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integrated studies in mental health > EPILEPSY > Flashcards

EPILEPSY Flashcards

1
Q

Define convulsion

A

Sudden attack of involuntary muscular contractions and relaxations

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2
Q

define seizure

A

Abnormal central nervous system electrical activity.

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3
Q

define epilepsy

A

A group of recurrent disorders of cerebral function characterised by both seizures and convulsions

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4
Q

epilepsy is usually present in childhood and adolescent.TRUE OR FALSE

A

TRUE

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5
Q

Epilepsy may occur for the first time at any age. TRUE OR FALSE

A

TRUE

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6
Q

how many percentage suffer a single seizure at some time

A

5%

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7
Q

how many percentage have recurrent seizures= epilepsy

A

0.5 - 1%

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8
Q

how many percentage is well controlled with drugs (prolonged remissions)

A

70%

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9
Q

how many percentage of epilepsy at least partially resistant to drug treatments = INTRACTABLE (pharmaco-resistant) EPILEPSY

A

30%

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10
Q

seizure is not usually life threatening.
TRUE OR FLASE

A

TRUE

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11
Q

The brain almost always stops the seizure on its own
true or false

A

True

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12
Q

What happens to a person breathing during a seizure

A

Breathing cease for a few seconds
patient turns blue

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13
Q

Do people feel pain during a seizure

A

No but sore muscles afterward

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14
Q

person may feel disorientated for a while after seizure
TRUE OR FALSE

A

TRUE

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15
Q

list the two broad classifications of seizures and how many subtypes they have

A

focal seizures also called partial seizures
( 3 subtypes)

Generalised seizures
( 6 subtypes)

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16
Q

Define focal (partial) seizures

A

Excessive electrical activity in one cerebral hemisphere > Affects only part of the body.

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17
Q

List the subtypes of focal ( partial ) seizures

A

simple partial
complex partial
secondary generalised

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18
Q

Explain simple partial seizure

A

Patients has sudden clonic jerking of one extremity lasting 60-90 seconds.

Patients is completely aware of the attack and can describe it in detail > Key feature: preservation of consciousness.

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19
Q

Explain complex partial seizure

A

Localised onset, but discharge can spread

Loss of awareness at seizure onset > Impairment of consciousness, although consciousness is not fully lost

Typically originate in frontal or temporal lobes (e.g. Temporal lobe epilepsy) > Difficult to treat with drugs > surgical resection.

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20
Q

Explain complex partial seizure

A

Localised onset, but discharge can spread

Loss of awareness at seizure onset > Impairment of consciousness, although consciousness is not fully lost

Typically originate in frontal or temporal lobes (e.g. Temporal lobe epilepsy) > Difficult to treat with drugs > surgical resection.

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21
Q

explain secondary generalised seizure

A

Focal seizures > generalised Seizures.

Often preceded by an AURA or warning sign > the senses of taste, smell or vision are heightened,

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22
Q

Define generalised seizures

A

Excessive electrical activity in both cerebral hemispheres.

Usually originates in the thalamus or brainstem.

Affects the whole body.

Loss of consciousness is common.

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23
Q

list the subtypes of generalised seizures

A

Myoclonic
Atonic
Tonic
clonic
tonic clonic ( grand mal)
Absence seizure(petit mal)
Status epilepticus

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24
Q

define myoclonic gen. seizures

A

Brief shock-like muscle jerks generalized or restricted to part of one extremity.

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25
Q

define atonic gen. seizure

A

Sudden loss of muscle tone.

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26
Q

define tonic gen. seizures

A

sudden stiffening of the body, arms, or legs

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27
Q

define clonic gen. seizures

A

rhythmic jerking movements of the arms and legs without a tonic component

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28
Q

define tonic clonic ( grand mal) gen. seizures

A

The most dramatic of all  Tonic phase followed by clonic phase

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29
Q

define absences ( Petit mal) gen. seizure

A

Rapid and brief loss of consciousness

More common in young children.

Can include the blinking of the eyelids or lip movements

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30
Q

define status epilepticus

A

A seizure lasting longer than 30 min, or 3 seizures without a normal period in between

May be fatal

Emergency intervention required

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31
Q

list epilepsy syndromes

A

West syndrome (infantile spasms)

Lennox–Gastaut syndrome

juvenile myoclonic epilepsy

Doose syndrome

Dravet syndrome

Benign neonatal convulsions

Temporal lobe epilepsy.

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32
Q

Doctors classify a patient’s seizures by seizure type and then attempt to assign them to a syndrome. TRUE OR FALSE

A

TRUE

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33
Q

The broad classifications of seizures is based upon the nature of the seizures rather than presence or absence of underlying cause. TRUE or FALSE

A

TRUE

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34
Q

In 19th century neurologist Hughlings Jackson classified epilepsy as….

A

a sudden excessive disorderly discharge of CEREBRAL neurons

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35
Q

what is the recent neurobiology of epilepsy

A

a central role for the excitatory neurotransmiter glutamate (increased in epilepsy)

inhibitory gamma amino butyric acid (GABA) (decreased)

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36
Q

refer back to slide 13, 14 & 15

A
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37
Q

list causes of epilepsy

A

Genetic (autosomal dominant genes)
Congenital defects
Severe head trauma
Ischemic injury, tumor
Drug abuse
Unknown ( the highest percentage - 65%)

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38
Q

explain Anti epileptic drug

A

is a drug which decreases the frequency and/or severity of seizures in people with epilepsy

Treats the symptom of seizures, not the underlying epileptic condition

Does not prevent the development of epilepsy in individuals who have acquired a risk for seizures (e.g., after head trauma, stroke, tumour)

Majority of patients respond to drug therapy (anticonvulsants).

Intractable cases > surgery may be necessary.

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39
Q

what is the goal of anti epileptic drug therapy

A

Goal of therapy > maximise quality of life by eliminating seizures (or diminish seizure frequency) while minimising adverse drug effects

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40
Q

The Mechanisms of Action of AEDs fall into three large categories, What are they?

A

Inhibition of voltage-gated Na+ channels to slow neuron firing.

Enhancement of the inhibitory effects of the neurotransmitter GABA.

Inhibition of calcium channels.

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41
Q

LIST the AEDs

A

phenytoin
carbamazepine
sodium valproate Ethosuximide
gabapentin
Lamotrigine
Tiagabine
Levetiracetam
Topiramate
Vigabatrin

42
Q

explain phenytoin, including MOAs

A

it is the oldest (1938) non-sedative AED

Effective in many forms of epilepsy - but not in absence seizures.

Highly bound to plasma proteins (about 90%) > non-linear relationship between dose and plasma concentration is non-linear.> extreme variations in plasma concentration > toxic effects > therapeutic drug monitoring essential

Mechanism of action (MOA)
Use-dependent block of sodium ion channels

Prolongs their inactive state > prevents further action potential generation

Reduces the synaptic release of glutamate and enhances the release of GABA

43
Q

list side effects of phenytoin

A

Nystagamus (involuntary and jerky repetitive movements of the eyeballs) > occur early in treatment

Gingival hyperplasia > increase in the size of the gingiva (gums)

Hirsutism > excessive body hair

Diplopia > double vision (dose related)

Ataxia > lack of voluntary coordination of muscle movements (dose related)

Sedation > dose related

foetal abnormalities when taken by the mother during pregnancy

44
Q

explain carbamazepine

A

Structurally related to tricyclic antidepressants

Similar profile to that of phenytoin, but with fewer unwanted side-effects.

Long considered drug of choice for partial and generalised seizure, but is be superseded by newer agents

Effective in many forms of epilepsy - but not in absence seizures.

Also useful in Trigeminal Neuralgia and Mania

Oxycarbazine > structurally and functionally related to carbamazepine

45
Q

explain carbamazepine MOAs

A

Similar to phenytoin

Blocks sodium channels

Decreases neurotransmitter release

46
Q

list the side effect of carbamazepine

A

sedation,
ataxia,
mental disturbances,
water retention.

47
Q

explain Sodium Valproate

A

Chemically unrelated to other anticonvulsants.

Effective in all forms of epilepsy, but drug of choice in treatment of Absences Seizures.

Relatively few side effects

Teratogenic!

48
Q

explain sodium valproate MAOs

A

Suppress repetitive neuronal firing through inhibition of voltage-sensitive sodium ion channels

Suppresses thalamic excitability by inhibiting transient low threshold calcium ion channels

Enhances GABA in CNS by inhibiting the catabolic enzyme GABA transaminase.

49
Q

list side effects of sodium valproate

A

alopecia (hair loss)
and liver damage (rare but serious).

50
Q

explain gabapentin

A

Effective in the treatment of Partial Seizures.

Relatively few unwanted side effects

51
Q

explain gabapentin MOAs

A

Blocks glutamate stimulated Ca ion channels.

Inhibits depolarisation-induced calcium influx at nerve terminals > decreased glutamate release.

52
Q

list side effects of gabapentin

A

nausea
and sedation.

53
Q

explain Lamotrigine

A

Used in the treatment of Partial Seizures and Tonic –Clonic and Absences Seizures

Relatively few unwanted side effects

54
Q

explain lamotrigine MAOs

A

Inhibits release of glutamate.

Suppress repetitive neuronal firing by inhibition of voltage-sensitive sodium ion channels

55
Q

list side effects of lamotrigine

A

nausea, sedation, ataxia and skin rashes.

56
Q

explain Tiagabine

A

Used in the treatment of Partial Seizures

Relatively few unwanted side effects

57
Q

explain tiagabine MOAs

A

Inhibits the GABA transporter responsible for removing extracellular levels of GABA

Increased levels of GABA in synapses

Increased inhibitory transmission

58
Q

list side effects of tiagabine

A

nausea, sedation and ataxia.

59
Q

explain Levetiracetam

A

Mainly used in partial seizures

60
Q

Explain levetiracetam MOAs

A

Binds to synaptic vesicular protein SV2A > alters synaptic neurotransmitter release

61
Q

list side effects of levetiracetam

A

Somnolence > sleepiness

Asthenia > abnormal physical

weakness or lack of energy

Dizziness

62
Q

explain Topiramate

A

Monosaccharide structure > different from all other AEDs

Effective against partial and generalised tonic-clonic seizures and absence seizures

Broad effectiveness against a range of epilepsy syndromes (Lennox Gastaut; West’s syndrome

Also approved for migraine headaches

well tolerated Side effects

63
Q

explain topiramate MOAs

A

Blocks voltage-gated sodium channels

Potentiates the effects of GABA > similar to benzodiazepines, but has distinct binding site on GABAA receptors

Depresses excitatory effect of kainate on glutamate receptors

64
Q

list the side effects of topiramate

A

Somnolence,
fatigue,
dizziness,
paraesthesia,
nervousness,
confusion
Acute myopia (near-sightedness)
and glaucoma, rare, but requires immediate withdrawal

65
Q

explain vigabatrin

A

Useful in the treatment of partial seizures

66
Q

explain vigabatrin MOAs

A

Irreversible inhibitor of the enzyme GABA aminotransferase > enzyme that degrades GABA

Increased levels of GABA released at synaptic sites

Enhanced neuronal inhibition

67
Q

list the side effects of vigabatrin

A

Well tolerated generally
Drowsiness
Dizziness
Weight gain

68
Q

formulations of cannabinoids are extremely useful widely in the treatment of epilepsy. TRUE OR FALSE

A

TRUE

69
Q

explain cannabidiol

A

major components of the Cannabis sativa plant

No psychoactive properties, unlike tetrahydrocannabinol (THC)

Cannabidiol can be synthesized (synthetic CBD) as well as extracted from C. sativa (plant derived).

Pharmaceutical-grade CBD approval by FDA and the European Medicines Agency
> treatment of seizures in Dravet syndrome and Lennox–Gastaut syndrome

70
Q

WHAT IS FOCAL SEIZURE ALTERNATIVE FIRST LINE treatment

A

levetiracetam, oxcarbazepine,
sodium valproate

71
Q

WHAT IS FOCAL SEIZURE FIRST LINE TREATMENT

A

carbamazepine,
lamotrigine

72
Q

what is the caution of focal seizure alternative first line treatment

A

be aware of potential effect of sodium valproate in pregnancy

73
Q

what is the adjunctive treatment of focal seizure if first line is not effective or tolerated

A

carbamazepine,
clobazam,
gabapentin,
lamotrigine,
levetiracetam, oxcarbazepine,
sodium valproate, topiramate

74
Q

what is the action if adjunctive treatment is not effective or tolerated

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

75
Q

First line treatment of gen. tonic clonic seizure

A

sodium valproate, lamotrigine (if sodium valproate is not suitable)

76
Q

what is the caution of gen tonic clonic seizure first line treatment

A

be aware of potential effect of sodium valproate in pregnancy. If the person has myoclonic seizures or may have juvenile myoclonic epilepsy lamotrigine may worsen myoclonic seizures

77
Q

what is the alternative first line treatment of gen. tonic clonic seizure

A

carbamazepine, oxcarbazepine

78
Q

what is the caution alternative first line treatment of gen. tonic clonic seizure

A

be aware that these drugs may worsen myoclonic or absence seizures

79
Q

what is adjunctive treatment (if first line treatment is not effective or not tolerated):

A

lamotrigine,
levetiracetam,
sodium valproate, topiramate

80
Q

what is caution of adjunctive treatment (if first line treatment is not effective or not tolerated)

A

be aware of potential effect of sodium valproate in pregnancy. If the person also has absences or myoclonic seizures, or may have juvenile myoclonic epilepsy do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin

81
Q

what is absence seizure first line treatment

A

ethosuximide,
sodium valproate (offer first if additional tonic clonic seizures are likely)

82
Q

what is absence seizure caution of first line treatment

A

be aware of potential effect of sodium valproate in pregnancy

83
Q

what is absence seizure alternative first line treatment

A

lamotrigine

84
Q

what is absence seizure adjunctive treatment (if first line treatment is not effective or not tolerated)

A

consider a combination of ethosuximide, lamotrigine or sodium valproate.

85
Q

what is absence seizure caution of adjunctive treatment (if first line treatment is not effective or not tolerated)

A

be aware of potential effect of sodium valproate in pregnancy

86
Q

what is the action if adjunctive treatment is not effective or tolerated in absence seizure

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

87
Q

what is the caution if adjunctive treatment is not effective or tolerated in absence seizure

A

do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin

88
Q

what is the first line treatment of myoclonic seizure

A

sodium valproate

89
Q

what is the caution of first line treatment of myoclonic seizure

A

be aware of potential effect of sodium valproate in pregnancy

90
Q

what is the alternative first line treatment of myoclonic seizure

A

levetiracetam,
topiramate

91
Q

what is the caution of alternative first line treatment of myoclonic seizure

A

be aware that topiramate has poorer side effects than sodium valproate or levetiracetam

92
Q

what is the adjunctive treatment (if first line treatment is not effective or not tolerated

A

levetiracetam,
sodium valproate, topiramate

93
Q

what is the caution of adjunctive treatment (if first line treatment is not effective or not tolerated

A

be aware of potential effect of sodium valproate in pregnancy

94
Q

what is the action if adjunctive treatment is not effective or tolerated

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

95
Q

what is the caution if adjunctive treatment is not effective or tolerated

A

do not offer carbamazepine, gabapentin,
oxcarbazepine,
phenytoin,
pregabalin,
tiagabine or
vigabatrin

96
Q

what is the first line treatment of tonic and atonic seizure

A

sodium valproate

97
Q

what is the caution of first line treatment of atonic and tonic seizure

A

be aware of potential effect of sodium valproate in pregnancy

98
Q

what is the adjunctive treatment (if first line treatment is not effective or tolerated

A

lamotrigine

99
Q

what is the action if adjunctive treatment is not effective or not tolerated

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

100
Q

what is the caution if adjunctive treatment is not effective or tolerated

A

do not offer carbamazepine, gabapentin,
oxcarbazepine,
pregabalin,
tiagabine or
vigabatrin

integrated studies in mental health (20 decks)

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