Neurology II

Question 1

The patient’s presentation of peripheral neuropathy, lymphadenopathy, and bleeding gums suggests that he has been taking which anti-epileptic? [1]

Answer 1

The patient’s presentation of peripheral neuropathy, lymphadenopathy, and bleeding gums suggests that he has been taking phenytoin

Question 2

It is useful when thinking about the management of epilepsy to consider certain groups of patients.

Which patients are have special considerations and how do you manage these? [3]

Answer 2

patients who drive:
- generally patients cannot drive for 6 months following a seizure.
- For patients with established epilepsy they must be fit free for 12 months before being able to drive

patients taking other medications:
- antiepileptics can induce/inhibit the P450 system resulting in varied metabolism of other medications, for example warfarin

women wishing to get pregnant:
- antiepileptics are generally teratogenic, particularly sodium valproate.
- It is important that women take advice from a neurologist prior to becoming pregnant, to ensure they are on the most suitable antiepileptic medication.
- Breastfeeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates

women taking contraception:
- both the effect of the contraceptive on the effectiveness of the anti-epileptic medication and the effect of the anti-epileptic on the effectiveness of the contraceptive need to be considered

Question 3

[] is considered the first line treatment for patients with generalised seizures with [] used for focal seizures.

Answer 3

Sodium valproate is considered the first line treatment for patients with generalised seizures with carbamazepine used for focal seizures.

Question 4

Carbamazepine may exacerbate [2] seizures

Answer 4

Carbamazepine may exacerbate absence seizures and myoclonic seizures