EPILEPSY DRUGS

Question 1

What is epilepsy?

Answer 1

A chronic disorder characterized by recurrent seizures due to abnormal synchronized brain activity.

Question 2

What percentage of patients achieve seizure control with antiepileptic drugs (AEDs)?

Answer 2

60-70% achieve adequate control with appropriately chosen AEDs.

Question 3

When are antiepileptic drugs indicated?

Answer 3

When two or more seizures occur within a short interval (6 months - 1 year).

Question 4

What are common seizure triggers?

Answer 4

Fatigue stress

Question 5

What are the two major types of seizures based on etiology?

Answer 5

Primary (idiopathic) and secondary (symptomatic due to an identifiable cause).

Question 6

What is the mechanism of seizure generation?

Answer 6

An imbalance between excitation (glutamate Na+

Question 7

What is the main excitatory neurotransmitter in the brain? .

Answer 7

Glutamate

Question 8

What is the main inhibitory neurotransmitter in the CNS? .

Answer 8

GABA

Question 9

What are narrow-spectrum antiepileptics?

Answer 9

Drugs effective mainly for focal and secondary generalized seizures (e.g. phenytoin

Question 10

What are broad-spectrum antiepileptics?

Answer 10

Drugs effective for both focal and generalized seizures (e.g. valproate

Question 11

What is the mechanism of action of phenytoin?

Answer 11

Blockade of Na+ and Ca2+ channels reducing excitatory transmission and potentiating GABA.

Question 12

How is fosphenytoin different from phenytoin?

Answer 12

Fosphenytoin is a water-soluble prodrug suitable for IV or IM use in status epilepticus.

Question 13

What are indications for phenytoin?

Answer 13

Partial and generalized tonic-clonic seizures and status epilepticus (slow IV infusion).

Question 14

What are common adverse effects of phenytoin?

Answer 14

Gingival hyperplasia hirsutism

Question 15

What is carbamazepine primarily used for?

Answer 15

Partial seizures and tonic-clonic seizures; also used for bipolar disorder and trigeminal neuralgia.

Question 16

What are the main adverse effects of carbamazepine?

Answer 16

GI upset
hyponatremia

Question 17

What is sodium valproate effective for?

Answer 17

A broad-spectrum AED for all types of epilepsy including generalized tonic-clonic

Question 18

What are major side effects of sodium valproate?

Answer 18

GI upset weight gain

Question 19

What is the primary indication for ethosuximide?

Answer 19

Absence seizures especially in children.

Question 20

What is the mechanism of action of ethosuximide?

Answer 20

Selective inhibition of T-type Ca2+ channels in thalamic neurons.

Question 21

What are common side effects of ethosuximide?

Answer 21

GI distress fatigue

Question 22

What is phenobarbital’s mechanism of action?

Answer 22

Potentiates GABA-A receptor activity prolonging Cl- channel opening and reducing excitability.

Question 23

What is phenobarbital used for?

Answer 23

Generalized tonic-clonic seizures partial seizures

Question 24

What are adverse effects of phenobarbital?

Answer 24

CNS depression cognitive impairment

Question 25

What is topiramate used for?

Answer 25

Partial generalized tonic-clonic

Question 26

What are major side effects of topiramate?

Answer 26

Cognitive dysfunction weight loss

Question 27

What is the primary mechanism of lamotrigine?

Answer 27

Blocks Na+ channels and inhibits release of excitatory amino acids (glutamate aspartate).

Question 28

What is lamotrigine commonly used to treat?

Answer 28

Partial and generalized tonic-clonic seizures Lennox-Gastaut syndrome

Question 29

What serious side effect is associated with lamotrigine?

Answer 29

Steven Johnson syndrome (severe skin reaction).

Question 30

What is levetiracetam’s unique mechanism?

Answer 30

Binds to SV2A protein to modulate neurotransmitter release and stabilize neuronal activity.

Question 31

What are indications for levetiracetam?

Answer 31

Partial-onset generalized tonic-clonic

Question 32

What is the treatment approach for status epilepticus?

Answer 32

Initial benzodiazepine (lorazepam or diazepam) followed by phenytoin or phenobarbital if needed.

Question 33

What is the preferred approach to AED therapy?

Answer 33

Monotherapy as it reduces adverse effects and drug interactions.

Question 34

When can AED therapy be discontinued?

Answer 34

After 2+ years of seizure freedom with a favorable prognosis (single drug

Question 35

What precautions are needed when AEDs are used during pregnancy?

Answer 35

Use the lowest effective dose supplement with folate

Question 36

What AEDs are typically considered safe for breastfeeding?

Answer 36

Carbamazepine phenytoin