DR Medhat MRCP

- * Carbamazepine may actually exacerbate absence seizure
- ** The 2007 SANAD study indicated that lamotrigine may be a more suitable first-line
drug for partial seizures although this has yet to work its way through to guidelines.
- Vigabatrin – rarley used anti-epileptic
o 40% of patients develop Visual field defects, which may be irreversible
o Visual fields should be checked every 6 months
• Important notes :
- AED cessation can be considered if seizure free for > 2 years – Stop AEDs over
2-3 months.
- In a patient who has been seizure free for more than 2 years, the chance of
recurrence in the next 2 years is 43% if they stop therapy compared with 10% if
drugs are continued.
- Factors that have been shown to increase the risk of seizures include:
1. Older age.
2. Use of multiple anticonvulsants.
3. History of myoclonic or tonic clonic seizure.
4. Previous abnormal imaging or EEG.
5. Seizure while on therapy.
Epilepsy & pregnancy :
o The risks of uncontrolled epilepsy during pregnancy generally outweigh
the risks of medication to the fetus.
o All women thinking about becoming pregnant should be advised to take
folic acid 5mg/day well before pregnancy to minimise the risk of neural
tube defects.
o Around 1-2% of newborns born to nonepileptic mothers have congenital
defects. This rises to 3-4% if the mother takes antiepileptic medication.
o Other points
1. Aim for monotherapy.
2. There is no indication to monitor antiepileptic drug levels.
3. Sodium valproate: associated with neural tube defects.
4. Phenytoin (Epanutin®): associated with cleft palate.
5. Lamotrigine : studies to date suggest the rate of congenital
malformations may be low. The dose of lamotrigine may need to
be increased in pregnancy.
6. Carbamazepine: often considered the least teratogenic of the
older antiepileptics (although it can cause neural tube defect ,so
folic acid should be co-prescribed with it)
7. Breast feeding is generally considered safe for mothers taking
antiepileptics with the possible exception of the barbiturates.
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