Paper I — 2020 February (Supplementary) (2010 Scheme) — Q1

Paper I

2020 February (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Enumerate the newer drugs used in the treatment of epilepsy. Write the mechanism of action of any two agents. Discuss the line of management of Status Epilepticus. (2+2+2)

Q16 marksEssays★✓

Answer

Newer antiepileptic drugs

• Lamotrigine, Levetiracetam, Gabapentin, Topiramate, Vigabatrin, Oxcarbazepine

Mechanism of action (any two)

• Lamotrigine: Blocks voltage-gated sodium channels, stabilizing neuronal membranes and inhibiting release of excitatory neurotransmitters (glutamate)
• Levetiracetam: Binds to synaptic vesicle protein SV2A, modulating neurotransmitter release; exact mechanism not fully elucidated but distinct from classical sodium-channel/GABA mechanisms
• Gabapentin: Binds to the α2δ subunit of voltage-gated calcium channels, reducing calcium influx and neurotransmitter release (originally designed as a GABA analogue but does not act directly on GABA receptors)

Management of status epilepticus

• Immediate: maintain airway, breathing, circulation; check blood glucose, correct hypoglycaemia if present; IV access
• First-line: IV Diazepam or Lorazepam (repeat once if seizures continue)
• Second-line: IV Phenytoin/Fosphenytoin loading dose
• Third-line: IV Phenobarbitone
• Refractory status epilepticus: General anaesthesia with thiopentone/propofol/midazolam infusion, with EEG monitoring and ICU care

Related Concepts

1. 1Antiepileptics

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5. 5A 28 years old man, while working on his computer in an IT company, suddenly went blank, fell down and appeared to be unconscious. He regains consciousness in the next 5 minutes but was confused and could not remember what happened. When he consulted a neurologist, he was diagnosed to have absence seizures. Answer the following:2014 March (2010 Scheme)Essay · 6 marks
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9. 9Briefly describe the mechanism of action, uses and adverse effects of sodium valproate.2025 March (Supplementary (SAY)) (2019 Scheme)Short Answer · 4 marks
10. 10Sodium valproate2022 May (Supplementary) (2010 Scheme)Short Note · 3 marks
11. 11Sodium valproate2024 March (Supplementary) (2010 Scheme)Short Note · 3 marks
12. 12Lamotrigine2017 February (2010 Scheme)Short Note · 3 marks
13. 13Phenytoin2023 March (Supplementary) (2010 Scheme)Short Note · 3 marks
14. 14Carbamazepine2013 September (Supplementary) (2010 Scheme)Short Note · 3 marks
15. 15Carbamazepine2023 July (Supplementary) (2010 Scheme)Short Note · 3 marks
16. 16Valproic acid2019 February (2010 Scheme)Short Note · 3 marks
17. 17Carbamazepine2021 February (Supplementary) (2010 Scheme)Short Answer · 1 mark
18. 18Phenytoin sodium.2025 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
19. 19Status epilepticus.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
20. 20In treatment of absence seizures2018 February (2010 Scheme)Short Answer · 1 mark
21. 21Drugs for absence seizures2021 May (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
22. 22 Carbamazepine in treatment of Trigeminal neuralgia Name the following (Two examples for each): (5x1=5)2024 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
23. 23Antiepileptic drugs2022 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
24. 24Drugs used in Absence seizures.2023 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks