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Onco/Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Causes of epilepsies?

A
  1. Gene mutations

2. Precipitating event (febrile seizure, brain trauma)

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2
Q

Which neurotransmitters are implicated in seizures?

A

GABA and glutamate
Underactivity of GABA (inhibitory) or overactivity of glutamate (excitatory) neurons.
Net effect = hyperexcitability

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3
Q

What is hypersynchrony?

A

Synchronous firing by large number of neurones due to unstable neuronal membrane function or imbalance GABA/glutamate. Terminated by opening voltage dependent Ca and K channels, preventing further spread. But scar tissue may form in area which seizure originates.

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4
Q

Types of generalized seizures? (6)

A
  1. ‘Grand Mal’ generalised tonic clonic
  2. Absence
  3. Myoclonic
  4. Clonic
  5. Tonic
  6. Atonic
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5
Q

Types focal seizures?

A
  1. Simple (awareness retained)
  2. Complex (impairment of awareness)
  3. Partial seizure with secondary generalization
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6
Q

What is the difference between generalised seizure and focal seizures?

A

Generalised seizures involves the whole brain- immediate loss of consciousness due to reticular formation involvement.

Focal (partial) seizure begins locally and remains localised. No loss of consciousness, short lived.
Symptoms are based on which brain regions are involved
Sensory- numbness, tingling
Motor- jerking, twitching of face
Autonomic- blushing, nausea, tachycardia
Psychic- hallucination

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7
Q

Symptoms of generalised tonic/clonic seizures?

A

Tonic: initial strong contraction, rigid spasm, involuntary cry, respiration stops; urination, defecation and salivation can occur - 1 min
Clonic: rapidly alternating muscular contraction and relaxation - 2-4 min

Unconscious for a few move minutes then gradually recover feeling ill and confused

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8
Q

Symptoms of absence seizures?

A

Stops activity, stares vacantly for <10 sec
Unaware of surounds and recover abruptly with no after-effects
Usually in children

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9
Q

Symptoms of myoclonic seizures?

A

Sudden bilateral jerks of muscle

Short lived, may be in clusters, often in infants

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10
Q

Symptoms of atonic seizures?

A

Akinetic - drop attacks

Sudden loss of muscle tone

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11
Q

Symptoms of tonic seizures?

A

Tone greatly increase in body - stiffening movements
Rigidity
Consciousness is usually preserved
Affects all/most of the brain - affecting both sides of the body

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12
Q

Symptoms of clonic seizures?

A

Rhythmic jerking movements of arms and legs
Rapidly alternating contraction and relaxation of the body
Movement cant be stopped by restraint

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13
Q

Why is status epilepticus a medical emergency?

A 
Prolonged continuos uninterrupted seizures (30 min+ )
Lack of oxygen and glucose
Increase glutamate release
Electrical imbalance opens membrane channels
Ca2+ influx
Triggers oxygen free radical formation
Brain becomes more electrically unstable
Cell injury
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14
Q

What is dravet syndrome?

A

Severe myoclonic epilepsy in infancy
Gene mutation in Na channel (SCN1A)

Poor development of language and motor skills

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15
Q

What factors can provoke seizures?

A
  • Sleep deprivation
  • Alcohol
  • Illicit stimulant drugs
  • Some medications
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16
Q

Which medications required TDM to access therapeutic levels?

A

Phenytoin
Ethosuximaide (rarely)
Carbamazepine

17
Q

Which medication need monitoring for compliance/drug interactions?

A

Carbamazepine

Sodium valproate

18
Q

What is the mode of action of barbiturates?

A

Prolong inhibitory postsynaptic potential by increasing the mean chloride channel opening time and hence the duration of GABA induced cell membrane hyperpolarisation

19
Q

What are 2 examples of barbiturates?

A

Phenobarbitone and primidone

20
Q

Why are benzodiazepines not suitable for long term use?

A
  1. Sedative effect

2. Development of tolerance

21
Q

MOA of acetazolamide?

A

Carbonic anhydrase inhibitor

22
Q

Common side effects of carbamazepine?

A 
Drowsiness
ataxia
dizziness
blurred vision
headache
Skin reactions

CYP3A4

23
Q

Why dose carbamazepine require concentration monitoring?

A

Metabolites posses anticonvulsant activity- auto induction
To measure steady state trough plasma concentration
Useful for determining compliance and interactions

24
Q

Which antiepileptic is commonly used for absence seizures?

A

Ethosuximide

25
Q

What type of seizure should lamotrigine be avoided in?

A

Myoclonic seizures - risk of aggravation

26
Q

Which antiepileptic medicaiton requires a loading dose?

A

Valproate

27
Q

When can antiepileptic therapy be discontinued?

A

2 years without seizure except in people with a high risk of occurance

Onco/Neuro (7 decks)

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