Epilepsy Flashcards
1
Q
the clinical manifestation of an abnormal and excessive excitations of a population of brain cells (cortical neurons)
A
Seizure
2
Q
sudden, violent, irregular movement of the limb or body, caused by involuntary contraction of muscles, associated with brain disorders e.g. epilepsy
A
Convulsions
3
Q
Hyperventilation triggers this type of seizure
A
Absence
4
Q
Are seizures caused by identified provocations (alcohol/drugs) considered epilespy?
A
NO
5
Q
What is the typical age of patients with seizures?
A
Bimodal peak = infancy and elderly
6
Q
Etiology of epilepsy that arises spontaneous, cause is unknown but likely related to genetic cause
A
Idiopathic etiology
7
Q
Etiology of epilepsy that is uncertain origin, no obvious cause
A
Cryptogenic etiology
8
Q
Etiology of epilepsy where there is evidence of underlying brain damage or cause
A
Symptomatic etiology
9
Q
site in the CNS from which the repetitive discharge originates
A
Focus
10
Q
This describes when with time, nerves near the focus are ‘recruited’ and begin the repetitive discharge (kindling)
A
Recruitment or spread
11
Q
the period after the seizure characterized by fatigue, amnesia, and difficulty focusing
A
Postictal depression
12
Q
What drug is used to treat Lennox-Gastaut syndrome?
A
Benzodiazepines
13
Q
Form of epilepsy with onset common between 1-6 years of age and in males
Characterized by intellectual disability, mixed seizures (tonic, atonic, atypical, etc), abnormal EEG activity of less than 2.5 Hz, and difficult management
A
Lennox-Gastaut syndrome
14
Q
Classification of seizures that begin locally and may have asymmetric manifestations
Types include simple and complex
A
Partial (focal) seizures
15
Q
Type of partial seizure that is without impairment of consciousness
A
Simple
16
Q
Type of partial seizure that is with impairment of consciousness
A
Complex
17
Q
This describes when partial seizures evolve over time to generalized seizures
Mechanism of evolution may be similar to the process of kindling
A
Secondarily generalized seizures
18
Q
Classification of seizures that originates in one part of one of the cerebral hemispheres; highly localized
A
Focal (partial)
19
Q
Classification of seizures that is diffuse and often involves both cerebral hemispheres
A
Generalized
20
Q
Is there loss of consciousness with generalized seizures?
A
is expected
21
Q
Is there loss of consciousness with simple partial seizures?
A
No
22
Q
Is there loss of consciousness with complex partial seizures?
A
yes
23
Q
Generalized non-motor seizures are primarily this type, and corresponds to the old term “petit mal”
A
Absence seizure
24
Q
Petit mal is a term corresponding to this type of seizure
A
Absence seizure
25
Characteristic 3-Hz spike-and-wave EEG pattern indicates this type of seizure
Absence seizures
26
What is the characteristic EEG pattern of absence seizures?
3-Hz spike-and-wave pattern
27
Type of generalized seizure with Lapse of consciousness, Cessation of purposeful behavior, and Motionless stare, may show brief upward roll of eyes
Absence seizure
28
Type of generalized seizure with stiffening and jerking
Loosely corresponds to “grand mal”
Tonic-clonic
29
Type of generalized seizure with stiffening and jerking
Tonic-clonic
30
Type of generalized seizure that loosely corresponds to "grand mal" seizure
Tonic-clonic
31
Type of generalized seizure with sudden, brief shock-like muscle contractions
Often triggered by strobing light and sound
Myoclonic
32
In tonic-clonic seizures, is the tonic or clonic phase first?
Tonic - tonic muscle contractions with arm and legs becoming extended
(clonic phase follows where tonic rigidity is interrupted by brief intermittent muscle relaxation)
33
Amnesia incontinence, headache, fatigue, and disorientation can occur in the postictal period after this type of generalized seizure
Tonic-clonic
34
Type of generalized seizure with sudden loss of tone in postural muscles
May be localized to head drop, limb drop, or slumping to ground
Sometimes called drop attacks or astatic seizures
Atonic
35
Type of generalized seizure that may present in clusters of up to 100 per episode and several clusters per day
Infantile spasms
36
Convulsion pattern of this type of generalized seizure includes sudden bending forward of body with stiffening of arms and legs
Infantile spasms
37
This type of diet may be helpful in epilepsy management
Ketogenic diet
(high in fats and low in carbs and protein)
38
Acidosis and ketosis are expected with this diet that may be helpful for epilepsy management
Ketogenic diet
39
Vagal nerve stimulator is most beneficial in this type of seizure
Absence
(also depression)
40
What are the 3 requirements for surgical treatment for epilepsy?
Absolute diagnosis of epilepsy
Failure on drug therapy trials
Clear identification of the electro-clinical syndrome
41
With epilepsy drugs, Never abruptly discontinue a drug after a patient has been taking it more than this long
2 weeks
42
What is the leading cause of treatment failure in epilepsy?
Noncompliance
43
If a patient misses a dose of their epilepsy drug, what should they do?
Take dose asap
Resume normal schedule with next dose
Do NOT double dose
44
This antigen is common in patients of Southeast Asia heritage, and predicts Stevens-Johnson risk of carbamazepine and phenytoin
HLA-B*1502
45
HLA-B*1502 antigen is common in patients this heritage, and predicts Stevens-Johnson risk of carbamazepine and phenytoin
Southeast Asia
46
HLA-B*1502 antigen is common in patients of Southeast Asia heritage, and predicts risk of this with use of carbamazepine and phenytoin
Stevens-Johnson syndrome
47
HLA-B*1502 antigen is common in patients of Southeast Asia heritage, and predicts Stevens-Johnson risk with use of either of these epilepsy drugs
Carbamazepine and Phenytoin
48
Is weight loss or gain a chronic effect of epilepsy drugs?
Weight gain
49
Is hypernatremia or hyponatremia a chronic effect of epilepsy drugs?
Hyponatremia
50
Interactions with other CNS depressants, Oral contraceptives may be less effective because of enzyme induction, Teratogenic effects and Coagulation disorders are shared toxicities of this type of drug
Epilepsy drugs
51
Antiepileptics may induce metabolism of these in oral contraceptives making them ineffective
Hormones
52
Do epilepsy drugs appear in breast milk?
Most do
53
3 epilepsy drugs that increase sperm abnormalities
Carbamazepine
Oxcarbazepine
Valproic acid
54
Epilepsy drug that may cause testicular atrophy and reduced testosterone
Valproic acid
55
Process by which a seizure or other brain event is both initiated and its recurrence made more likely
(Seizures that are not fully treated will generally become more intense)
If you can fully control seizures, you may be able to stop medications
Kindling
56
MOA of this antiepileptic drug is central inhibition of carbonic anhydrase that increases central CO2 levels that inhibit neuronal activity
Acetazolamide
57
MOA of Acetazolamide is central inhibition of this enzyme that increases central CO2 levels that inhibit neuronal activity
Carbonic anhydrase
58
MOA of Acetazolamide is central inhibition of carbonic anhydrase that increases central levels of this, which inhibits neuronal activity
CO2
59
Does the MOA of Acetazolamide involve central or peripheral inhibition of carbonic anhydrase?
Central
60
What is the MOA of Acetazolamide?
Central inhibition of carbonic anhydrase
(increases central CO2 levels that inhibit neuronal activity)
61
Does Acetazolamide have short or long duration of action?
Short
62
What limits the use of Acetazolamide use in epilepsy?
Rapid development of tolerance
63
Antiepileptic drug with use limited to epilepsy of periodic and predictable occurrence
Acetazolamide
64
What is the MOA of Benzodiazepines?
Allosteric enhancement of GABA inhibition
65
The MOA of Benzodiazepines involves allosteric enhancement of this
GABA inhibition
66
Antiepileptic drug that allosterically enhances GABA inhibition
Benzodiazepines
67
Tolerance may develop abruptly after long-term use, so avoid using this class of drugs to chronically treat most seizures
Benzodiazepines
68
What is the MOA of Carbamazepine?
Blocks sodium channels
69
Carbamazepine blocks these channels
Sodium
70
2 anti-epileptic drugs with bone marrow depression, hepatotoxicity, and teratogenicity as adverse effects
Carbamazepine
Valproic acid / Divalproex sodium
71
What is the first line drug for partial and generalized seizures?
Carbamazepine
72
Anti-epileptic drug that is an auto-inducer with active metabolite
Carbamazepine
73
These are adverse effects of this anti-epileptic drug:
Bone marrow depression (black box warning)
Asian patients (black box warning for life threatening rash, screen for HLA-B 1502 variant)
Hepatotoxicity
Teratogenicity (1% spinal bifida)
Carbamazepine
74
Hyponatremia limits use of this anti-epileptic in elderly
Oxcarbazepine
75
This adverse effect of Oxcarbazepine limits use in the elderly
Hyponatremia
76
Anti-epileptic drug with MOA of inhibiting T-type calcium channels
Ethosuximide
77
What is the MOA of Ethosuximide?
Inhibition of T-type calcium channels
78
Ethosuximide inhibits this type of channel
T-type calcium channels
79
Ethosuximide is the first line drug for this type of seizure
Absence
80
First line drug for absence seizures
Ethosuximide
81
Anti-epileptic drug that blocks N-methyl-D-aspartate receptors at the glycine binding site
Felbamate
82
Felbamate blocks this receptor
N-methyl-D-aspartate receptors
83
What is the MOA of Felbamate?
Blocks NMDA receptors at the glycine binding site
84
Aplastic anemia (1/3k) and liver failure (1/10k) are black box warnings of this anti-epileptic
Typically within 1st year of therapy
Felbamate
85
What are two black box warnings of Felbamate?
Aplastic anemia (1/3k)
Liver failure (1/10k)
86
Anti-epileptic that is reserved for patients not responding to other less dangerous drugs
Felbamate
87
Anti-epileptic that binds to a specific receptor to inhibit calcium channels
Gabapentin
88
What is the MOA of Gabapentin?
Binds to a specific receptor to inhibit calcium channels
89
Gabapentin binds to a specific receptor to inhibit this type of channel
Calcium channels
90
Withdrawal from this anti-epileptic is characterized by anxiety, insomnia, sweating and pain
Gabapentin
91
Anti-epileptic that is also indicated for chronic pain, migraines, spasticity, bipolar disorder, psychosis, and restless leg syndrome
Gabapentin
92
Anti-epileptic that blocks Na+ channels suppressing the release of glutamate and aspartate, thus decreasing seizure frequency
Lamotrigine
93
Lamotrigine blocks these channels, suppressing the release of glutamate and aspartate
sodium channels
94
Lamotrigine blocks sodium channels, suppressing the release of these 2 compounds
Glutamate and Aspartate
95
What is the MOA of Lamotrigine?
Blocks Na+ channels suppressing the release of glutamate and aspartate
96
Rash early in therapy that may become severe (life threatening) and dose limiting is a black box warning for this anti-epileptic
Lamotrigine
97
Anti-epileptic that has additive toxicity with other antiepileptic drugs
Lamotrigine
98
Anti-epileptic drug that binds synaptic vesicle protein 2A to modulate neurotransmitter release
Levetiracetam
(and Brivaracetam)
99
Levetiracetam (and Brivaracetam) bind to this to modulate neurotransmitter release
Synaptic vesicle protein 2A
100
Levetiracetam (and Brivaracetam) bind to synaptic vesicle protein 2A to modulate this
Neurotransmitter release
101
What is the MOA of Levetiracetam (and Brivaracetam)?
Bind synaptic vesicle protein 2A to modulate neurotransmitter release
102
Cognitive disruption in adults and Behavioral disruption in children are adverse effects of this anti-epileptic
Levetiracetam
(and Brivaracetam)
103
High levels of this anti-epileptic appear in breast milk
Levetiracetam
(and Brivaracetam)
104
This antiepileptic drug antagonizes post-synaptic AMPA receptors, reducing glutamate-mediated neuronal activation
Perampanel
105
Perampanel antagonizes post-synaptic receptors of this type, reducing glutamate-mediated neuronal activation
AMPA
106
Perampanel antagonizes or agonizes post-synaptic AMPA receptors?
Antagonizes
107
Perampanel antagonizes post-synaptic AMPA receptors, reducing neuronal activation that is mediated by this
glutamate
108
What is the MOA of Perampanel?
Antagonizes post-synaptic AMPA receptors, reducing glutamate-mediated neuronal activation
109
What is the most important MOA of Phenobarbital?
Enhancement of GABA inhibition
(also blocks calcium channels)
110
Anti-epileptic that enhances GABA inhibition, and blocks calcium channels, blocking excitatory processes (glutamate release)
Phenobarbital
111
Serious rash and other hypersensitivity disorders are adverse effects of this anti-epileptic
Phenobarbital
112
Anti-epileptic that may cause:
Sedation, respiratory and cardiac depression
Cognitive disruption and hyperactivity in children
Phenobarbital
113
Phenobarbital can not be used in patients with this condition
Porphyria
114
This anti-epileptic cannot be used in patients with porphyria
Phenobarbital
115
This anti-epileptic is oxidized to phenylethylmalonamide (PEMA) and phenobarbital, which are all active
Primidone
116
Which of the following has the longest duration: Primidone, PEMA, or phenobarbital?
Phenobarbital
(its blood level is 2x that of primidone)
117
Primidone is oxidized to these 2 compounds
Phenylethylmalonamide (PEMA)
Phenobarbital
118
Anti-epileptic that disrupts sodium channel activation and mainly blocks spread of seizure
Phenytoin
119
This anti-epileptic follows zero order kinetics at therapeutic levels
Phenytoin
120
Gingival hyperplasia is an adverse effect of this anti-epileptic
Phenytoin
121
Elevated cardiac toxicity when used intravenously is a black box warning of this anti-epileptic
Phenytoin
122
Dermatological toxicity in Asian patients with HLA-B*1502 variant is an adverse effect of this anti-epileptic
Phenytoin
123
What is the MOA of phenytoin?
Disruption of Na+ channel activation and mainly blocks spread of seizure
124
Phenytoin disrupts this type of channel
Sodium
125
Pregabalin disruption of this appear most important in its MOA
Calcium
126
Anti-epileptic that has risk of respiratory depression when in combination with opioids
Pregabalin
127
Pregabalin has risk of respiratory depression when in combination with these drugs
Opioids
128
Pregabalin has risk of this when used in combination with opioids
Respiratory depression
129
Anti-epileptic that:
Slows Na+ channel reactivation
Enhances GABA inhibition
Modules Ca++ channels
Blocks glutamate receptors
Topiramate
130
Topiramate slows reactivation of these channels
Sodium
131
Topiramate blocks these receptors
Glutamate
132
Anti-epileptic that shows saturable binding to RBC
Topiramate
133
Topiramate shows saturable binding to this
RBC
134
Impaired concentration, memory difficulties, attentional deficits, confusion, and Nephrolithiasis are adverse effects of this anti-epileptic
Topiramate
135
First line drug for partial and generalized seizures that is also used in migraines and pain management
Topiramate
136
Anti-epileptic drug that:
Slows Na+ channel reactivation
Enhances GABA inhibition
Modulates Ca++ channels
Direct membrane stabilizer
Valproic acid / Divalproex sodium
137
Pancreatitis is a black box warning of this anti-epileptic
Valproic acid / Divalproex sodium
138
Valproic acid / Divalproex sodium use should be avoided in patients with this type of disease (black box)
Mitochondrial disease
139
Anti-epileptic with black box warning against use in patients with mitochondrial disease
Valproic acid / Divalproex sodium
140
Pancreatitis, weight gain, hepatotoxicity, teratogenicity and bone marrow suppression are adverse effects of this anti-epileptic
Valproic acid / Divalproex sodium
141
This anti-epileptic is generally considered as the drug of choice for patients with generalized and unclassified epilepsies – but safety is a powerful consideration
Valproic acid / Divalproex sodium
142
Anti-epileptic that should not be used with clonazepam due to intense depression and absence epilepsy side effects
Valproic acid / Divalproex sodium
143
Valproic acid / Divalproex sodium should not be used with this drug, due to intense depression and absence epilepsy with concurrent use
Clonazepam
144
Valproic acid / Divalproex sodium should not be used with clonazepam due to side effects of intense depression and this type of epilepsy
Absence
(even in cases where a patient has never had it before)
145
Anti-epileptic that is an irreversible inhibitor of GABA-transaminase, a primary GABA degradation enzyme
Vigabatrin
146
Vigabatrin is an irreversible inhibitor of this enzyme
GABA-transaminase
(a primary GABA degradation enzyme)
147
What is the MOA of Vigabatrin?
Irreversible inhibitor of GABA-transaminase
(a primary GABA degradation enzyme)
148
Anti-epileptic that may cause permanent visual disturbance and vision loss (black box warning)
Vigabatrin
149
Anti-epileptic that may aggravate absence and myoclonic seizures in patients with generalized seizures
Vigabatrin
150
Anti-epileptic that may aggravate absence and myoclonic seizures in patients with generalized seizures, and also may intensify depression, psychosis or behavioral disturbances
Vigabatrin
151
A black box warning of Vigabatrin is that is may cause loss of this
Vision
152
Anti-epileptic indicated for seizures associated with CDKL5 deficiency disorder in patients >2 years age
Ganaxolone
153
Anti-epileptic that enhances the inhibitor effects of GABAa receptors, stabilizing neuronal activity and reducing seizure frequency
Ganaxolone
154
Life-threatening neurological condition characterized by 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness
Status epilepticus
155
Propofol anesthetic is an alternative drug used to treat this condition
Status epilepticus
156
This drug is an alternative used to treat Status epilepticus
Propofol
157
Spina bifida may occur from use of this drug's teratogenicity
Carbamazepine
158
Anti-epileptic that is a powerful inducer and should not be used in porphryia
Phenobarbital
159
This drug is the most teratogenic of all anti-seizure compounds
Valproic acid / Divalproex sodium
