You are reviewing a patient with Parkinson's disease.
Which one of the following types of medications has been most linked with impulse control disorders?
Correct Answer C:
Parkinson's disease: management:
Currently accepted practice in the management of patients with Parkinson's disease (PD) is to delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If the patient is elderly, levodopa is sometimes used as an initial treatment.
Dopamine receptor agonists:
Levodopa:
MAO-B (Monoamine Oxidase-B) inhibitors:
Amantadine:
COMT (Catechol-O-Methyl Transferase) inhibitors:
Antimuscarinics:
*Pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction.
Which one of the following medications is most useful for helping to prevent attacks of Meniere's disease?
Meniere's disease:
Meniere's disease is a disorder of the inner ear of unknown cause. It is characterized by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age. Meniere's disease has a similar prevalence in both men and women.
Features:
Natural history:
Management:
A 23-year-old man with a history of migraine presents for review. His headaches are now occurring about once a week. He describes unilateral, throbbing headaches that may last over 24 hours. Neurological examination is unremarkable. Other than a history of asthma he is fit and well.
What is the most suitable therapy to reduce the frequency of migraine attacks?
Pizotifen is used less commonly nowadays due to side-effects such as weight gain. Propranolol should be avoided in asthmatics.
Migraine: management:
It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including migraines.
Acute treatment:
Prophylaxis:
*Caution should be exercised with young patients as acute dystonic reactions may develop.
Which one of the following statements regarding the stopping of anti-epileptic drugs (AED) is most correct?
Correct Answer B: The above reflects 2004 NICE guidelines and should be done under the guidance of a specialist. Benzodiazepines should be withdrawn over a longer period.
Epilepsy: treatment:
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
Sodium valproate is considered the first line treatment for patients with generalized seizures with carbamazepine used for partial seizures.
Generalized tonic-clonic seizures:
Absence seizures* (Petit mal):
Myoclonic seizures:
Partial seizures:
*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.
A 24-year-old female presents to her GP due to increased frequency of migraine attacks. She is now having around four migraines per month.
Which type of medication would it be most appropriate to prescribe to reduce the frequency of migraine attacks?
Correct Answer D:
Topiramate is also recommended by NICE as first-line prophylaxis against migraine. However, given that she is female and of child-bearing age a beta-blocker (such as propranolol) is a better choice.
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