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BRAIN - Epilepsy Flashcards

1
Q

mutation/mode of inherence/breed associated with juvenile myoclonic epilepsy

A

Rhodesian Ridgeback
mutation DIRAS1 (role in acetylcholine release and neurodevt)
fully penetrant autosomal recessive

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2
Q

clinical signs associated with juvenile myoclonic epilepsy

A

myoclonic seizures occuring mainly during relaxation
generalised tonico-clonic seizure in 1/3 of patients
35% photosensitive
absent seizure

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3
Q

2 antiepileptic treatements in juvenile myoclonic epilepsy

A

levetiracetam
potassium bromide
in human valproic acid

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4
Q

EEG in juvenile myoclonic epilepsy

A

ictal and inter-ictal generalised and irregular 4-5 Hz spike and wave complexes and polyspike-waves complexes with a fronto-central maximum

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5
Q

Which gene is associated with epilepsy in Lagotto Romagnolo and Belgian Shepherd?​

A

Lagotto Romagnolo: LGI2​
Belgian Shepherd: ADAM23​

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6
Q

Which cytokines have increased CSF concentration after seizures in dogs? Specifically in idiopathic epilepsy?​

A

All causes: IL-6 & TNF-alpha
IE: TNF-alpha

CSF TP concentrations were not significantly higher in the study dogs compared to controls.

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7
Q

DDx episodic disorders​

A

Syncope​
Narcolepsy​
Cataplexy​

Seizure​
Neuromuscular weakness​
Paroxysmal behaviour changes (compulsive disorders)​

Vestibular attack​
Idiopathic head tremor​
Paroxysmal dyskinesia​

SNC-SNP-VIP​

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8
Q

How many dogs with frontal lobe neoplasia are presented with seizure as the first clinical sign?​

A

75%​

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9
Q

What are the prediction factors of early seizure recurrence in dogs?

A

Epileptic seizures recurred in 50% of patients within a mean time of 7 hours.

IE: abnormal postictal neurological examination with prosencephalon signs

Structural epilepsy: one seizure 72 hours before hospital admission and abnormal neurologic examination

Reactive seizures: long-term antiepileptic monotheraphy

All dogs: abnormal neurological examination, occurrence of cluster seizures, status epilepticus, or combination of them 72 hours before presentation

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10
Q

What breed of cat is associated with audiogenic reflex seizures? And what kind of seizures?

A

Birman
Myoclonic seizures, frequently occurring prior to GTCS
late onset (median 15 years) and absence seizures (6%), with most seizures triggered by high-frequency sounds amid occasional spontaneous seizures (up to 20%).

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11
Q

Which EEG rhythm is associated with REM-sleep?

A

Beta (higher than 12.1 Hz)

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12
Q

What are the factors significantly associated with short term mortality in SE.

A

Increased patient age
Shorter duration of hospitalization
Development of SE before arrival
SE caused by a potentially fatal etiology

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13
Q

Audiogenic reflex seizures are usually associated with deafness or hearing impairment: true or false?

A

True
Half of the population

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14
Q

What are the two most common causes of reactive seizures in dogs?

A

Intoxication & hypoglycemia

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15
Q

What are clinical features associated with DIRAS1 epilepsy?

A

Juvenile onset
Absence seizures
Myoclonic seizures with propagation to generalized tonic-clonic seizures (38%)
Photosensitivity (35% observed, 66% in EEG)
Nodding of the head
4-5Hz spike-and-wave complexes and polyspike-wave complexes with a fronto-central maximum

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16
Q

Which test is useful for differentiating seizure and syncope? Is this test specific and/or sensitive? What does it mean (confirmation, exclusion…)?

A

ROC analysis of sPi as a marker of GTCS yielded an AUC, with an optimum cutoff point of 0.97 mmol/L, corresponding to specificity and sensitivity levels of 100% and 44%.
Hypophosphatemia only in seizure group. Especially with sPi < 0.97 mmol/L, may be useful in clinical practice to rule in GTCS.

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17
Q

Give 5 genetic epileptic conditions.

A

Idiopathic: Belgian Shepherd (ADAM23, RAPGEF5), Dutch partridge dog (CCDC85A)

Juvenile benign: Lagotto Romagnolo (LIG2)

Juvenile myoclonic epilepsy with photosensitivity: Rhodesian Ridgeback (DIRAS1)

Severe early-onset epilepsy, mitochondrial dysfunction and neurodegeneration: Parson Russell Terrier (PITRM1)

Myoclonic epilepsy with neuronal glycoproteinosis (Lafora): Beagle, Chihuahua, French Bulldog, Griffon Bruxellois, Miniature Wirehaired Dachshund, Newfoundland, Pembroke Welsh Corgi, Domestic Shorthair (NHLRC1 = EPM2B)

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18
Q

At which age the EEG characteristics stabilize?

A

The characteristics of the EEG corresponding to the adult animal begin to appear at 12 months of age but stabilize after 24 months of age.

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19
Q

Intranasal midazolam has the same efficiency in status epilepticus management than intrarectal midazolam: true or false?

A

False

IN-MDZ is superior to IR-MDZ: IN-MDZ and R-DZP terminated status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively. All dogs showed sedation and ataxia.

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20
Q

Which AED is associated with the more highest prevalence of adverse effect? Give the %

A

A significant relationship was identified between the occurrence of reported AEs and monotherapy group, with a higher prevalence in the PB group (77%) and a lower prevalence in the ZNS group (39%).

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21
Q

What is the autoimmune syndrome associated with phenobarbital in dog? What serology can be tested?

A

Systemic lupus erythematosus
Anti-nuclear antibody (ANA)

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22
Q

What is the most frequent cause of status epilepticus as first epileptic manifestation in dogs?

A

Structural: 45%
Reactive: 31%
Idiopathic: 23%

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23
Q

mechanism for:
1/ Gabapentine/pregabaline
2/ Phenobarbital
3/ Zonisamide
4/ Potassium bromide
5/ Levetiracetam
6/ Imepitoin

A

1/ Binds to α2δ subunit of VGCa channel
2/ Activate GABAa receptor directly and indirectly by allosteric action (alpha-beta)
3/ Inactivate Na+ channel, increase GABA release and modulate VGCa channel type T
4/ Hyperpolarise neurons by passing through the neuronal chloride channels
5/ Binds synaptic vesicle protein SV2A, modulates neurotransmiter release
6/ Activate GABAa receptor via BZP (beta-gamma) site with low affinity (partial agonist)

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24
Q

What are the findings predictors of postictal changes?
Which brain sites are commonly affected?

A

Predictors of postictal changes:
- Epilepsy of unknown origin
- Cluster seizures or status epilepticus
- Lower time from last seizure to MRI

Brain sites
- Piriform lobe
- Hippocampus
- Temporal neocortex
- Cingulate gyrus

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25
Q

molecule for myoclonic seizures

A

levetiracetam

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26
Q

Definition of an epileptic seizure

A

Manifestation of excessive synchronous, usually self-limiting epileptic activity of neurons in the brain, resulting in transient occurrence of signs which may be characterized by short episodes with convulsions or focal features

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27
Q

Potassium bromide treatment was strongly associated with high hair arsenic in dogs with idiopathic epilepsy: true or false?

A

True

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28
Q

Levetiracetam is an interesting AED which is best used as an add-on in a pulse administration protocol because
1. Long term Levetiracetam increases other AEDS side effects
2. Levetiracetam has a high long term toxicity
3. Some dogs develop progressive tolerance to the treament in the case of prolonged treatment with Levetiracetam
4. Long term maintenance, as an add-on AED decreases other AED serum concentration, especially PB

A

3

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29
Q

ABCB1 gene mutation is associated with refractory idiopathic epilepsy in Australian Shepherd: true or false?

A

False
Only in Border Collies

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30
Q

Give 3 molecules that can increase serum concentration of phenobarbital and the associated mechanism.

A

Antiacids: cimetidine, omeprazole, lansoprazole

Antibiotics: chloramphenicol, trimethoprim, fluoroquinolones, tetracyclines

Antifungal: ketoconazole, fluconazole, itraconazole

Others: fluoxetine, felbamate, topiramate

Inhibition of hepatic microsomal cytochrome P450 enzymes

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31
Q

prevalence epilepsy dog

A

0.6-0.75%

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32
Q

most common seizure type in dog

A

focal epileptic seizure evolving into generalised epileptic seizure

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33
Q

definition epilepsy

A

disease of the brain characterized by en enduring predisposition to generate epileptic seizures. Usually practically applied when 2 ore more unprovoked epileptic seiz at least 24h apart

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34
Q

criteria for genetic epilepsy

A

genetic testing
breed prevalence > 2%
genealogical analysis or familial accumulation of epil individual

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35
Q

EEG % interictal paroxysmal episod in dog with IE

A

25%

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36
Q

toxic causing epilepsy

A

carbamate, organoph, lead, etylene glycol, metaldehyde, strichnine

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37
Q

% dogs with reactive seizure presented in status + higher risk ?

A

41%, associated with higher risk

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38
Q

% dogs with structural epil which have a normal neuro exam
epilepsy first sign in … of dogs with intracranial disease
more frequent local for structural brain disease assoc with seiz

A

23%
76%
frontal lobe

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39
Q

focal seizure are more frequent in structural epil T/F

A

false, 20% in both cases

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39
Q

time for disparition of post ictal MRI change
+ histological changes

A

10-16 weeks
oedema, neovascularisation, reactive astriocytosis, acute neuronal necrosis

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39
Q
  1. tier 1 confidence level of idiopathic epilepsy
  2. tier 2
  3. tier 3
A
  1. > 2 unprovoqued epil >24h apart
    6m-6y
    unremarkable interictal physical exam (except EAD induced an d post-ictal)
    blood test (CBC, biochemistry profile, electrolytes, cholest, TG, bilirubin, fasting bil ac and/or amonic
    urinalysis
  2. fasting and post prand bile acide, MRI, CSF analysis
  3. ictal or inter ictal EEG abnomalities
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40
Q

post ictal change CSF

A

mild pleocytosis (up to 12/uL) when < 12h

association between CSF WBC count and interval since last seizure

no assoc prot, cluster seizures

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40
Q

link age, interict abno and cause of epil

A

Structural more fqt <1y and >7y
IE more probable 1-5y, interictal period>4w

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41
Q

when perform an MRI in dog with epilepsy

A

age <6m or >6y
interictaly neurological abnomality
status or cluster
drug resistance with a single AED

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42
Q

when is recomanded epilepsy treatment

A

interictal period <6m
status or cluster
post-ictal signs severe or last longer than 24h
ferquency or duration increasing or seizure severity deteriorating over 3 interictal period

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43
Q

toxic AE in dogs

A

lamotrigine (cardiotox)
vigabatrin (neurotox + haemolytic)

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44
Q

phenobarbital:
1. efficacity
2. elimination half life
3. peak serum concent
4. plasma binding prot
5. % excreted unchanged in urine

A
  1. 60-93%, superior to KBr
  2. 37-73h (decrease progressively, stabilizes 30-45d)
  3. 4-8h
  4. 45%
  5. 25%
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45
Q

raison for hepatotoxicity in phenobarb

A

induction cyt P 450 =>increase heaptic production reactive oxygen species

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46
Q

pharmacocinet interaction PHBR

A

metabolized by cyt P450 or linked to prot
decrease efficacy of levet, zonisamide, benzodiazepine + corticosteroids, cyclosporine, metronidazole, voriconazole, digoxine, digitoxin, phenylbutazone, thiopental

PB metabolism can be inhibited by P450 inhib:
cimetidine, omeprazole, lanzoprazole, chloramphenicol, trimetoprim, fluoroquin, tetracyclines, keto/fluco/itroconazole, fluoxetine, felbamate, topiramate

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47
Q

type 1/2 adverse effect pheno

A

type 1: sedation, ataxia, polyphagia, PUPD
type 2: hepatotoxicity, anemia, thrombocytopenia, neutropenia, superficial necrolytic dermatitis, pancreatitis, dyskinesia, anxiety, hypoalbuminemia

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48
Q

imepitoin
1. elimination
2. receptor
3. adverse effect
4. dose

A
  1. extensively metabolised in liver, ecreted via fecal route
  2. low afinity partial agonist for GABA A receptor
  3. polyphagia, hyperact, somnolence, PD, hypersaliv, emesis, diarrhea, prolapse nict mb, decrease vision, sensib to sound
  4. 10-30 mg/kg BID
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49
Q

KBr
1. elimination half life
2. bound to plasma prot
3. elimination
4. drug interaction
5. adverse effect type 1
6. adverse effect type 2
7. dose

A
  1. 25-46 days
  2. unbound
  3. unchanged in urine, tubular reabsorption in compet with chloride (high chloride increase elim)
  4. loop diuretic (furosemide) increase elim
  5. sedation, ataxia, PL weakness, PUPD, polyphagia, GI irritation
  6. personality change, persistant cough, increase risk pancreatitis and megaoeso
  7. bitherap 15 mg/kg BID (loading 625 mg/kg over 48h)
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50
Q

levetiracetam
1. elimination half life
2. receptor
3. adverse effect
4. interaction
5. prot binding
6. elim

A
  1. 3-6h
  2. presynaptic prot SVA2
  3. sedation, ataxia, vomiting, decrease appetite
  4. P450 alter disposition: increase dosage with pheno
  5. minimal
  6. minim hepat metab, mainly unchanged in urines
51
Q

felbamate:
1. adverse effect
2. mechanism
3. interaction
4. elimination + half life

A
  1. keratocongonctivitis, blood dyscrasia
  2. inhib glycine-enhanced NMDA-induced intracel Ca current, blokade voltage gated Na channel, inhib voltage gated Ca current
  3. raised pheno level in a dose dpd manner, elimi reduced with gabapentine
  4. half life 6h, mainly metab liver
51
Q

zonisamide:
1. adverse effect
2. mechanism
3. elim half life
4. prot binding
5. elim
6. dose
7. dosage can be altered by

A
  1. sedation, ataxia, loss apetite, type 2: hepatox, renal tub acidosis,
    neutropenia, erythema multifome
  2. blockage Ca chan, enhancemt GABA release, inhib glutamate release, inhib voltage gated Na channel
  3. 15h
  4. low
  5. hepat metab P450, excretion kidney
  6. 3-7 mg/kg BID (7-10 with pheno)
  7. hemolysis
52
Q

topiramate:
1. mechanism
2. elim half life
3. elimination

A
  1. enhance GABA-ergic activity, inhib voltage gated Na and Ca channel, kainate evoked current and carbonic ahnydrase isoenzyme
  2. 2-4h
  3. 70-80% unchanged in urine, biliary excretion
53
Q

def non convulsive EEG seiz/status + prevalence + risk factor

A

epileptiform discharge lasting at least 10 sec or any pattern with definite evolution in frequency, location or morphology without prominent motor activity

status >10 min

prevalence 29% and 16%
mortality higher than patient without EEG seizures

risk factor ES/ESE: young age, seizure <8h before, history cluster

54
Q

zonisamide: adverse effect + half life in cat

A

sedation 17%, ataxia 11%, hyporexia 17%, emesis 5%
non regenerative anemia, metabolic acidosis, increase ALT/ALP, anticonv hypersensitivy syndrome
adv effect with q12h>q24h

half life 30h, steady state 1 w

55
Q

behavioural comorbidity of epilepsy

A

attention deficit hyperactivity disorder like
cognitive impairement
fear and anxiety

56
Q

most prevalent breed with vestibular epilepsy, EEG, prognosis

A

Pugs

EEG: interictal spikes in fronto-temporal ans dronto-parietal area

100% response to AE
presumed idiopathic cause

57
Q

effect zonisamide treatment on Phbr concentration

A

increased (5/9) hepatotoxic dose
metabolised by CYP450

58
Q

region assoc with seizures triggered by eating
breed overrepresentated
main type of seizures

A

perisylvian region (maj temporal in hum)
Retrievers
focal evolving in generalised

maj idiopath epil

59
Q

risk factor for early recurrencence in dogs hospitalized for seizure eval according for StE/IE/RE

A

IE: abnormal neurol exam
StE: abnormal neurol exam, seizure 72h before
RE: long term

60
Q

diffusion in dog with epil

A

increase ADC in amygdala and in semioval centrum (cell loss and increase intercellular space=

61
Q

risk factor structural epil in cat

A

pedigree cat, >7y, abnormal neurologic exam, ictal vocal (salivation decrease likelihood)

62
Q

EEG abnomalies associated with PSS shunts/ intracran pathology/ IE

A

high voltage low frequency background activity in PSSS and intracran path
bilateral symmetric triphasic: PSS
IE: spike-waves

63
Q

EEG artifacts

A

eyes movement: frontopolar elect +/- frontal. Mono, biphasic sharp waveform or complex polyphasic slow waveform (1Hz)

eye blinks: positive pole (cornea) move closer to frontopolar elect: symmetric downward deflexion

EMG: sudden arrytmic burst, prolonged duration and frequency (20-100 Hz)

ECG: electrical (QRS) and mechanical (vessel). Rythmic, regular, temporaly correlated with heart contraction

ear: similar than ocular mobility

Alternating current (50-60 Hz): very high freq, long duration. Serie of sharp, rapid, positive-negative deflection in one or more elect

electrode artifact: brief transient limited to one elect teh low freq high amp rythm across the entire scalp

salt bridge: when 2 elect are too close. unipol mont appear superimposable, isoelect wave in longit montage

64
Q

preval diagnosis with CSF in normal MRI

A

0.5%

65
Q

negative prognostic indicator for status

A

GME, absence control 6h after hospit onset, partial SE

mortality 25%

66
Q

phenobarb induced hematol change in cat

A

75% cytopenia
most freq neutropenia 50%, thrombocytopenia 25% and anemia 20%

even when phbr in therapeutic range, life-threatening 1.5%

67
Q

interaction canabidiol and pheno

A

no interaction

68
Q

histological lesion in cat with familial spontaneous epil
+ perfusion on MRI

A

lower number of neuron in cornu amnionis 3 hippocampus
hypoperfusion (but other etude with some hyper)

69
Q

age-realted changes in MRI spectroscopy

A

young dog increased choline decreased NAA

70
Q

feline audiogenic reflex seizure
type seizure
age, breed
treatment
prognosis

A

non progressive, myoclonic (generalised TC when repetitive stimultation) seizures triggered by loud, sudden sound

cat>15yo

Birman

levetiracetam 50% freedom from seiz

71
Q

higher probability of MRI post ictal change

A

cluster or status
unknown-origin epilepsy
lower time from last seiz

72
Q

adverse effect topiramate in cat

A

renal tubular acidosis

73
Q

diffusion in epilepstic dog

A

lower cerebral flow, greather mean time of contrast arival

74
Q

effect food with adimistration of levet

A

food slow absorption, decrease plasma concent

75
Q

diffusion MRI in idiopath epil

A

interictal DWI: increase dif in piriform
ADC : reduction 3-6h, increase 12-24h, normalisation 48h
DTI: change in cingulate gyrus (lower FA)

76
Q

spectroscopy in epileptic dog

A

higher NAA/cho in temporal lobe

reduced NAA/Cr , reduces Glx/cr in thalamus in dogs under treatment

77
Q

serum marker for structural epilepsy

A

neurofilament light chain higher than IE

78
Q

mechanism BBB dysfunction in epilepsy

A

leakage serum albumine ->binding TGF B in astrocytes -> reactive astroglyosis ->generation excit synapse, dim GABA inhib, change extracellular matrix

79
Q

BBB dysfunction in epil dog

A

higher blood brain barrier permeability in IE

increase activity/expression MMP9 in serum/CSF,

lower gene expression Kir4 (astro K channel) and claudin 5 (endothelial TJ) in pirif lobe

80
Q

% response of zonisamide for IE dog

A

76% 50% reduction
55% seizure freedom

adverse effect (13%): reduced appetite, vomit, hindlimb weakness, constip

blokage volt gated Na channel + voltage gated type T calcium channel, enhance GABAA recept function, inhib glutamate release, scavenge free radic

81
Q

interaction pheno / levetiracetam

A

pheno decrease leve concentr in a dose dpdt manner + more rapid elim (suspicion oxid leve induced by pheno

82
Q

CBD: mechanism, first/ ajunct tretment for epil + adverse effects

A

binding to channels (not canabinoid recep ->decrease glutamate, activ 5-hydrotryptophan, inhib adenosine reuptake

first: 2.5 mg/kg BID, reduction seiz freq 33%

adjunct: 9 mg/kg/d 24% decrease in seizure day

decrease appetite and vomiting, ataxia
increase liver enzyme

83
Q

phenobarb induced hematol change in cat

A

75% cytopenia (neutropenia 60%, leukopenia 50%, thrombocytopenia 25%, anemia 20%)

polytherap : lower hematocrite

84
Q

volumetry change in IE

A

reduced cingulate gyrus volume

85
Q

phenobarbarb type 2 reaction

A
  1. systemic lupus erythematus:
    fever, multiple cytopenia
    positive antinuclear AB titer
  2. pseudolymphoma: generalised lymphadenopathy, pyrexia, hepatomeg/splenomeg (histocyt-neutroph inflam)
    3-5 weeks after init
  3. pancreatitis, blood dyscrasia, necrolytic dermatitis, dyskinesia
86
Q

why benzodiazep loss efficacy during prolonged seiz

A

internalisation GABAa recepty
+ overexp NMDA

87
Q

risk factor associated with short term mortality and recurrence status

A

short term mortality (0%) increase age, decreased duration hospit, SE before arrival, SE from fatal etiol

recurrence (30%): history phjaramcoresist, focal

88
Q

which tube for leve dosage

A

only serum (in situ hydrolysis in plasma or whole blood)

89
Q

dermatologic reaction pheno, KBr, zonisamide

A

pheno: metabolic epidermal necrosis (superficial necrotizing dermtatitis) after several m/y, probably hepatocutaneous

KBr: panniculitis, pustulous derm, non supp white maccules

zonisamide: erythema multiforme

90
Q

% idiopathic epil dog with hippocampal atrophy

A

56%

88% same side as temporal epil

91
Q

effect topical lido application on EEG muscle artifact

A

not helpful

92
Q

focal epilepsy with dear-related behaviour:
1. breed
2. associated with … signs
3. histo
4. age of onset
5. antiepil

A
  1. boerboel
  2. autonomic ans motor
  3. vacuoles in the perikaryon in deep cerebal cortical region (pariet, temp, occip)
  4. 3m
  5. pheno, KBr
93
Q

pathol with cerebral vacuoles

A
  1. focal epil with fear related behavious in boerboel dogs
  2. transmissible spongiform encephalopathy
  3. RABGAPA3 in Alaskan Huskies, Black Russian Terrier, Rottweiler. intracytopl vacuols in cerebellar/BS/thal/SC nuclei. Ataxia, ocular abnom, laryngeal paral
  4. ATG4D Lagotto Romagnolo. cerebellar ataxia, vacuol cytopl CNS/PNS
  5. fucosidosis
  6. GMA gangliosisdosis
  7. intox
94
Q

predominant type seiz pomeranian

A

focal (limb contraction)

95
Q

juvenile epil Rhodesian % photos

A
96
Q

breed with increase frequence status/cluster

A

cluster + status: Border Collie
Status: Aust Sheperd

97
Q

IE related death % in italian spinone, Border, Irish Wolfhund, great swiss montain

A

IT: 32%
Border: 35%
Irish Wolfhund: 52%
great swiss montain: 35%

decrease survival time Border and Aust sheperd if onset < 2y

98
Q

mutation begnign familial epil lagotto romagnolo + epil assoc with

A

focal-onset seizures, start 5-9 weeks, spontaneously remit 13 w
LGI2 mut (synapse formation during dev)

Behavioural abn: inattention, axcitability impulsivity, event after 4y

99
Q

% structural epil in Boxer

A

93% (neoplasia)

100
Q

most common seiz type in irish setter

A

generalised

101
Q

ab in cat limbic encephalitis
seizures type

A

leucin rich glioma-inactivated I
voltage gated potassium channel

focal seiz, cluster, interictal behaviour change

102
Q

types of SE

A

motor: convulsive, myoclonic, focal motor, hyperkinetic

non convulsive: comatose or not comatose

103
Q

physioathology of status

A

5-10 min: impending
neurotransmit release/imbalence
ion channel opening/closure
first line treat

10-30 min: established
GABAaR decrease, inetrnalisation of GABAaR
NMDA and AMPA R upregulation
second>first

> 30 min refractory
excitatory and inhibit neuropeptide realease/imbalance
BBB transporter upregulation
third line treat

> 24h superrefractory
gene exp alteration

104
Q

1st, 2nd, 3rd line treatment status

A

1st: mida IN, IV or diazepam IV +/- mida CRI

2nd: leve IV + pheno IV +/- fosphenytoin IV

3rd: ketamine IV +/- dexmedeto, propofol, pentobarb, inhalational anest

105
Q

action mechanism propofol, dexmedeto, keta

A

dexmedeto: alpha2 adrnorecept ago ->supression norepi release, decrease cerebral oxygen demand, vasoconstriction brain

propofol: GABAaR, non BZP site + glycine and NMDA antag. Heinz body anemia in cat

inhalant anesth GABAa
anesth barbiturate GABAa
phosphetoin GABAa, NMDA AMPA

106
Q

elim half life antiepileptics

A

KBr 15d
imepitoin 2h
levetiracetam 2-4h

107
Q

zonisamide is metabolised by

A

hepatic enzyme CYP3A4
weak carbonic anhydrase inhibitor
coadmn with pheno increase clearance by 50% and shorten elim half life

higher risk idiosynch react if allergic episod with sulfonamide

108
Q

LGI (leucin rich glioma inactivated) proteins

A

LGI1 binds to
1. presyn volt gated k channel Kv1 -> increase Ca influx and neurotrans release
2. presynap ADAM 23 ->affect neurite outgrowth
3. post synap ADAM22 (tabilised synapse with presyn)
4. regulation AMPA (glutamate recept)

LG role in maturation glutaminergic synapse (LGI2 immediately post nat)

109
Q

pathologies associated with LGI proteins

A

Lagotto Romagnolo mut LGI2: familial juvenil epil.

Belgian Sheperd ADAM23: predisp adult epil. focal seiz, 3-4y, very low freq SE

limbic seizure in cat: antibodies against VGKC complexes/LGI1

suppression LGI1expression in glioblastoma

110
Q

transcranial magnet stim act by which neurotransmit

A

dopamine

111
Q

ABCB1 gene in epil

A

Border: assoc ABCB1 and phenobarb resistance in only one variant

112
Q

medium-chain TG action

A

elevation beta hydroxybutiric acid (suspected by ATP channel and GABAb)

reduce seizure frequency, better QoL
reduces pheno concent 8%, ALKP 10%

113
Q

mineral in epileptic dogs

A

higher Cu, Zn, Se, As
lower P

114
Q

cardiac troponin 1 and seizure

A

tropo 1 higher in dogs with recent seiz
associated with number seiz and age

115
Q

ammoniema after seizure in cat

A

transient hyperammonemia

116
Q

feline temporal lobe epil:
1. equivalent in humans
2. type of seizure
3. localisation
4. causes

A
  1. autoimmune limbic encephalitis and temporal lobe epil
  2. focal, orofacial or head twitching, hypetrsalivation, lip smacking, mydriasis, vocalisation, motionless staring with interict behaviour change
  3. hippocampus and piriform lobe
  4. astrocytoma/lymphome, voltage gated potassium channel antibodies (targeting LGI1), DCC: deleted in colorectal carcinome = netrin 1 recept
117
Q

in cat half life
1. pheno
2. leve
3. zonisamide
4. gaba
5. diazepam

A
  1. 40-80h, escalating dose over time is rare in cat
  2. 3h
  3. 33h
  4. 2.5-3.5h
  5. 15-20h, no functional toler i cat
118
Q

lore often focal/generalised seizures in cat with hypertyroidism/hepatic encephalopathy

A

focal

119
Q

feline audiogenic reflex seizure

A

15y
Birman
levetiracetam
high pitched sound

120
Q

% IE, structural, reactive seizures in cat

A

reactive 15-25%
structural 40-70%
idiopath 22-57%

121
Q

% cat with intracran lymphoma positive for FeLV

A

18%

122
Q

causes of ischemic CVA in cat

A

hypertension (renal, hyperthyroidism)
cuterebra (< 4y, access to outdoor in sumer months)
systemic neoplasia
cardiomyopathy
sepsis
vasculitis
vascular degeneration

123
Q

thimaine deficiency:
1. localisation
2. causes
3. signs

A
  1. lateral geniculate nuclei, caudal colliculi, facial nuclei, cerebellar nodulus, medial vestibular nuclei
  2. diets preserved with sulfur dioxide, inaquately suppelmented, thimaine degradeds by heating, diet with thiaminase
  3. imapaired vision, mydriasis, ataxia, ventroflexion, vestibular signs, seizures (60%). 80% of seizuring cat with status/cluster
124
Q
  1. salivation during seizure
  2. ictal vocalisation

in cat is more likely in …

  1. status/cluster more frequent in IE/struct/react
A
  1. IE
  2. structural epil
  3. 10-20% in IE vs 40% in other causes, associated with poorer survival
125
Q

hepatic enz induction with pheno in cat

A

NO, but some cases of increase ALT

126
Q

most common adverse effect pheno cat + factors

A

sedation, ataxia
increase with dose, second AE

127
Q

% epileptic cat with normal MRI and abnormal CSF

A

4.6 %

128
Q

maj cause epil <12m in cat

A

structural

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