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CM Clinical Symposia > Epilepsy (15) > Flashcards

Epilepsy (15) Flashcards

1
Q

Seizures

A

Abnormally excessive and hyper synchronous activity of neurones located predominantly in cerebral cortex

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2
Q

Twitches/convulsions

A

Cortical discharges transmitted to muscles

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3
Q

Classification of seizures

A
  1. Generalised
  2. Partial
  3. Secondary generalised
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4
Q

Generalised

A

Initial activation of neurones throughout both hemispheres (tonic clonic/clonic/atonic)

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5
Q

Partial

A

Initial activation of a limited number of neurones in a part of 1 hemisphere (absence/myoclonic/simple/complex)

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6
Q

Secondary generalised

A

Partial seizure that later spread to involve majority of 2 cerebral hemispheres

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7
Q

Manifestation of partial seizure in parietal lobe

A

Tingling/jerking in leg, arm, face

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8
Q

Manifestation of partial seizure in occipital lobe

A

Flashing lights/spots, vomiting

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9
Q

Manifestation of partial seizure in temporal lobe

A

Strange smell or taste, altered behaviour, deja vu, lip smacking/chewing movements

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10
Q

Manifestation of partial seizure in frontal lobe

A
  • Adversive seizures (Eyes/head both turn to one side)

- Jacksonian seizure (tingling feeling in hand/arm)

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11
Q

EEG

A

Electroencephalogram

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12
Q

EEG uses

A

Scalp electrodes to record electrical activity along scalp - firing of neurones within brain, series of electrical impulses originating in brain are amplified and summed into waves (Spike-wave discharges)

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13
Q

Status epliepticus

A

State of persistent seizure, more than 30 mins/2+ without full recovery

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14
Q

Why is SE a medical emergency?

A

The longer a seizure lasts, less likely it will stop on its own and more likely to reoccur in future

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15
Q

Treatment for SE

A

GABAa receptor agonist e.g. diazepam

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16
Q

Epilepsy

A

2 or more unprovoked seizures

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17
Q

Mechanisms underlying seziures

A

Excitation or inhibition > too much neuronal activity > seizure

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18
Q

Excitation (too much)

A

Ionic - Na+, Ca2+ influx, neurotransmitter - glutamate, aspartate release

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19
Q

Inhibition (too little)

A

Ionic - Cl-influx, K+ efflux

neurotransmitter GABA release

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20
Q

Inhibitory interneurones

A

Allow activity to spread in one direction but not sideways, release inhibitor neurotransmitter GABA

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21
Q

GABA

A

Major inhibitory neurotransmitter, found at 30% of synapses, acts via GABAa or GABAb

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22
Q

GABAa

A

Ligand-gated chloride channel receptor

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23
Q

GABAb

A

G protein-coupled receptor

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24
Q

What determines intrinsic properties of each channel

A

GABAR subunit

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25
Types of epilepsies caused by mutation in GABAa receptor subunits
- Childhood absence epilepsy (CAE) - FS (pure febrile seizures) - GEFS+ (generalised epilepsy with febrile seizures plus) - JME (juvenile myoclonic epilepsy) - DS (Dravet syndrome - SMEI severe myoclonic epilepsy in infancy)
26
Dravet syndrome associated with which mutation
GABRG2(Q390X) > loss of 78 C-terminal aa (changes it from transmembrane protein to a globular cytosolic protein)
27
Febrile seizures
Associated with fever
28
Tonic-clonic/grand mal
Generalised
29
Myoclonic seizure
Involuntary twitching of a muscle/group of muscles
30
Absence seizure
Lapses of awareness, staring, last only a few seconds, common in children
31
Complex partial seizure
Feeling deja vu, fear, euphoria/depersonalization
32
Tonic seizure
Tone is greatly increased, arms/legs sudden stiff movements, during sleep usually involved most/all of brain
33
Post-status epileptics animal models single episode of status epileptics is used to incite
Epilpetogenesis (via pilocarpine)
34
Pilocarpine is a
Pro-convulsant drug, non-selective muscarinic receptor agonist
35
Purpose of anti epileptic drugs
Decreases frequency and/or severity of seizures in people with epilepsy, treats symptom of seizures not underlying epileptic condition
36
Modes of action of anti-epileptic drugs
1. Suppress action potential 2. Enhance GABA transmission 3. Suppression of excitatory transmission
37
Suppress action potential using
Sodium channel blocker/modulator, potassium channel opener
38
Enhance GABA transmission
GABA uptake inhibitor, GABA mimetics
39
Suppression of excitatory transmission
Glutamate receptor antagonist
40
Main mechanisms of action
1. Enhancement of GABAergic transmission 2. Inhibition of Na+ channels 3. Mixed actions
41
Anti epileptics for partial simple and complex seizures
Carbamazepine, phenytoin, valproic acid
42
Anti epileptics for Generalised tonic clonic
Carbamazepine, phenytoin, valproic acid
43
Anti epileptics for Absence seizures
Ethosuximide, valproic acid
44
Anti epileptics for Atypical absence, atonic, myoclonic seizures
Valproic acid
45
Anti epileptics for Febrile seizures
Diazepam, rectal
46
Enhancing GABAergic transmission
- Enhance action of GABAa receptors with barbiturates (phenobarbital)/benzodiazepines (clonazepam) - Inhibit GABA transaminase (vigabatrin) - Inhibit GABA uptake (tiagabine)
47
Benzodiazepines
- Clonazepam - Clorazepate - Diazepam (valium) and Iorazepam
48
Clonazepam effective against
Generalised tonic-clonic, absence and partial seizures
49
Clorazepate effective against
Partial seizures (used with other drugs)
50
Diazepam (valium) and lorazepam effective against
Status epilepticus when give IV
51
Mechanism of action of benzodiazepines
Increase affinity of GABA for its receptor (increases Cl- current, supresses seizure focus by raising action potential threshold, strengthens surround inhibition - prevents spread)
52
Problems with benzodiazepines
Sedation, tolerance and dependence, respiratory depression (iv)
53
Inhibition of Na channels
Phenytoin, Carbamazepine and oxcarbamazepine, Lamotrigine
54
Phenytoin
- During an action potential voltage-dependent Na channel (closed, open, inactivated) - Na channels don't recover from inactivated state until membrane has repolarised - Binds to inactivated state and slows down its recovery
55
Mixed actions
Gabapentin, Valproate, Levetiracetam
56
Valproate effective for?
Tonic-clonic and absence (bipolar)
57
How is valproate taken?
Orally, well absorbed
58
Mechanism of action of valproate
- Inhibits Na channels - Decreased GABA turnover (inhibition of succinic semialdehyde dehydrogenase - inhibit GABA transaminase, increased synaptic GABA) - Blocks neurotransmitter release by blocking Ca2+ channels
59
Antiepileptics and pregnancy
Monotherapy, folic acid recommended, Phenytoin and Valporate not allowed, oxcarbamazepine
60
Foetal hydantoin syndrome caused by
Taking phenytoin (sometimes carbamazepine)
61
Foetal hydantoin syndrome symptoms
Intrauterine growth restriction with microcephaly, dysmorphic craniofacial features and limb defect (hypoplastic nails and distal phalanges), growth problems and developmental delay, heart defects and cleft lip
62
Foetal valproate syndrome (FVS)
6-9% risk of congenital defects
63
Optogenic stimulation used for
Partial seizures, use of halorhodopsin similar to GABAa hyperpolarise the neurone in reaction to yellow light
64
Epilespia partialis continua
Rare, recurrent motor epileptic seizures that are focal (hands and face)
65
Epilespia partialis continua caused by
Large, acute brain lesions from strokes
66
Treatment for Epilespia partialis continua
Medication and therapy-resistant, stop secondary generalisation

CM Clinical Symposia (24 decks)

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