Epilepsy

Question 1

Why is epilepsy control vital?

Answer 1

To prevent occurrence of seizures by maintaining a dose of one or more anti-epileptic drugs.

Question 2

What is crucial for the adjustment of anti-epileptic drugs?

Answer 2

Start with low doses and titrate upwards.

Question 3

What is the recommended frequency for administering anti-epileptic drugs?

Answer 3

Keep the frequency as low as possible.

Question 4

Which anti-epileptic drugs can be given once a day at bedtime?

Answer 4

• Lamotrigine
• Phenytoin
• Phenobarbital
• Perampanel

Question 5

What does the acronym lp3 stand for?

Answer 5

Once a day at bedtime anti-epileptic drugs.

Question 6

What should be done if one monotherapy drug does not work?

Answer 6

Alternative drugs should be tried.

Question 7

How should anti-epileptic drugs be changed or withdrawn?

Answer 7

Slowly and with caution.

Question 8

Is concurrent use of anti-epileptic medication recommended?

Answer 8

No, it can lead to more side effects.

Question 9

What restrictions are there for valproate in individuals under 55?

Answer 9

New measures apply for both male and female.

Question 10

Under what condition must topiramate not be used?

Answer 10

In females of childbearing potential unless PPP has been met.

Question 11

What risk does topiramate pose during pregnancy?

Answer 11

It can cause cleft palate.

Question 12

What advice does the MHRA give regarding epilepsy and suicidal thoughts?

Answer 12

Increased suicidal thoughts can occur just after one week.

Question 13

What is the risk associated with switching between brands of anti-epileptics?

Answer 13

There is a risk of switching between brands.

Question 14

Which anti-epileptics require maintenance on the same brand?

Answer 14

• Carbamazepine
• Phenobarbital
• Phenytoin
• Primidone

Question 15

What is Category 2 of anti-epileptics?

Answer 15

• Lamotrigine
• Valproate
• Topiramate
• Clonazepam
• Clobazam

Question 16

Which category of anti-epileptics does not need to maintain the same brand?

Answer 16

Category 3: Levetiracetam, Pregabalin, Gabapentin.

Question 17

What is anti-epileptic hypersensitivity syndrome?

Answer 17

A rare but potentially fatal condition.

Question 18

What symptoms indicate anti-epileptic hypersensitivity syndrome?

Answer 18

• Fever
• Rash
• Liver dysfunction
• Renal abnormalities
• Pulmonary abnormalities
• Organ failure

Question 19

What can be done if anti-epileptic hypersensitivity syndrome occurs?

Answer 19

Withdraw the medication immediately.

Question 20

When can anti-epileptic medication be withdrawn?

Answer 20

If the patient has been seizure-free for at least two years.

Question 21

What should be done if there is any doubt or concern regarding epilepsy treatment?

Answer 21

See an epilepsy specialist.

Question 22

Can seizures occur after several years of being on anti-epileptics?

Answer 22

Yes, they can.

Question 23

How should anti-epileptics be withdrawn?

Answer 23

One drug at a time over at least three months.

Question 24

What should be avoided when withdrawing anti-epileptics?

Answer 24

Abrupt withdrawal, especially of barbiturates and benzodiazepines.

Question 25

What increases the risk of teratogenicity during pregnancy?

Answer 25

Especially during the first trimester.

Question 26

What must women of childbearing potential follow?

Answer 26

PPP (Pregnancy Prevention Program).

Question 27

Which anti-epileptics are considered safer to use in pregnancy?

Answer 27

* Lamotrigine * Levetiracetam

Question 28

What should pregnant females continue taking?

Answer 28

Folic acid.

Question 29

How can status epilepticus in pregnancy be treated?

Answer 29

As normal.

Question 30

What minimizes the risk of neonatal hemorrhage associated with anti-epileptics?

Answer 30

Vitamin K injection at birth.

Question 31

What can anti-epileptics interfere with?

Answer 31

Other drugs like contraceptives and warfarin.

Question 32

What should all pregnant women be notified about?

Answer 32

UK Epilepsy and Pregnancy Register.

Question 33

What should be done if a driver has a seizure?

Answer 33

Stop immediately and inform the DVLA.

Question 34

What is the protocol for the first unprovoked epileptic seizure?

Answer 34

Get investigated and do not drive for six months.

Question 35

What must patients with established epilepsy do to drive?

Answer 35

Be compliant with medications and not a danger to the public.

Question 36

How long must patients be seizure-free to drive if they have established epilepsy?

Answer 36

At least one year.

Question 37

What is the driving restriction after withdrawing or changing medication?

Answer 37

Do not drive for six months.

Question 38

What happens if any seizure occurs after a driving restriction?

Answer 38

Cannot drive for one year.

Question 39

What is encouraged for breastfeeding women on anti-epileptics?

Answer 39

Epileptic monotherapy.

Question 40

What must breastfeeding women monitor for?

Answer 40

Signs of toxicity, sedation, and feeding issues.

Question 41

What may breastfeeding women need to do if toxicity occurs?

Answer 41

Stop breastfeeding.

Question 42

What is the risk associated with Primidone and Phenobarbital with benzodiazepines?

Answer 42

Established risk of drowsiness.

Question 43

What is status epilepticus defined as?

Answer 43

A seizure lasting five minutes or more, or recurrent seizures without recovery.

Question 44

What causes status epilepticus?

Answer 44

* Poorly controlled epilepsy * Metabolic abnormalities * Alcohol or drug withdrawal * Infection * Tumor * Airway obstruction * Shock

Question 45

What is the aim of treatment for status epilepticus?

Answer 45

To stop the seizure as soon as possible.

Question 46

After how many minutes are seizures unlikely to stop without intervention?

Answer 46

Five minutes.

Question 47

What is the treatment for status epilepticus?

Answer 47

IV lorazepam; if unavailable, rectal diazepam or oromucosal midazolam.

Question 48

What must be used in status epilepticus for alcohol abuse?

Answer 48

Parenteral thiamine.