Anti-epileptic Flashcards
Rxs of choice
Carbamezepine Lamotrigine Levetiracetam Oxcarbazepine Ethosuximide Valproic Acid Diazepam
Epilepsy
- RECURRENT seizures
- abnormal, excessive, synchronous discharges from CNS poulation
- often focus
1ary epilepsy
No cause or incident
2ary epilepsy
Trauma, neoplasm, developmental abnormalities, Cereberovascular dz
Status epilepticus
Convulsions more than 30 mins
Focal seizures
No consciousness loss
Focal dyscognitive seizure
Confusion stumbling, falling
Consciousness impaired
Partial seizures secondarily generalized
From local to thalamus to whole brain
GTC
GTC seizure - grand mal
Tonic rigidity + tremor
Absence seizure (petit mal)
10-45 secs (maybe 100 day)
Consciousness altered
Start in childhood - intellectual disability
Myclonic seizure
Isolated clonic jerks w/ multiple spikes in EEG,
ryhtmic clonic seizures
Atonic seizure
Sudden loss of posture leading to collapse
Infantile spasms
Bilateral attacksof brief recurrent myoclonal jerks
Most start before 1 year
Intellectual disability common
Brain malformations that cause epilepsy
- Focal cortical dysplasia
- Double cortex
- heteropia
Seizures arise in
Cortex
Also generalized through thalamic inputs
Hippocampus involved in
Temporal lobe epilepsy
- repetitive action potentials
- –>limbic system + temporal lobe
- severe memory deficits + cognitive problems
Rx Mechs
- Decrease Depolarization by Na+ , Ca channels
- Reduce synaptic vesicle fusion
- Modulate GABA receptor
- multiple mechs
Epilepsy
Path
*imbalance b/w excitation(too much) vs. inhibition (too little)
Anti-epileptic Rx target
- Down Glu/Glu at receptors
- UP Gaba receptor activty
- UP GABA release
- DOWN Gaba-T (gaba breakdown)
Problem with removing Glutamate?
Many SE
Target Gaba A receptor
Barbituate
Benzos
Benzos
Uses
for STATUS EPILEPTICUS
*Diazepam, Lorazepam
For ABSENCE, TONIC-CLONIC, MYOCLONIC
Simple / Complex Partial Seizure?
Rx
- Carbamezepine
- Phenytoin
Recent
- Gabapentin, Topiramate
- Lamotrigine, Lacosamine
Generalized Tonic-Clonic Seizures
Rxs
- Carbamazepine
- Phenytoin
- Valproic acid
Recent
- Gabapentin, Topiramate
- Lamotrigine, Lacosamide
Absence Seizure?
Rx
- Ethosuximide
- Valproic Acid
Recent
*Lamotrigine
Myoclonic Seizure?
Rx
- Valproic Acid
* Clonazepam
Status Epilepeticus?
Rx
- Lorazepam/Diazepam
- Fosphenytoin/Phenytoin
- Phenobarbitol
Phenytoin Carbamazepine Lamotrigine Lacosamide Zonisamide Ethosuximide
Mech?
Effect on ION CHANNELS
Benzos
Vigabatrin
Tiagabine
Mech?
Effects on GABA mechs
Valproic acid (GABA) Gabapentin (Ca2+, GABA) Pregabalin (Ca2+, GABA) Levetiraetam (Ca2+; GABA) Topiramate (Ca2+; GABA) Felbamate (Ca2+; GABA) Rufinamide Phenobarital (GABA)
Mech?
Mixed Actions
Epilepsy
Path
Initiation
- High freq AP
- Hypersychronization
*UP intracell K –> Depole, UP Ca2+ in Synapse, NMDA (Glutamate) –>excite
Acquired Brain conditions that cause epilepsy
- Stroke
- GSW - trauma
- tumor
