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Clinical Therapeutics > Epelipsy > Flashcards

Epelipsy Flashcards

1
Q

What is epelipsy?

A

An epileptic seizure is a transient episode of uncontrolled discharge of cerebral neurones causing a variety of symptoms, usually associated with a disturbance of consciousness

Epilepsy is the term used to describe when such seizures recur

Brief change in behaviour caused by disordered, rhythmic and synchronous firing of populations of neurones

Can be preceded by an aura: numbness, tingling or hallucinations

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2
Q

Causes of epilepsy

A

70% unknown origin
30%:
* Head trauma
* poisoning
* infection
* brain tumor
* cardiovascular
* maternal injury

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3
Q

howare seizures categorised into groups

A

Seizures are divided into groups depending on:
1. onset - where they start in the brain
2. awareness affected
3. involvment of other symptoms eg, movement

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4
Q

focal vs generalized seizures

A

Focal onset - focal point of hyperecitability with potential routes of transfer to other parts of the brain.
Generelized onset - high levels of activity simulatenously at both hemispheres

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5
Q

Importance of correct diagnosis

A

A drug may be very effective for one particular type of epilepsy but may make other forms of epelipsy worse.

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6
Q

Focal seizures

A
  1. person is concious
  2. symptoms: tingling, twitching, flashing light to joy and fear
  3. dependent on part of brain affected
  • Focal impaired awareness seizures affect larger part of one hemisphere
  • person may be confused and show strange repetitive movements called: automatisms
  • auditory or visual hallucinations
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7
Q

Generelized seizures

A
  • Absence: Blank, unresponsive, briefly unconcious
  • Tonic Clonic: unconcious, stiff muscles (tonic), shake/jerk (clonic)
    -afterwards person may feel sleepy, tired, headaches
  • Atonic: muscles relax
  • myclonic: muscles twitch whilst concious
  • status epilepticus: continuous or repeated seizures longer than 30mins
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8
Q

Status epilepticus

A

continuous or repeated seizures lasting longer than 30mins
* medical emergency during tonic clonic
Treatment:
1. buccal midazolam
2. rectal diazepam
emeregency medication may cause breathlesness - person must be closley watched.

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9
Q

Pathophysiology of seizures

A
  1. Increase in excitatory inputs via Ach or glutamate
  2. Reduction in inhibitory drive via GABA
  3. Change in Na channel activity to redcue threshold and/or increase rate of APs
    OR
    Change in K+ channel activity to increase rate of APs
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10
Q

cause of increased excitability

A
  1. Membrane depolarization - alteration in Na or K+ channel function and/or extracellular potassium build up
  2. Release of excitatory amino acids (EAA) eg, Glutamate
  3. Reduced Inhibatory transmission eg reduced GABA transmission
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11
Q

Diagnostic testing of epilepsy

A

Neurolory consultant required due to high rate of misdiagnosis
Detailed history- eyewitness
Physical exam
ECG
Blood tests

Imaging techniques: CT scan or MRI
Neuropsychological assessment
EEG

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12
Q

Action of AEDs

A
  1. Decreased excitatory transmission (glutamate, Ach)
  2. Increase inhibatory (GABA) transmission
  3. stabalize membranes and prevent depolarization by inhibiting Na, CA channels and/or activating K+ channels
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13
Q

Mechanism of action AEDs

Inhibit Na+ channels

A
  1. Sodium Valproate
  2. Phenytoin
  3. Carbamazepine
  4. Lamotrigine
  5. Topiramate
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14
Q

Inhibit Ca+ channels

A
  1. Ethosuxamide
  2. Sodium Valporate
  3. Gabapentin
  4. Pregablin
  5. Leviteracetam
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15
Q

Activate K+ channels

A
  • Retigabine
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16
Q

Enhance GABA transmission

A
  1. Benzodiazapines
  2. Barbiturates (phenobarbital)
  3. valporate
  4. gabapentin
  5. tiagabine
  6. vigabatrin
  7. topiramate
  8. felbamate
17
Q

Inhibit EAA transmission

A
  1. Perampenal
  2. Topiramate
  3. Valporate
  4. Felbamate
18
Q

Carbimazepine

A
  • Carbamazepine appears to act by inhibiting Na+ channels and depolarizing action potentials in brain neuron
  • 1st line treatment partial seizures
19
Q

Valporate (valproic acid)

A
  • 1st line generalized
  • Ehanced GABA transmission,inhibits EAA transmission
  • Adverse effectes: hepatotoxicity, tetratogenicity, pancreatitis
20
Q

MOA

Lamotrigine

A
  • 1st line generalized seziures
  • inhibit Na+ channels, inhibitis EAA transmission
  • Adverse effects: hepatotoxicity, teratogenicity, and pancreatitis
21
Q

Topiramate

A
  • 1st line generalized generalized seizures
  • Inhibits Na+ channels, Inhibits GABA transmission, inhibits EAA transmission
  • Adverse effects: anorexia, loss apetite, anxiet
22
Q

Phenytoin

A

*1st line focal (partial)
* Phenytoin is a voltage-gated, sodium channel blocker, stabilizing the inactive state of the sodium channel and prolonging the neuronal refractory period
* Rash, electrolyte imbalance, vitamin-d deficiancy

Clinical Therapeutics (10 decks)

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