Epilepsy management

Question 1

what is a helpful adjunct in diagnosing epilepsy?

Answer 1

EEG

Question 2

some patients with epilepsy might have a ———– EEG

Answer 2

normal

Question 3

if neuroimaging is to request to diagnose epilepsy it usually is?

Answer 3

MRI

Question 4

when is MRI used to diagnose epilepsy?

Answer 4

epilepsy before the age of 2, those who have any suggestion of a focal onset on history/examination or those in whom seizures continue despite use of first-line medication

Question 5

what is the first step of epilepsy treatment?

Answer 5

establish diagnosis and epilepsy type

Question 6

what is the second step of epilepsy treatment?

Answer 6

use only one drug at a time

Question 7

initial titration should be to ——- maintenance doses and ——-/———- titration should in ———, ———- doses

Answer 7

low
upward/downward
slow
stepped

Question 8

what is the first line treatment of tonic clonic seizures?

Answer 8

sodium valproate if unsuitable –> Lamotrigine

Question 9

what is the second line treatment of tonic-clonic seizures?

Answer 9

levetiracetam
topiramate
clobazam

Question 10

what is the first-line treatment of absence seizures?

Answer 10

ethosuximide

sodium valproate

Question 11

what is the firsst-line treatment for myoclonic seziures?

Answer 11

sodium valproate

Question 12

what is the second line treatment for myoclonic seizures?

Answer 12

levetiracetam

Question 13

what is the first line treatment for focal seizures?

Answer 13

lamotrigine

carbamazepine

Question 14

what is the firsst-line treatment for unclassified seizures?

Answer 14

sodium valproate

Question 15

what is the sescond line treatment for unclassified seizures?

Answer 15

lamotrigine

topiramate

Question 16

what is the mode of action of carbamazepine?

Answer 16

sodium channel inactivation

Question 17

what are the adverse effects of carbamazepine? 5)

Answer 17

diplopia, ataxia, blood dysrasias, teratogenic, hyponatraemia

Question 18

carbamazepine can be used in

Answer 18

trigeminal neuralgia as well as first line for focal seizures

Question 19

what is the mode of action of phenytoin?

Answer 19

sodium channel inactivation

Question 20

what are the adverse effects of phenytoin? (10)

Answer 20

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megalobastic anaemia, teratogenic

Question 21

what teratogenic effects does phenytoin cause?

Answer 21

cleft palate and cardiac defects

Question 22

phenytoin can be used as?

Answer 22

seizure prophylaxis as well

Question 23

what is the mode of action of lamotrigine?

Answer 23

blocks voltage gated sodium gated channels

Question 24

what are adversse effects of lamotrigine?

Answer 24

rash and steven johnson syndrome

Question 25

which anti-epileptic drug caan be useed in pregnancy?

Answer 25

lamotrigine

Question 26

lamotrigine may exacerbate

Answer 26

myoclonic seizures

Question 27

what is the mode of action of ethosuximide?

Answer 27

blocks thalamic T-type calcium channels

Question 28

what are the adverse effects of ethosuximide? (5)

Answer 28

GI upset, fatigue, headache, urticaria, stevens-johnson syndrome

Question 29

ethosuximide is used first-line in?

Answer 29

absence seizures

Question 30

what is the mode of action of sodium valproate?

Answer 30

sodium channel inactivation with increased GABA concentration

Question 31

what are the adverse effects of sodium valproate? 95)

Answer 31

GI upset, liver failure, neural tube defectss, tremor, weight gain

Question 32

what are the neural tube defects caused by sodium valproate?

Answer 32

spina bifida

Question 33

what should be aware of when using valproate?

Answer 33

be aware in women or girls of childbearing age

Question 34

what is status epilepticus?

Answer 34

a convulsive seizure which continues for a prolonged period (longer than five minutes) or when convulsive seizures occur one after the other with no recovery in between

Question 35

what is the treatment for status epilepticus? in the community

Answer 35

buccal or rectal midazolam - 1st line in the community

Question 36

what is the treatment of status epilepticus in hospitals or if IV acceesss is already established?

Answer 36

IV lorazepam

Question 37

if seizures continue in sstatus epilepticus?

Answer 37

administer IV phenobarbital or phenytoin as second line treatment

Question 38

DVLA regulation regarding group 1 vehicles: | if seizure occurs when awake?

Answer 38

stop driving for 1 year

Question 39

DVLA regulation regarding group 1 vehicles: | if seizure occurs when asleep?

Answer 39

can drive but only if there is no awake attack for 3 years

Question 40

DVLA regulation regarding group 1 vehicles: | if seizure occurs when awake but doesnt affect consciousness?

Answer 40

will still qualify got license if these are the only type of attack you've ever had and the first one was 12 months ago

Question 41

DVLA regulation regarding group 2 vehicles: | one-off sseizure?

Answer 41

stop driving for 5 years

Question 42

DVLA regulation regarding group 2 vehicles: | more than 1 seizure/diagnosis of epilepsy?

Answer 42

must be seeizure and medication free for 10 years