1 - CNS Part II

Question 1

Where do seizures originate?

Answer 1

Synchronous, high-frequency discharge from a group of hyperexcitable neurons called a focus

Question 2

What’s the difference between a simple partial seizure and a complex partial seizure?

Answer 2

complex involved impaired consciousness. Simple do not.

Question 3

What’s the difference between a generalized seizure and a secondarily generalized seizure?

Answer 3

Secondarily generalized means it starts with a partial seizure and evolves into a generalized

In a generalized seizure, loss of conscious is immediate

Question 4

Which types of seizures occur mainly in children?

Answer 4

Petit Mal

Atonic

Febrile

Question 5

What are myoclonic seizures?

Answer 5

consist of sudden muscle contraction and last for just 1 second. Can be focal or massive.

Question 6

When do seizures qualify as status epilepticus?

Answer 6

when they persist for 15-30 minutes or longer

OR

a series of recurrent seizures during which the patient does not regain consciousness

Question 7

Nearly all antiseizure drugs work through five basic mechanisms:

Answer 7

1. Suppression of sodium influx
2. Suppression of calcium influx
3. Promotion of potassium efflux
4. Glutamate receptor blockade
5. GABA potentiation

Question 8

Glutamate is the primary excitatory transmitter of the CNS, and it works on two receptors:

Answer 8

NMDA

AMPA

Question 9

What is GABA’s role in the brain?

Answer 9

Inhibitory neurotransmitter

Question 10

For people with seizures for whom drugs do NOT help, what are three other options?

Answer 10

Surgery

Vagus Nerve Stimulator

Keto Diet

Question 11

Only one drug appears effective against all forms of epilepsy:

Answer 11

Valproic Acid

Question 12

Should pregnant patients continue taking their antiseizure medications?

Answer 12

Yes, even though they do carry a risk of congenital anomalies

The risk to a fetus from uncontrolled seizures is much, much higher than the risk from the drugs

90% of women have normal pregnancies with normal babies

Question 13

What can pregnant women who are taking antiseizure drugs do to avoid congenital anomalies?

Answer 13

Supplemental folic acid

Avoid valproic acid if at all possible

Maybe Vitamin K 1 month before delivery? (research is not conclusive)

Question 14

Name the major traditional antiseizure drugs:

Answer 14

1. Phenytoin
2. Fosphenytoin
3. Carbamazepine
4. Valproic Acid
5. Ethosuximide
6. Phenobarbital
7. Primidone

Question 15

What is the MOA of Phenytoin?

Answer 15

Blockades sodium entry only into neurons that are hyperactive, leaving healthy neurons unaffected

Question 16

What are some benefits to the newer generation antiseizure drugs?

Answer 16

Better tolerated and pose a smaller teratogenic risk

Most don’t induce drug metabolizing enzymes to a significant degree

Question 17

Which newer antiseizure drugs are approved for monotherapy?

Answer 17

Eslicarbazepine and Oxcarbazepine

felbamate

lacosamide

lamotrigine

topirimate

vigabatrin

Question 18

Which antiepileptics are CYP450 inducers?

Answer 18

Carbamazepine

Phenytoin

Barbiturates

DECREASE THE EFFICACY OF OTHER DRUGS

Question 19

Which antiepileptics are CYP450 inhibitors?

Answer 19

Valproate

INCREASES THE CONCENTRATION OF OTHER DRUGS

Question 20

What is DRESS syndrome?

Answer 20

Fever

Eosinophilia

Lymphadenopathy

Rash

Question 21

Which antiepileptics can cause DRESS?

Answer 21

Carbamazepine

Phenytoin

Fosphenytoin

Phenobarbital