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CANN > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what are 3 ways to classify seizure?

A

where/onset, awareness, and motor/nonmotor

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2
Q

what are some causes of nonepileptic seizures?

A

alcohol withdrawals, fevers, psychological trauma

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3
Q

IPSP and EPSP summation not action potential directly; usually thalamocortical

A

Paroxysomal Depolarization

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4
Q

Focal cortical dysplasia

A

Focal area of abnormal neuronal organization and development
Most common cause of medically refractory epilepsy in kids and 2nd in adults
Seen as blurring of the grey–white matter junction and hyperintense signal on FLAIR imaging
Potential causes: mostly unknown, maybe genetics or in utero infection

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5
Q

Tuberous sclerosis complex

A

Loss of TSC1 (codes for hamartin) or TSC2 (tuberin) genes. Inherited or spontaneous
Affects mTOR pathway
Multisystem hamartomas (including cortical tubers

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6
Q

Dravet’s Syndrome

A

SCN1A mutated; codes for a voltage-gated Na+ channel on GABAergic neurons

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7
Q

Angelman syndrome

A

UBE3A deleted or mutated on maternal copy of chromosome 15. Codes for ubiquitin protein ligase E3A Seizures, ataxia, severe intellectual disability and developmental delay, nonverbal, inappropriate laughter

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8
Q

Rett syndrome

A

MECP2 mutation on X chromosome
Codes for methyl CpG binding protein 2 (MeCP2); involved in interpreting DNA methylation, synaptic maintenance
Predominantly in females
developmental regression, ataxia, seizures, stereotyped handwringing/loss of hand purposeful movement, difficulty with speech

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9
Q

What are some infections that cause epilepsy?

A

Neurocysticercosis
Cerebral malaria
Viral encephalitis
Tuberculosis
HIV
Zika virus

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10
Q

Chronic brain inflammation leading to intractable seizures, progressive hemiparesis, and cognitive loss

A

Rasmussens syndrome

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11
Q

metabolic epilepsy caused by changes in

A

GLUT1 and mitochondria

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12
Q

What are pharmokinetics of ASM?

A

Well absorbed orally
Cross the blood brain barrier readily
Most are metabolized in the liver (many by CYP2C9, CYP2C19, or CYP3A4) and excreted by the kidney - exceptions: gabapentin, vigabatrin

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13
Q

Which ASMs inhibit VG Na channels?

A

Phenytoin, Carbamazepine, Lamotrigine, VPA, Topiramate

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14
Q

What are ADRs of VG Na targeting ASMs?

A

affect heart

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15
Q

Phenytoin

A

used for focal seizures, if given IV use fosphyentoin (Cerebryx), nonsedative

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16
Q

What are some drug interactions of phenytoin?

A

Induces CYP450, CYP2C19
“Broad spectrum inducer”
Can induce its own metabolism! Highly binds to plasma proteins

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17
Q

which drugs affect phenytoin

A

eslicarbazepine, oxacarbazepine, topiramate

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18
Q

ADRs of phenytoin (PHENYTOIN)

A

CytochromeP-450 inducer
Hirsutism
Enlargedgums(gingival hyperplasia)
Nystagmus
Yellow-browningofskin(melisma, freckle-like spots)
Teratogenicity
Osteopenia
Impairedfolate absorption
Neuropathy

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19
Q

Carbamazepine

A

focal seizures and bipolar disorder

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20
Q

induces CYP3As

A

Carbamazepine

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21
Q

What are some ADRs of Carbamazepine

A

exacerbate myclonic or absence seizures, osteopenia, blurred vision, blood disease, hyponatremia

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22
Q

Lamotrigine

A

for focal and general seizures, including absence. Also good for bipolar

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23
Q

What are ADRs lamotrigine?

A

SJS, dizziness, hemophagolytic lymphohistocytosis (uncontrolled immune response)

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24
Q

VPA

A

for focal seizures and general. Good for myoclonic and bipolar. Is a broad INHIBITOR

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25
Q

What are some ADRs of VPA?

A

GI, sedates, bad neurodevelopment, pancreatitis, hepatotoxic

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26
Q

Topiramate

A

monotherapy for focal and general seizure

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27
Q

Whats MOA and interactions of Topiramate?

A

blocks VG Na channels, antagonize AMPA, enhance GABAa. May increase phenytoin

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28
Q

ADRs of Topiramate

A

sedation glaucoma, decreasing levels in pregnancy

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29
Q

What are ASMs that inhibit Ca channels?

A

Gabapentin, Pregabalin, Ethosuxide

30
Q

Ethosuximide

A

ABSENCE SEIZURES by inhibiting T-tyoe Ca

31
Q

Levetiracetam

A

does general tonic clonic seizures in adults and focal in kids by binds to synaptic vesicle protein, SV2A; don’t give to someone with behavior probs

32
Q

ASMs that block GluRs

A

Perampanel -AMPA and Felbamate - NMDA

33
Q

Perampanel

A

focal in age 4 and up, and general in greater than 12

34
Q

Perampanel drug interactions

A

Extensively metabolized by the liver
Not recommended for patients with severe hepatic (or renal) impairment

Also interacts with alcohol and levonorgestrel oral contraceptives

35
Q

ADRs of Perampanel

A

weight gain, aggression

36
Q

Felbamate

A

rarely used because only for very severe because causes liver failure/aplastic anemia.

37
Q

ASMs that increase inhibition

A

Tiagabine, Vigabatrin, BZs, Phenobarbital

38
Q

Tiagabine

A

focal seizures, inhibits GABA uptake through GAT-1

39
Q

Vigabatrin

A

An irreversible inhibitor of GABA T which is that degrading enzyme of GABA. Used in infants, TSC

40
Q

ADRs of Vigabatrin

A

dizziness, weight gain
In infants: MRI abnormalities
Long-term tx associated with irreversible peripheral visual field defects in 30-50% of patients and Higher in males. Decreases serum phenytoin

41
Q

Phenobarbital

A

for really resistant status epilepticus, a barbituate, and 1st line in NEONATES. Induces CYP450s.

42
Q

ADRs of phenobarbital

A

sedation, tolerance, cardio/respi depression, cleft palate

43
Q

BZ for Myoclonic, atonic, focal and general t/c seizures. Admin I/V or rectally to stop status epilepticus and nasally for cluster seizures

A

Diazepam (also Lorazepam)

44
Q

BZ Used for absence seizures; adjunctive for other types of seizures
One of the more potent ASMs. SJS potential ADR

A

Clonazepam

45
Q

All … are rescue drugs

A

BZs

46
Q

Cannabidiol trx ASM

A

Epidiolex

47
Q

Toxicities of ASMs

A

Osteomalacia, osteoporosis (Carbamazepine, barbiturates, phenytoin, valproic acid)
Altered connective tissue metabolism or growth (phenytoin, phenobarbital)
Polycystic ovarian syndrome (valproic acid)
Neurologic
Neuropathy (phenytoin, carbamazepine)
Cerebellar degeneration (phenytoin)
Sexual dysfunction (phenytoin, carbamazepine, phenobarbital)

48
Q

How does ASMs affect pregnancy?

A

Several anti-seizure drugs → ↑ metabolism of hormonal contraceptives → contraceptive failure
(Phenytoin,phenobarbital,carbamazepine, topiramate,clobazam)
Pregnancy planning is vital; many anti-seizure drugs are teratogenic
Patients considering pregnancy should be on high doses of folic acid prior to conception

49
Q

Syncope vs seizure

A

syncope - confusion for less than 30 sec, eyes upward lateral deviation, flaccid.
seizure - confusion for greater than 2 min, tongue bite, stiff

50
Q

how to diagnose nonepileptic seizures

A

need EEG at time of occurrence, which looks for sharp waves

51
Q

What’s 2 important characteristics of nonepileptic seizures

A

eyes closed tight for >40 sec, and assymetrical movements

52
Q

when do seizures usually occur after alcohol withdrawal

A

6 to 48 hours later

53
Q

TRUE or FALSE: you should use MRI for epilepsy

A

false because over 50% epileptic people have normal MRI

54
Q

whens onset absence epilepsy, results, and treatment

A

4-10yrs, see 3Hz spikes and hyperventilation during seize, give ethosuximide

55
Q

Onset age: 12-18 years old
Seizures: myoclonic jerks (morning), GTC, some have absence
Exam: neurologically normal, photosensitive

A

Juvenile Myoclonic

56
Q

most common epilepsy in adults, deja vu, staring seizures, can be focal to bilateral tonic clonic

A

temporal lobe epilepsy which you can also treat with lobectomy if mesial temporal sclerosis

57
Q

Etiology often brain insults, malformations of cortical development such as TSC; or genetic
Age: by 4 yrs old
Seizures: multiple types tonic, tonic-clonic, atonic, FASS, FAIS, FTBTC, atypical absence
Exam: often diffuse neurologic impairment (cerebral palsy and intellectual disability); epileptic encephalopathy
Prognosis: Drug resistant

A

Lennox Gastaut Syndrome which you treat with clobazam and vagus nerve stimulation

58
Q

ADR carbamazepine

A

hyponatremia, SJS

59
Q

ADR ethosuximide

A

GI effects, leukopenia

60
Q

ADR Phenobarbital

A

somnolence

61
Q

ADR Phenytoin

A

hirsutism, gingival hyperplasia

62
Q

ADR VPA

A

tremor, weight gain, hair loss, GI

63
Q

ADR pregabalin

A

weight gain

64
Q

ADR Topiramate

A

change verbal fluency, memory, weight loss

65
Q

ADR Vigabatrin

A

permanent peripheral vision loss

66
Q

ADR clobazam

A

drooling

67
Q

ADR Perampanel

A

irritability

68
Q

which ASM decrease warfarin

A

carbamazepine, phenobarbital, phenytoin, elisacarbazepine

69
Q

which ASM increase warfarin

A

felbamate, VPA

70
Q

what drugs (besides warfarin) can ASM decrease

A

protease inhibitors and immunosuppressants

71
Q

Neurology unit
Specialized personnel
Designed to evaluate, diagnose, and treat unprovoked seizures. Guidelines for use:
Treatment failure of 1 year
Failure of 2-3 AEDs

A

Epilepsy Monitoring Unit

CANN (7 decks)

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