| What should be considered if there is a non-response to adequate medication? | Non response to adequate dose and duration of medication | (centres with specialists like paediatrician, neurologist) • Redflag Signs • Progressive problems, rapid appearance of new symptoms • Recent injury • Symptoms appearing after alcohol binge • Status epilepticus after stabilization • Non response to adequate dose and duration of medication • Serious side effects • Neuroimaging | 232 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf | (centres with specialists like paediatrician, neurologist) • Redflag Signs • Progressive problems, rapid appearance of new symptoms • Recent injury • Symptoms appearing after alcohol binge • Status epilepticus after stabilization • Non response to adequate dose and duration of medication • Serious side effects • Neuroimaging | 1 | page=1,block=31 | 0.700 | valid |
| What are some side effects of the medication with a starting dose of 30mg HS? | Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. Polytherapy and valproate to be avoided in women with epilepsy | 48 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. | 1 | page=1,block=67 | 0.700 |
| What symptoms are listed that might indicate a serious condition? | Fever o Headache o Vomiting o Altered Sensorium o Severe Giddiness o Loss of function of body | o Fever o Headache o Vomiting o Altered Sensorium o Severe Giddiness o Loss of function of body IMPENDING SE ESTABLISHED SE REFRACTORY SE 5 MIN 30 MIN 60 MIN 2 IV drugs fail (Benzo + IV AED) Out of Hospital/home : Buccal/Intranasal IMDZ with acute repititive seizures/status (0.3-0.5 mg/kg) | 2 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf | o Fever o Headache o Vomiting o Altered Sensorium o Severe Giddiness o Loss of function of body IMPENDING SE ESTABLISHED SE REFRACTORY SE 5 MIN 30 MIN 60 MIN 2 IV drugs fail (Benzo + IV AED) Out of Hospital/home : Buccal/Intranasal IMDZ with acute repititive seizures/status (0.3-0.5 mg/kg) | 1 | page=1,block=35 | 0.700 | valid |
| What are some adverse effects of Lamotrigine? | Sedation, ataxia, dizziness, skin rash, SJS (lower risk with slow titration) | MUST INFORM CONSULTANT ON CALL Super refractory > 24hr no control AED– BROAD SPECTRUM (GENERALIZED SEIZURES) DOSE (MAINTENANCE: MG/D) ADVERSE EFFECTS Sodium Valproate (avoid in women of child bearing age unless non responsive to other drugs) Starting dose :200mg TDS Maintenance Dose: 600-2400 Anorexia, wt gain, nausea, vomiting, tremors, hair loss, PCOS, thrombocytopenia Lamotrigine Starting dose: 25mg HS (Lower dose with VPA) Maintenance Dose: 100-300 Sedation, ataxia, dizziness, skin rash, SJS (lower risk with slow titration) Levetiracetam Starting dose: 250mg BD Maintenance Dose: 1000-3000 Somnolence, dizziness, cognitive slowing, psychosis Topiramate Starting dose: 25mg OD Maintenance Dose: 100-400 Sedation, somnolence, cognitive problems, weight loss, word finding difficulty, renal stones, seizure worsening AED (focal seizures) Carbamazepine Starting dose: 100mg BD Maintenance dose: 400-1200 Sedation, dizziness, ataxia, skin rash, SJS, hyponatremia, seizure worsening in some situations Oxcarbazepine Starting dose: 150mg BD Maintenance dose: 600 to 1800 Sedation, dizziness, ataxia, headache, hyponateremia, skin rash Phenobarbitone Can be used for generalized also | 457 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf |
| What are some side effects of Phenytoin? | Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. Polytherapy and valproate to be avoided in women with epilepsy | 191 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. | 1 | page=1,block=67 | 0.700 |
| Which types of treatments should women with epilepsy avoid? | Polytherapy and valproate | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. Polytherapy and valproate to be avoided in women with epilepsy | 404 | list | 0.740 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952345_neurology_epilepsy.pdf | Starting dose: 30mg HS Maintenance dose: 60-180 Sedation, ataxia, depression, memory problems, hyperactivity in children, skin rash Phenytoin Starting dose: 200mg HS Maintenance dose:200-400 Ataxia, sedation, gum hyperplasia, coarsening of facial features, hirsutism, memory problems, osteomalacia & bone loss, skin rash Folic Acid 5 mg/day to be added along with AEDs in all women of child bearing age. Polytherapy and valproate to be avoided in women with epilepsy | 1 | page=1,block=67 | 0.700 |
| What is the recommended dose of IV Lorazepam for seizures? | up to 0.1 mg/kg @ 2mg/min | IV Lorazepam up to 0.1 mg/kg @ 2mg/min OR IV Midazolam 0.1-0.2 mg/kg bolus or 0.05-0.5 mg/kg/hr in CIV OR IV Diazepam upto 0.25-0.4 mg/kg over 2-3 min • Phenytoin @50 mg/min 20 mg/kg repeat plus 10 mg/kg if seizures do not stop in 15-20 min • If seizures not controlled or contra indiction (CI) to PHT Intravenous Valproate 25-40 mg/kg @3-6 mg/kg/min • If CI to above two; Phenobarbitone 20 mg/kg IV @ less than 5-60 mg/min but be prepared to Intubate and ventilate ICU IV Midazolam loading 0.2 mg/kg OR CIV 0.05-0.5 mg/kg/hr (can go up to 2 mg/kg/hr) Taper gradually after seizure stops (preferably as evidenced by EEG) Thiopental 5-7 mg/kg IV bolus further 50 mg until seizures controlled 3-5 mg/kg/hr for only 48 hours OR Propofol IV loading 2-5 mg/kg CIV 1-15 MG/KG/HR OR Pentobarbital IV upto 10 mg/kg @ <0.2-0.4 mg/kg/min CIV 0.5-2 mg/kg/h OR Ketamine bolus 1.5 mg/kg CIV 0.01-0.05 mg/kg/h max 10mg/kg/hr * to be EEG Monitoring Levetiracetam 20-30 mg/kg IV at 5 mg/kg/min (max 3g) or Levetiracetam 1500-3000 mg via NGT or Lacosamide 200-400 mg IV at 40-80 mg/min Topiramate 150-800 mg bid via NGT Airway, blood pressure, temperature, intravenous access, electrocardiography, CBC, glucose, electrolytes, AED levels, ABG, oximetry, tox screen, central line If alcoholic- thiamine & glucose, if diabetic GLUCOTEST/blood sugar & glucose IV. | 13 |
| What should be administered if there is a contraindication to Phenytoin? | Intravenous Valproate 25-40 mg/kg @3-6 mg/kg/min | IV Lorazepam up to 0.1 mg/kg @ 2mg/min OR IV Midazolam 0.1-0.2 mg/kg bolus or 0.05-0.5 mg/kg/hr in CIV OR IV Diazepam upto 0.25-0.4 mg/kg over 2-3 min • Phenytoin @50 mg/min 20 mg/kg repeat plus 10 mg/kg if seizures do not stop in 15-20 min • If seizures not controlled or contra indiction (CI) to PHT Intravenous Valproate 25-40 mg/kg @3-6 mg/kg/min • If CI to above two; Phenobarbitone 20 mg/kg IV @ less than 5-60 mg/min but be prepared to Intubate and ventilate ICU IV Midazolam loading 0.2 mg/kg OR CIV 0.05-0.5 mg/kg/hr (can go up to 2 mg/kg/hr) Taper gradually after seizure stops (preferably as evidenced by EEG) Thiopental 5-7 mg/kg IV bolus further 50 mg until seizures controlled 3-5 mg/kg/hr for only 48 hours OR Propofol IV loading 2-5 mg/kg CIV 1-15 MG/KG/HR OR Pentobarbital IV upto 10 mg/kg @ <0.2-0.4 mg/kg/min CIV 0.5-2 mg/kg/h OR Ketamine bolus 1.5 mg/kg CIV 0.01-0.05 mg/kg/h max 10mg/kg/hr * to be EEG Monitoring Levetiracetam 20-30 mg/kg IV at 5 mg/kg/min (max 3g) or Levetiracetam 1500-3000 mg via NGT or Lacosamide 200-400 mg IV at 40-80 mg/min Topiramate 150-800 mg bid via NGT Airway, blood pressure, temperature, intravenous access, electrocardiography, CBC, glucose, electrolytes, AED levels, ABG, oximetry, tox screen, central line If alcoholic- thiamine & glucose, if diabetic GLUCOTEST/blood sugar & glucose IV. |