow depression - Vit. D
Toxic hepatitis - LFT
Stevens-Johnson Syndrome, depression

Question 17

Monitoring: Lamotrigine

Answer 17

Skin reactions - occurs if started at high dose or given with Valp, monitor FBC, rashes

Question 18

Monitoring: Topiramate

Answer 18

Vision
Renal stone formation