Drug Treatment of Epilepsy Flashcards

1
Q

What are epileptic seizures?

A

Episodic high frequency discharges by a localised group of neurons in the brain
- They are not constantly occurring
- There are factors which decreases seizure threshold including stress and sleep deprivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do drugs in relation to epilepsy work?

A

to prevent excessive neurotransmission - whether that be increase excitation or increase inhibiton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Main Excitatory “ON” switch in the brain

A

Glutamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Main Inhibitory “OFF” switch in the brain

A

GABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of Epilepsy depend on…

A

The area of the brain affected
- Motor Cortex → Convulsions
- Hypothalamus → Peripheral autonomic effects
- Reticular formation (Upper brainstem) → loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is determining the correct dosage of anti-epileptics essential?

A

Over medication can result in sedative effects including memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The primary cause of epilepsy

A

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is secondary epilepsy?

A

a result of brain damage which generally leads to seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are partial seizures?

A

Also known as Local or Focal

Discharge is localised to one brain region and hemisphere

Can be Simple or Complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complex local seizure

A

Consciousness is affected (often the Temporal lobe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are generalised seizures?

A

Discharge involves both hemispheres and reticular systems - consciousness is affected

Can be differentiated to Absence Seizures or Tonic-Clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Absence Seizure

A

Also known as Petit Mal..
Most common in children: staring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tonic-Clonic Seizures

A

Also known as Grand Mal
Tonic phase - muscle spasm, respiration stops, bowel/bladder discharge
Clonic phase - release

Physical signs - violent jerking, unable to stand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Main aims of antiepileptics

A

to reduce electrical excitability of excitatory neurons (i.e., glutamate) or to increase inhibitory neurotransmission (i.e., GABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4 Main Mechanisms of Antiepileptic Drugs

A
  1. Use-dependent Na+ channel block
  2. Ca2+ channel inhibition
  3. Increase GABA-mediated neural inhibition
  4. Inhibit glutaminergic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other approved antiepileptic strategies

A

Carbonic anhydrase inhibitors
CBD (i.e., think of Dravett’s)
Ketogenic diet

17
Q

Example of drug which blocks use-dependent Na+ channel

A

Phenytoin, Carbamazepine, Lamotrigine, Valproate

18
Q

Example of drug which inhibits Ca2+ channel

A

Ethosuximide, Gabapentin, (Phenytoin & Valproate as well)

19
Q

Drugs which inhibit glutaminergic transmission

A

NMDA/AMPA/mGluR antagonists

20
Q

Drugs to enhance GABA activation

A

Phenobarbital, Benzodiazepeines

21
Q

Drugs which inhibit GABA deaminase

A

Valproate, Vigabatrin

22
Q

Inhibit GABA reuptake

A

Tigabine

23
Q

Na+ channel blockers stabilise these channels when..

A

in its inactivate state (i.e., when it is use-dependent!)

24
Q

The most widely used AED?

A

Carbamazepine (CBZ)
→ strong inducer of P450 enzymes
→ increases metabolism of phenytoin, warfarin, OCP etc..

25
Q

Prodrug analog of CBZ

A

Oxcarbazepine - metabolised in the liver to CBZ

  • used as a monotherapy in children, but in adjunct therapy in adults with partial therapy

Less drug interactions as it is less potent on P450

26
Q

What is generally first line treatment of partial and secondary generalised seizures?

A

Phenytoin

27
Q

How is Ca2+ channel inhibition useful in treatment of epilepsy?

A

Ca2+ activates proteases responsible for vesicle fusion

28
Q

Which Ca2+ Channels are implicated in periodic discharge observed in partial seizures?

A

Low threshold T channels

29
Q

MOA of Ethosuximide

A

inhibits T type Ca2+ channels (pre & postsynaptic)
Also inhibits Na+/K+ ATPase and GABA deaminase

30
Q

MOA of gabapentin

A

NOTHING TO DO WITH GABA

Presynaptic L type Ca2+ channel inhibitor
Decreases release of glutamate and other associated modulators, therefore increasing GABA levels

31
Q

MOA of Valproate

A

Increases GABA in the brain

Simulates glutamate decarboxylase, inhibits GABA deaminase and weakly blocks Na+ and Ca2+ channels

32
Q

MOA of Vigabatrin

A

irreversibly blocks GABA deaminase, therefore increasing GABA in the brain

  • Side effects: Depression and psychotic disturbances