Epilepsy

Question 1

Types of epilepsy

Answer 1

Focal
Generalised
tonic-clonic
absence
myoclonic
lennox-gastaut syndrome

Question 2

Features of tonic-clonic seizures

Answer 2

Tonic, clonic and poetical phases

Tonic phase sees loss of consciousness, and muscle rigidity

clonic phase sees muscle twitching/convulsions

post-ictal phase sees slow return to normal, with confusion, amnesia, fatigue, headache, hypertension, nausea

Question 3

Non-pharmacological interventions for epilepsy

Answer 3

Surgery is an option for focal seizures, where the region where the seizure begins in is removed.

Vagus nerve stimulation has been seen to reduce seizure rates in many patients

Deep brain stimulation uses an electrode in the thalamus to interrupt the spread of excitation. severe potential side effects

Question 4

Sodium valproate/valproic acid mechanism, uses and side effects

Answer 4

also used in migraine, bipolar, anxiety and mood disorders.

Can cause nausea, sleepiness and dry mouth.

Primary mechanism is through the inhibition of GABA transaminase, which degrades GABA - prolongs GABA transmission. Also a mild blocker of VGICs (K, Na, and Ca), weak inhibitor of NMDA, and inhibitor of histone deacetylase.

Question 5

VGSC blockers mechanism, uses and side effects

Answer 5

e.g., lamotrigine, also used for bipolar and schizophrenia

Can cause rash, nausea, sleepiness and headache

Selectively blocks VGSCs at high frequency firing.

Lamotrigine also seen to block VGCCs and 5-HT3.

Ultimately causes decrease in excitatory transmission (glutamatergic)

Question 6

gabapentin mechanism, uses, and side effects

Answer 6

also for MS and neuropathic pain. can cause dizziness, fatigue, and ataxia.

Primary mechanism through block of high-voltage activated ca channels (HVA). This reduces glutamate release in the highly excitatory state seen in seizures.

Brain slices see an increase in [GABA], mediated through an unknown mechanism.