Ch 5 Epilepsy Flashcards
The prevalence of congenital malformations in offspring of women on an AED is?
4-10% which is 2-4x increase from the expected prevalence of the general population
Which AED has lower risk of teratogencity and should be considered to use during pregnancy?
Lamotrigine
How are lamotrigine levels affected during pregnancy?
The clearance of lamotrigine increases during pregnancy, so the dose should be adjusted during this time
Which AED has some of the highest fetal malformation rates and should be avoided during pregnancy?
Valproate (2-3x higher than carbamazepine or lamotrigine)
It also has dose dependent cognitive adverse events
What is the fencer’s posture associated with?
Frontal lobe epilepsy and indicates epileptic activation of the supplemental motor area
Which AED can worsen generalized epilepsy (especially myoclonic epilepsy)?
Gabapentin
Which AED has he least potential interactions with any other medication?
Gabapentin (it’s neither an enzyme inducer nor inhibitor)
In cases of epilepsy of childhood that is refractory to multiple AEDs, what is the next step?
the ketogenic diet (initiated in the hospital by starvation for 1-2 days followed by strict diet)
Define simple febrile seizure (6)?
< 15 mins, generalized seizure, lack of focality, normal neuro exam, no persistent deficits, negative family history
Define complex febrile seizure (6)?
> 15 mins, focal features, abnormal neuro exam, seizure recurrence in < 24 hours, postictal sign (Todd’s paralysis), more likely due to meningitis/encephalitis or underlying seizure d/o
How to treat simple febrile seizure?
supportive care
How to treat complex febrile seizure?
short term ppx: diazepam and antipyretics
long term ppx: phenobarbital or valproic acid
What is generalized epilepsy with febrile seizure plus (GEFS+)?
patients in whom febrile seizures continue past the defined upper limit of age (febrile seizures occur 6mo to 5 yrs old)
What is the mutation of GEFS+?
SCN1A
What is Rasmussen’s syndrome?
Severe inflammatory brain d/o characterized by progressive unilateral hemisphereic atrophy, progressive neurologic dysfunction (hemiparesis and cognitive deterioration), intractable focal seizures (epilepsia partialis continua).
What is the treatment of Rasmussen’s syndrome?
heispherectomy
What are the first line and second line therapies for progressive myoclonic epilepsies?
1st line: Valproic acid (caution: pt with mitochondrial mutation may develop fulminant hepatic failure while on valproic acid)
2nd line: Clonazepam, Levetiracetam, Topiramate, Zonisamide
What is the advantage of fosphenytoin over phenytoin (4)?
Compared to phenytoin, fosphenytoin is (1) not associated w purple glove syndrome (2) can be given rapidly IV (3) lower occurrence of cardiovasc side effects (4) can be given IM
Common side effects of phenytoin (3)?
dizziness, nystagmus, drowsiness
What AEDs are known to exacerbate some myoclonic epilepsies?
Lamotrigine, Gabapentin, Carbamazepine, Pregabalin, and Vigabatrin
Out of the following, name which medications are hepatic enzyme inducers and which are hepatic enzyme inhibitors: phenytoin, carbamazepine, valproic acid, phenobarbital, primidone
hepatic enzyme inhibitor: valproic acid
hepatic enzyme inducers: phenytoin, carbamazepine, phenobarbital, primidone
what are the main first line and second line agents in the treatment of absence seizures?
First line: ethosuximide
2nd line: valproic acid, topiramate, zonisamide and lamotrigine (although lamotrigine can actually cause aggravation of absence seizures on rare occasions)
The adult pattern of normal posterior dominant alpha rhythm in older children and adults is usually seen by the age of?
8 to 10 years
In a patient with HSV encephalitis, what abnormality could you expect to find on EEG?
PLEDs (periodic lateralizing epileptiform discharges). Can also be seen in any destructive process such as anoxia, HSV encephalitis, stroke, and tumor
