epilepsy

Question 1

what counts as status epilepticus

Answer 1

Seizures which last more than 5 minutes (or more than one seizure in 5 min, without regain of consciousness)

Question 2

other name for grand mal seizure

Answer 2

tonic-clonic seizure

Question 3

what is tonic, what is clonic

Answer 3

tonic is tightening of muslces, eyes drifting upwards. clonic is jerking mvts and possible sphincter opening

Question 4

what are the 5 stages of a tonic-clonic seizure

Answer 4

Premonition (‘aura’ - a vague sense that a seizure is imminent; changes in sensation, intense emotion, mood change)
Pre-tonic-clonic phase (a few myoclonic jerks or brief clonic seizures)
Tonic phase (tonic contraction of the axial musculature; upward eye deviation and pupillary dilatation; tonic contraction of the limbs; cyanosis; respiratory muscle contraction - “epileptic cry”; tonic contraction of jaw muscles)
Clonic phase - jerks of increasing amplitude followed by relaxation (sphincter opening may occur)
Postictal period (generalized lethargy; decreased muscle tone, headaches, muscle soreness)

Question 5

epilepsy diagnosis

Answer 5

2 or more seizures more than 24h apart

Question 6

EEG between seizures looks

Answer 6

normal

Question 7

2 examples of structural changes in epilepsy

Answer 7

mossy fibres sprouting leads to aberrant pathways
loss of chandelier cells (GABAergic) leads to loss of inhibition

Question 8

where do chandelier cells have their effect

Answer 8

axon initial segmnet

Question 9

which receptors are involved in burst firing neurones in epilepsy

Answer 9

NMDA

Question 10

why would astrocyte deficiency/malfunction cause epilepsy

Answer 10

astrocytes clear up glutamate from synapse after action potential through EAAT1 and 2. Too much glutamate left hanging about can lead to aberrant action potentials

Question 11

which neurones are most involved in epilepsy

Answer 11

interneurones

Question 12

what is mTOR pathway

Answer 12

regulattor of growth and homeostasis - protein synthesis

Question 13

what is REST pathway- what conditions

Answer 13

leads to negative regulation
of the expression of many genes in the CNS

global ischemia, stroke, epilepsy, Alzheimer’s and Huntington’s disease.

Question 14

what do you need to think about re pharmacokinetics phenytoin, carbemazepine

Answer 14

CYP450 enhancer, so other drugs pt is on will be eliminated faster - less effective

Question 15

sodium channel antiepileptics

Answer 15

Phenytoin
Leads - lamotrigine
To - Topiramate
Less - lacosamide
Sodium - sodium valproate
Channel - carbemazapine
Zoom - zonisamide

Question 16

valproate age restric

Answer 16

no under 55 women unless 2 consultants agree no other effective option

Question 17

which antiepileptics target Ca channel. which sub-unit

Answer 17

Ethosuximide (used in absence seizures, targets T-type calcium channels)
Gabapentin and pregabalin (alpha2delta subunit of calcium channels; also enhanced GABA synthesis)

Question 18

benzo ending and mia

Answer 18

zepam GABA A receptor allosteric agonist

Question 19

What ion is transported in GABA channel

Answer 19

Cl-

Question 20

epileptic neuro transmitter drugs

Answer 20

Neurotransmitter release
Levetiracetam (protein SV2A; modulates neurotransmitter release)
Neurotransmitter uptake
Tiagabine (GAT-1 transporter)
Neurotransmitter metabolism
Vigabatrin (inhibition of GABA transaminase)
Neurotransmitter receptors
Perampanel (selective non-competitive antagonist of AMPA receptors)
Felbamate (NMDA receptors; also GABAA receptors?)

Question 21

tx status epilepticus

Answer 21

Benzodiazepines (buccal midazolam or rectal diazepam) are recommended by NICE as the first-line treatment for patients without intravenous access. If intravenous access were available, lorazepam would be the drug of choice.