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NOTES: Neuro Review by Minnie > 92b/93b - Epilepsy and Anticonvulsants > Flashcards

92b/93b - Epilepsy and Anticonvulsants Flashcards

1
Q

Which 1st generation AEDs are enzyme inducers?

A
  • Phenobarbital
  • Phenytoin
  • Carbamazepine
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2
Q

Which AED is the drug of choice for abscence seizures?

A

Ethosuximide

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3
Q

What is the mechanism of the benzodiazepines?

Which seizures do they treat?

A

Increased frequency of Cl- channel opening

Effective for myoclonic seizures

Rescue medication for status epilepticus

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4
Q

Describe the general mechanisms of seizure generation

A
  • Too much excitation
    • Ionic: too much inward Na+, Ca2+
    • NeuroT: Too much glutamate, aspartate
  • Too little inhibition
    • Ionic: too little inward Cl-, outward K+
    • NeuroT: Not enough GABA
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5
Q

What is the mechanism of ethosuximide?

What is it used for?

A

Blocks T-type Ca2+ currents in the thalamus

Drug of choice for abscence seizures

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6
Q

What is the most concerning possible side effect of lamotrigine?

A

Steven-Johnson syndrome

  • But broadly, lamotrigine is a good broad-spectrum AED that is safe in pregnancy
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7
Q

Which AED can also be used for migraine prophylaxis and neuropathic pain?

A

Topiramate

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8
Q

Describe the signs of a myoclonic seizure

A

Myoclonic = generalized

  • Myoclonus
    • Brief, shock-like jerk of a muscle or group of muscles
    • Bilateral, synchronous
    • vs. clonus which is repeated rhythmic jerking
    • If several myoclonic jerks occur in rhythmic succession, it is a clonic seizure
  • Consciousness NOT impaired
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9
Q

Which AEDs are safe in pregnancy?

A

Lamotrigine

But need frequent adjustment in dose b/c serum levels fall in the 3rd trimester

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10
Q

Describe the signs of a tonic seizure

A

Tonic = generalized

  • Symmetric, tonic muscle contraction of extremities
  • Tonic flexion of waist and neck
  • Lasts 2-20 seconds
  • EEG
    • Sudden attenuation, generalized polyspike waves
    • (similar to atonic)
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11
Q

Which kind of epilepsy is characterized by focal seizures with impaired consciousness with automatisms?

A

Temporal lobe epilepsy

  • Automatisms = lip smacking, swallowing, fumbling, picking at clothes
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12
Q

What is the mechanism of Levetiracetam?

What is it used for?

What is its notable side effect?

A
  • Mechanism
    • Binds to synaptic vescicle protein SV2A to regulate neurotransmitter release
    • Also reduces activity through high-voltage Ca2+ channels
  • Use
    • Broad spectrum - used as monotherapy or adjunctive
  • Side effect
    • CNS depression and irritability
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13
Q

What EEG changes are associated with abscence seizures?

A

3 Hz spike-wave discharges in every channel

Lasts for 3-10 seconds

  • Abscence seizures are generalized
  • Sudden onset, sudden resolution
  • No post-ictal confusion
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14
Q

What is the mechanism of carbamazepine?

What is it used for?

A

Inhibits Na+ channels

Tricyclic

Used to treat epilepsy w/predominantly focal seizures

Will worsen abscence seizures

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15
Q

Which kind of epilepsy is characterized by seizures that originate in the hippocampus and/or amygdala?

A

Mesial temporal lobe epilepsy

  • Focal seizures evolve into a bilateral, convulsive seizure early on
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16
Q

In which populations should valproate be avoided?

A
  • Pregnant women
    • High risk of neural tube defects
  • Neonates
    • Hepatic toxicity due to elevated liver enzymes
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17
Q

Which AEDs can be used for neuropathic pain?

A

Gabapentin

Carbamazepine

Pregabalin

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18
Q

Which 1st generation AED is an enzyme inhibitor?

A

Valproate

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19
Q

What is the mechanism of zonisamide?

What is it used for?

A

Blocks Na+ and T-type Ca2+ channels

Blocks carbonic anhydrase (-> side effect = kidney stones)

Used as add-on therapy for partial and generalized seizures

20
Q

What is the mechanism of gabapentin?

What is it used for?

A

Interferes with GABA uptake

Add-on therapy for focal seizures

Lacks potency for seizure - used off-label for neuropathic pain

21
Q

Which AED is first line for generalized epilepsies?

What is its mechanism?

A

Valproate

  • Broad spectrum
  • Mechanisms:
    • Enhances GABA activity
    • Inhibits Na+ current
    • Activates K+, T-type Ca2+ channels
22
Q

Which AED causes significant appetite increase and weight gain?

A

Pregabalin

23
Q

What is the mechanism of topiramate?

What is it used for?

What are the major side effects?

A
  • Mechanism
    • Blocks Na+ channels
    • Increases frequency of GABAA opening
    • Interferes with glutamate binding
  • Uses
    • Broad specturm (monotherapy or adjunctive for focal or general)
    • Also used for migraine prophylaxis, neuropathic pain, tremor
  • Side effects
    • Memory and cognitive impairment
    • Appetitie suppression and weight loss
24
Q

List the 5 types of generalized seizures

A
  • Atonic
  • Tonic
  • Clonic
  • Tonic-clonic
    • Tonic-clonic or myoclonic
  • Abscence
25
Q

Which AED induces its own metabolism? What is the significance?

A

Carbamazepine

Need to start at low doses and titrate up (will be inefective if the dose isn’t increased!)

26
Q

What is the mechanism of pregabalin?

What is it used for?

What is its major side effect?

A
  • Mechanism
    • Inhibits voltage-gated Ca2+ channels
    • Also reduces the release of some neurotransmitters
  • Uses
    • Neuropathic pain
    • Peripheral neuropathy
    • Fibromyalgia
    • Anxiety
  • Side effect
    • Appetite increase and weight gain
27
Q

Which AEDs can be used to treat migraine?

A

Valproate

Topiramate

Zonisamide

28
Q

Which AED is likely to cause prominent hyponatremia?

A

Oxcarbazepine

29
Q

What is the difference between a focal and generalized seizure?

A

Where the seizure starts

  • Focal
    • Seizure starts from one side
    • May progress to affect both sides of the brain, resulting in motor activity on both sides of the body (a secondarily generalized seizure)
  • Generalized
    • Seizure start from both sides
30
Q

Which AEDs can be used to treat bipolar disorder?

A

Lamotrigine

Valproate

Carbamazepine

31
Q

What is the major difference between a focal seizure wtih impairment of consciousness and an abscence seizure?

A

No post-ictal confusion with abscence seizure

32
Q

What defines epilepsy?

A

Recurrent (2+) seizures that are not provoked by systemic or acute neurological insults

  • This excludes seizures due to metabolic disorders or alcohol or sedative drug withdrawal or
33
Q

What is the mechanism of phenytoin?

What is it used for?

A

Inhibits rapid firing of Na+ channels

Phenytoin is the most widely used AED

Used extensively to treat status epilepticus

34
Q

Which kind of epilepsy is characterized by seizures preceded by aura?

A

Temporal lobe epilepsy

  • Aura may involve epigastric sensation, deja vu, emotional feeling, perceptual distorion, autonomic
35
Q

Which AED does not have complete absorption >4mg?

A

Gabapentin

36
Q

Describe the signs of an atonic seizure

A

Atonic = generalized

  • Sudden loss of postural tone
    • Severe = fall
    • Mild = head or jaw draw
  • Consciousness usually impaired
  • EEG
    • Sudden diffuse atenuation, generalized polyspike waves
    • Similar to tonic
37
Q

Which AED is likely to cause a drop in IQ during therapy, memory deficits, appetite suppression, and weight loss?

A

Topiramate

38
Q

What is the mechanism of oxcarbazepine?

What is it used for?

A

Blocks Na+ channels

(its basically better carbamazepine; less risk of toxic metabolite buildup)

Used for monotherapy in focal (aka partial) seizures

Note: tends to cause prominent hyponatremia

39
Q

Describe the signs of a tonic-clonic seizure

A

Tonic-clonic = generalized

  • Loss of consciousness
  • Post-ictal confusion, lethargy
  • Tonic phase
    • Stiffening + fall
    • Ictal cry
  • Clonic phase
    • Rhythmic extremity jerking
  • Drooling, foaming at the mouth, biting tongue
  • Bladder and bowel incontinence
  • Agitation
40
Q

Describe the signs of an abscence seizure

A

Abscence = generalized

  • Sudden onset
  • Eye blinks
  • Brief automatic mouth or hand movments
  • Changes in muscle tone
  • No post-ictal confusion
41
Q

Which AED is associated with aplastic anemia and hepatic failure?

A

Felbamate

42
Q

Which AED is most likely to cause CNS depression and irritability?

A

Levetiracetam

43
Q

What is the mechanism of phenobarbital?

A

Increases duration of GABAA Cl- channel opening

Side effect: may cause CNS depression when combined with alcohol or benzos

44
Q

What is the mechanism of lamotrigine?

What is it used for?

A

Inhibits Na+ channels and glutamate release

  • Broad spectrum
    • Monotherapy or or adjunctive for generalized and focal seizures
  • Safe in pregnancy!!
    • But serum levels fall in 3rd trimester, needs adjustment

Feared side effect = Steven-Johnson syndrome

45
Q

Which kind of seizure is associated wtih generalized 3 Hz spike-wave discharges on EEG?

A

Abscence

46
Q

Describe the seizures commonly associated with temporal lobe epilepsy

A
  • Preceded by aura
    • Often a weird taste in the mouth
  • Focal seizures with impaired consciousness with automatisms
    • Lip smacking, swallowing, fumbling, picking at clothes

Often cannot be medically controlled; opt for anteromesial temporal lobectomy

47
Q

Which two “clinically relevant” drugs may exacerbate epileptic seizures?

A

Tramadol (an analgesic)

Venlafaxine (an SNRI antidepressant)

NOTES: Neuro Review by Minnie (12 decks)

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