Epilepsy

Question 1

A finite clinical manifestation of abnormal and excessive excitation of a population of cortical neurons is called a?

Answer 1

Seizure

Question 2

A syndrome characterized by chronic, recurrent seizures unprovoked by systemic neurologic insults is called?

Answer 2

Epilepsy

*Epileptogenesis is the sequence of events that converts normal neuron network into hyperexcitable

Question 3

Metabolic/electrolyte imbalance, intoxication, sedatives/ethanol, sleep deprivation, reduction in treatment, hormonal variation, stress, hypoxia, fever/infection and concussion are all common what?

Answer 3

Seizure precipitants

Question 4

What are the two main classes of seizures?

Answer 4

1-Partial seizures

2-Generalized seizures

Question 5

What are the 3 types of partial seizures?

Answer 5

1-Simpe partial (aware and responsive, focal)
2-Complex partial (initially aware, focal with minor spread
3-Secondarily generalized (initially aware, then loss of responsiveness as seizure generalizes)

Question 6

Characterized by loss of awareness and responsiveness generalized from onset, what are the 3 types of Generalized Seizures?

Answer 6

1-Tonic-clonic (T=stiff, C=jerking, AKA grand mal)
2-Absence (Petit mal)
3-Atonic (drop)

Question 7

Which type of seizure is focal, and has normal awareness, memory and consciousness throughout seizure?

Answer 7

Simple Partial Seizures

*Shortest duration (60-90 sec), motor and somatosensory

Question 8

Which type of seizure has localized onset and spreads, and has awareness that may be impaired as it progresses?

Answer 8

Complex Partial Seizure

*15-120 sec

Question 9

Which type of seizure begins as simple and/or complex partial seizures but fully generalize with Tonic and Clonic phases?

Answer 9

Secondarily Generalized Seizures

*30-240 sec, has Postictal phase of confusion and somnolence

Question 10

Which type of seizure is characterized as a vacant stare that may appear as a loss of attention?

Answer 10

Generalized Absence Seizure

Question 11

Which type of seizure is generalized from onset and involves stiffening and jerking?

Answer 11

Generalized Tonic-Clonic Seizure

*Often lethargic and confused after and wants to sleep

Question 12

What is the main problem of ASDs that are available?

Answer 12

They treat symptoms and 1/3 of patients are refractory to all treatments available

Question 13

What are the 3 main mechanisms for ASDs?

Answer 13

1-Enhancement of GABA-mediated inhibition
2-Reduction of excitatory transmission
3-Modification of ionic conductance

Question 14

What are the 5 main drugs used to treat epilepsy?

Answer 14

1-Carbamazepine
2-Phenytoin
3-Topiramate
4-Valproate
5-Ethosuximide

Question 15

Which ASD is indicated for simple and complex Partial and generalized tonic-clonic seizures and is associated with Stevens Johnson syndrome?

Answer 15

Carbamazepine

*Avoid in absence patients (may aggravate) High drug-drug interaction rate

Question 16

What is the Mechanism of Action of Carbamazepine?

Answer 16

Blocks use-dependent voltage gated Na channels to inhibit repetitive firing. similar to Phenytoin

Question 17

Which syndrome is a mild form of toxic epidermal necrolysis that results in painful lesions of the mucous membranes?

Answer 17

Stevens-Johnson Syndrome

*Slow acetylators, immunocompromised, sodium channel blockers and radiotherapy patients at higher risk

Question 18

What type of juice blocks CYP3A4 resulting in increased plasma levels of carbamazepine?

Answer 18

Grapefruit juice

Question 19

Which ASD is indicated for uncomplicated absence seizures only and has a 40 hour half-life?

Answer 19

Ethosuximide

*minor weight loss. reduces T-type Ca channel currents

Question 20

Which ASD is indicated in Simple and complex partial and generalized tonic-clonic seizures, causes gingival hyperplasia and has zero-order kinetics at high doses?

Answer 20

Phenytoin

*not recommended for absence patients. blocks Na channel

Question 21

Which ASD is indicated in simple and complex partial generalized tonic-clonic, and lennox-gastaut syndrome as is associated with weight loss and word recall problems?

Answer 21

Topiramate

*increases metabolism of estrogen thus affecting birth control

Question 22

What is the mechanisms of action of Topiramate?

Answer 22

Broad Specturm- Blocks Na channels, inhibits Ca currentsf, AMPA/Kainate receptors and potentiats GABA currents

Question 23

Which ASD is indicated for generalized complicated absence, atypical absence, myoclonic tonic clonic and simple and complex partial seizures and is associated with weight gain and Reye-like syndrome?

Answer 23

Valproic acid

*contraindication for hepatic disease. increased neural tube defects

Question 24

What is the mechanisms of action of Valproic Acid?

Answer 24

Broad spectrum- blocks VGSC, reduces NMDA currents, Increases GABA-mediated Cl currents

Question 25

A category D risk, which drug is associated with Spina bifida and other birth defects?

Answer 25

Valproate

Question 26

Which three drugs are indicated for Partial seizures?

Answer 26

1-Carbamazepine
2-Phenytoin
3-Topiramate (if secondarily generalized)

Question 27

Which two drugs are indicated for generalized onset tonic clonic seizures?

Answer 27

1-Valproate

2-Topiramate

Question 28

Which two drugs are indicated for absence seizures?

Answer 28

1-Ethosuxmide (Uncomplicated)

2-Valproate (Complicated)

Question 29

What are 5 important dental considerations for those with Epilepsy?

Answer 29

1-Increased decay
2-Increase fracture risk due to vitamin D deficiency
3-Gingical Hyperplasia
4-Impaired wound healing/prolong bleeding
5-Increase drug interactions