Sun14November1246PM 18

A 24-year-old woman presents to the Emergency department with generalised seizures.

Following emergency treatment she is referred to the neurologist who establishes a diagnosis of new onset tonic-clonic epilepsy.

Which one of the following options is the most appropriate initial management?

(Please select 1 option)

Lamotrigine should be offered as first line of treatment Correct

Progesterone only implant is recommended for emergency contraception

Vagal nerve stimulation should be considered early on in the management

Sodium valproate should be offered as a first line of treatment

Folic acid 5 mg should be commenced immediately

Explanation

NICE guidelines on Epilepsy (CG137) recommend sodium valproate and lamotrigine as first line treatment choices in patients with generalised tonic clonic seizures only. However this is a young woman of child-bearing age and sodium valproate can cause neural tube defects in the fetus, especially if on a dose higher than 800 mg per day. Compared to sodium valproate, lamotrigine would be a safer choice. Also lamotrigine is thought not to induce liver enzymes that have a bearing on contraception.

NICE guidelines recommend the prescription of 5 mg of folic acid only in women who are considering the possibility of pregnancy and are on an antiepileptic drug. Anticonvulsant drugs, especially sodium valproate, interfere with the intestinal folic acid absorption. A deficiency of folic acid can lead to neural tube defects in the fetus.

Intrauterine devices are preferred methods of emergency contraception in women on antiepileptic drugs. If the patient chooses a progesterone only preparation, then the dose would need to be increased and expert advice sought.

Vagal nerve stimulation is recommended only in patients who are refractory to medical treatment and unsuitable for surgical resection.

Answer Statistics

1

58%

2

5%

3

31%

4

8%

Times answered: 284