READ-part- AND REMEMBER-part....

EPILEPSY

Seizures result from episodic electrical discharges in cerebral neurons associated with
prolonged depolarization, during which sustained , high- frequency, repetitive firing
(SHFRF) occurs, followed by prolonged-hyperpolarization.
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Patient Profile -Epilepsy

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Patient Name Thomas Lipton

Address Room 9, Paediatric Ward

Age 7 years Height 125cm

Sex Male Weight 30kg

Allergies Carbamazepine (Agranulocytosis)

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DIAGNOSIS

Presenting complaint 1. Fever (temperature 39.2oC)

2. Increased seizure activity

3. Vomiting

Medical history 1. Cerebral Palsy

2. Epilepsy (poorly controlled seizures)

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LAB/DIAGNOSTIC TESTS

Date Test Reference Range

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MEDICATION RECORD
Date Medication & Strength Qty Sig

17/3 Diazepam 5mg 50 i tds

17/3 Sodium Valproate 200mg 100 i bd

17/3 Lamotrigine 50mg 100 i bd

17/3 Vigabatrin 500mg 100 i daily

17/3 Phenytoin 30mg 100 i bd

17/3 Phenytoin 50mg 100 I bd

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PHARMACIST’S NOTES
Nil
Q79

Which of the following statements regarding epilepsy in childhood is INCORRECT?

A epilepsy is one of the most common chronic neurological conditions of childhood

B the majority of children with a first unprovoked seizure will have a recurrence****

C antiepileptic medication treatment should not be commenced routinely after the first unprovoked seizure

D potential adverse effects of antiepileptic medications are a major determinant in the choice of medication

E if seizure free for two or more years, withdrawal of antiepileptic treatment should be considered

Q80

Which of the following would NOT be an appropriate treatment for someone with acute status epilepticus?

A intranasal midazolam

B rectal diazepam

C rectal paraldehyde

D oral sodium valproate***

E buccal midazolam

Q81

The doctors are concerned about whether the doses of anticonvulsants are appropriate and enquire as to whether
measuring blood levels of the patient’s anticonvulsants would be useful. For which of the following anticonvulsants are
plasma levels of MOST value in clinical practice?

A diazepam

B lamotrigine

C sodium valproate

D phenytoin****

E vigabatrin
Q82

Which of the following anticonvulsants is MOST likely to be associated with visual field effects?

A diazepam

B lamotrigine

C sodium valproate

D phenytoin

E vigabatrin***

Q83

In conversation with the medical staff, Thomas’ mother mentions that he has gained a lot of weight recently. Weight gain
is a well recognised side effect of which of the following anticonvulsants?

A sodium valproate*****

B lamotrigine

C phenytoin

D tiagabine

E phenobarbitone

END OF PATIENT PROFILE

79 B
80 D
81 D
82 E
83 A

PILEPSY- 23. Sodium Valproate - mechanism of action Inhibits GABA transaminase (inhibits GABA breakdown) GAB
A Enhances the inhibitory effect of GABA Reduces excessive neuronal firing Action Potential Action Potential

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PILEPSY- 24. Sodium Valproate - side effects At therapeutic levels In Pregnancy •Significantly increased risk of •
Thinning and curling of hair • Hepatotoxicity (P450 inhibitor) • Weight gain • Thrombocytopaenia • Pancreatitis •
Teratogenicity birth defects with Sodium Valproate •The relative risk is 2-5x higher than other antiepileptic drugs •Extreme
caution in women of childbearing age
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PILEPSY- 25. Cytochrome P450 Enzymes • P450 cytochromes are the major enzymes involved in drug metabolism •
mainly act in the liver P450 inducers speed up the metabolism of drugs (decrease drug availability) P450 inhibitors lead to build
up of unmetabolised drugs (increase drug availability) INDUCERS INHIBITORS Phenytoin / Carbamazapine Sodium
Valproate


PILEPSY- 26. Longterm Management - Surgery Surgery may be considered when there is: •A mass lesion in the brain
•Uncontrolled epilepsy

PILEPSY-STATUS EPILEPTICUS TREATMENT ALGORITHM • Assess cardiorespiratory function • Insert

oral airway, administer oxygen 30% to 100% • Insert indwelling intravenous catheter • Monitor
respiration, blood pressure, body temperature, EKG ... to 1 hour followed by an infusion of
1 mg/kg/h • Valproate rectal suppositories or retention enemas: Dosage of 200-1200 mg every
6 hours in adults or 1 5-20 mg/kg in pediatric patients Intravenous valproate sodium dose is
100-200 mg/min; ...

PILEPSY-18. Phenytoin - Pharmacokinetics • Mainly hepatic break down • Zero order kinetics
• Narrow therapeutic range • Risk of toxicity Continuous BP and ECG monitoring

PILEPSY-Midazolam is a fast-acting, water-soluble benzodiazepine, which is rapidly absorbed

via both the nasal and buccal mucosa and can be ...

PILEPSY-Juvenile myoclonic epilepsy (JME) has been thought to be a lifelong condition, and
many clinicians feel that these patients should continue AED treatment indefinitely even if
seizure-free. There are no randomized studies of this, but a recent, ... in JME remain more
likely to recur than in other epilepsies. Given these numbers, there is a reasonably good chance
that patients who are seizure-free for 2 or more years on medication can remain seizurefree
after medication withdrawal.