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Questions and Answers
What is the primary goal of epilepsy treatment?
What percentage of patients are maintained on one antiseizure drug (ASD)?
When should drug treatment for epilepsy be started?
What is the recommended approach for drug treatment for epilepsy?
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What should be considered if a patient is seizure-free for three years?
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How do current antiepileptic drugs mainly act?
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What laboratory test result is expected in a patient on cytochrome P450 (CYP450) inducers?
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Which drug inhibits many hepatic enzyme systems and displaces some drugs from plasma albumin?
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What is the primary communication pathway between the body and the brain in Vagus Nerve Stimulation Therapy (VNS)?
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Which surgical procedure involves the removal of one cerebral hemisphere?
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Which side effect is commonly associated with Vagus Nerve Stimulation Therapy (VNS)?
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Which class of drugs is devoid of enzyme-inducing or inhibiting properties?
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Which side effect is NOT associated with Vagus Nerve Stimulation Therapy (VNS)?
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Which type of seizure is also known as 'grand mal'?
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What is the preferred drug for status epilepticus due to its rapid onset of action and low dose administration rate?
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Which demographic group may require lower doses of AEDs due to compromised renal or hepatic function and increased risk of drug-drug interactions?
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Which allele is associated with an increased risk of developing Stevens-Johnson syndrome as a reaction to carbamazepine in Asians and South Asians?
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What should patients receiving certain AEDs do to counter the risk of osteoporosis or osteomalacia due to interference with vitamin D metabolism?
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Which AEDs are mentioned as examples for various seizure types in the text?
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What is the percentage of patients who remain seizure-free with the first AED drug?
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What adverse effect is commonly associated with AEDs such as phenytoin, phenobarbital, and carbamazepine?
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What is the recommended alternative to lorazepam for status epilepticus when lorazepam is unavailable?
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What risk do women taking enzyme-inducing AEDs like phenobarbital and carbamazepine face with oral contraceptives?
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Study Notes
- The text discusses strategies to enhance inhibitory transmission and decrease excitatory activity in the brain to manage seizures, using drugs that affect GABA or modify ion conductance.
- Antiepileptic drugs (AEDs) are mentioned for various seizure types: tonic-clonic (grand mal), partial (focal), absence, myoclonic, and status epilepticus. Examples include phenytoin, valproate, lacosamide, lorazepam, ethosuximide, and carbamazepine.
- During pregnancy, epileptic women face a risk of teratogenicity, but withdrawing medication can be riskier. Seizure-free females have a high chance of remaining seizure-free throughout pregnancy, and clearance of some drugs like phenobarbital, phenytoin, and carbamazepin increases.
- Women taking enzyme-inducing AEDs (phenobarbital, phenytoin, carbamazepine, topiramate, lamotrigine, and felbamate) may experience contraception failures with oral contraceptives.
- Neonates and infants, as well as children, require lower doses of AEDs due to slower metabolism and elimination. Elderly individuals may require lower doses due to compromised renal or hepatic function and increased risk of drug-drug interactions.
- Hypoalbuminemia can affect AED protein binding and necessitate measuring free serum concentrations instead of total serum concentrations.
- Common side effects of AEDs include cognitive impairment (barbiturates), sedation, dizziness, blurred vision, poor concentration, ataxia, and long-term side effects such as osteomalacia or osteoporosis due to interference with vitamin D metabolism (phenytoin, phenobarbital, carbamazepine, oxcarbazepine, felbamate, and valproic acid).
- During status epilepticus, lorazepam is preferred due to its rapid onset of action and low dose administration rate. Diazepam is an alternative when lorazepam is unavailable.
- Seizure freedom rates with AED use: 47% with the first drug, 14% with the second drug, 3% with the third drug, and 36% medication resistant.
- AEDs have various cognitive side effects and idiosyncratic reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis.
- Carbamazepine is associated with idiosyncratic reactions, particularly in Asians and South Asians, due to the HLA-B1502 allele, and HLA-A3101 is associated with an increased risk of developing Stevens-Johnson syndrome.
- AEDs may cause osteoporosis or osteomalacia due to interference with vitamin D metabolism (phenytoin, phenobarbital, carbamazepine, oxcarbazepine, felbamate, and valproic acid). Patients should receive vitamin D supplementation and calcium, and undergo bone mineral density testing if other risk factors for osteoporosis are present.
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Description
Test your knowledge on epilepsy treatment, pharmacotherapeutic regimen, monitoring parameters, complications, and drug interactions. Learn about establishing therapeutic goals, nonpharmacologic treatments, and educating patients or caregivers on epilepsy and its pharmacotherapy.
