Question 3 Ms B, a 25 year old patient, has been referred to a first seizure/urgent assessment neurology clinic from Acc

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Question 3 Ms B A 25 Year Old Patient Has Been Referred To A First Seizure Urgent Assessment Neurology Clinic From Acc 1 (51.23 KiB) Viewed 50 times

Question 3 Ms B, a 25 year old patient, has been referred to a first seizure/urgent assessment neurology clinic from Accident & Emergency after three episodes in rapid succession of brief seizures. Ms B collapsed and lost consciousness whilst out walking, a witness called emergency services and was able to describe the events. Ms B is unable to give much detail of the event. Ms B has no past medical or family history of note, is only taking the combined oral contraceptive pill, had not consumed any alcohol in the past 24 hours and had a normal routine blood screen when she attended A&E. The neurologist makes a diagnosis of generalised tonic- clonic seizure and arranges for an MRI scan and EEG to support this diagnosis a. Using your knowledge of the causes and diagnosis of epileptic seizures, discuss why Ms B was referred for both an MRI and EEG scan (20% of marks, 200 words) b. Which one of the following anti-epileptic pharmacological treatments would be prescribed as first-line treatment and explain why? (20% of marks, 150 words) • sodium valproate carbamazepine • lamotrigine • ethosuximide c. Based upon your understanding of the mechanism of drug action describe how the first-line treatment anti-epileptic drug works to control Ms B's generalised tonic-clonic seizure? (30% of marks, 150 words) d. At Ms B's six-month pharmacy review, her seizures are reasonably well controlled with good compliance taking her prescribed anti-epileptic drug. However, during the past 2 months she has been experiencing periods of insomnia and mentioned she has been taking the complementary Chinese herbal medicine, St John's Wort. recommended to her by a friend. The pharmacist explains that St John's Wort should be avoided by patients with epilepsy, discusses some alternative options and refers Ms B to her GP. Use current guidelines and evidence-based management to discuss the rationale behind the pharmacist's recommendations and referral to the GP. (20% of marks, 150 words) After 4 years of being seizure-free describe how Ms B's anti-epileptic treatment can be discontinued? (10% of marks, 100 words)