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BB2 > 13 - Epilepsy > Flashcards

13 - Epilepsy Flashcards

1
Q

What is epilepsy?

A

Neurological disorder that represents a brain state that supports recurrent, unprovoked seizures

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2
Q

What are seizures?

A

abnormal, paroxysmal changes in the electrical activity of the brain; they reflect large scale synchronous discharges of neuronal networks

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3
Q

What is the prevalence of epilepsy in the UK?

A

1% prevalence in the UK

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4
Q

What is focal onset

A

Where the seizure affects one hemisphere of the brain

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5
Q

What is generalised onset

A

The seizure effects both cerebral hemisphere

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6
Q

What is status elipticus

A

A form of epilepsy which is a life-threatening medical emergency
Seizures which last >5 mins or >1 seizure in 5 mins, without regaining consciousness

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7
Q

Stages of a tonic clonic seizure

A 
Premonition
Pre-tonic-clonic phase
Tonic Phase
Clonic Phase
Postictal period
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8
Q

Premonition

A

Vague sense that a seizure is about to happen

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9
Q

Pre-tonic-clonic phase

A

A few myoclonic jerks or breif seizures

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10
Q

Tonic Phase

A

Tonic contraction of axial musculature causing contraction of the limbs, cyanosis, pupillary dilation, respiratory muscle contraction and contraction of the jaw muscles

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11
Q

Clonic phase

A

Jerks of increasing amplitude

followed by relaxation - sphincter opening may occur

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12
Q

Postictal period

A

generalised lethargy
decreased muscle tone
headache
muscle soreness

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13
Q

How to diagnose epilepsy

A

Occurrence of 2 or more seizures

witness is essential

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14
Q

Which area of hippocampus is there cell loss in epilepsy

A

CA2

CA3

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15
Q

What will you see in an MRI of epileptic

A

Loss of neurones

distortion and compression of layers, gliosis, different tract orientation

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16
Q

What are chandelier cells

A

interneurons which are GABAergic cells

Control activity of cortical pyramidal cells

17
Q

What happens to chandelier cells in epilepsy and what does this cause

A

Loss of inhibitory chandelier cells increases the risk of abnormal excitatory activity

18
Q

Conditions with high risk of epilepsy

A 
Craniotomy
Traumatic Brain Injury 
Stroke
Brain Tumour
Aneurysm
CNS infection
19
Q

Cellular mechanisms linked to development of epilepsy

A

Abnormal neuronal excitability - Ion channels
Decreased neuronal inhibition - GABA
Increased neuronal excitation - Glutamate

20
Q

What role do glial cells have in epilepsy

A

Role in glutamate transport and clearance via glutamate transporters EAAT1 and EAAT2

21
Q

Phenytoin

A

SODIUM CHANNEL BLOCKER
Stabilises inactivated state of channels; dose –dependent or zero order or saturation kinetics; liver enzyme induction; not used in absence seizures

22
Q

Carbamazepine

A

SODIUM CHANNEL BLOCKER
Stabilises the inactivated state of channels; liver enzyme induction; hypersensitivity reactions; not used in absence seizures

23
Q

Sodium Valporate

A

SODIUM CHANNEL BLOCKER

Can be used in all types of seizures

24
Q

Lamotrigine

A

SODIUM CHANNEL BLOCKER

Also activity at calcium channels; presynaptic inhibition of glutamate release – Favourable in pregnancy

25
Q

Topiramate

A

SODIUM CHANNEL BLOCKER

Also active at AMPA and kainite glutamate receptors

26
Q

Lacosamide

A

SODIUM CHANNEL BLOCKER

Binds to the inactivated state of channels

27
Q

Zonisamide

A

SODIUM CHANNEL BLOCKER

Blocks calcium channels too

28
Q

Ethosuximide

A

CALCIUM CHANNEL BLOCKER

Used in absence seizures(Petit mal), blocks T-type calcium channels

29
Q

Gabapentin (pregabalin)

A

CALCIUM CHANNEL BLOCKER

Also increases GABA levels– Target the a2δ subunit

30
Q

Clonazepam

A

BENZODIAZEPINE

GABAA receptor positive allosteric modulators –> Sedation

31
Q

Phenobarbitone

A

BARBITURATE

GABAA receptor positive allosteric modulators

32
Q

Stiripentol

A

Similar to barbiturate

33
Q

Levetiracetam

A

NTS RELEASE

Binds to the synaptic protein SV2A; modulates neurotransmitter release

34
Q

Tiagabine

A

NTS UPTAKE

Inhibits GAT-1 transporter for GABA

35
Q

Vigabatrin

A

NTS SYNTHESIS

Inhibition

36
Q

What do you treat focal seizures with

A

carbamazepine, lamotrigine, sodium valproate

37
Q

What do you treat tonic clonic seizures with

A

carbamazepine, lamotrigine, sodium valproate

38
Q

What do you treat absence seizures with

A

ethosuximide, sodium valproate

39
Q

What do you treat Myoclonic Seizures with

A

sodium valproate, clonazepam, levetiracetam

BB2 (27 decks)

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