Epilepsy

Question 1

Aetiology of epilepsy- Genetic

Answer 1

can be caused by spontaneous genetic mutations:
- for early onset epilepsy- X-linked CDKL5 (cyclin dependent kinase like 5) mutations GABA (CL-)or ACH receptor genes mutation,
VNaC, VKC mutation
- 85% of Dravet syndrome (infant)- Sodium channel α1A subunit (SCN1A) gene mutations

Question 2

Aetiology of epilepsy- strucutral

Answer 2

• Birth trauma or anoxia (low O2)
• Congenital abnormalities (during birth and development)
• Traumatic head (brain) injures
• Disease: brain tumors (60%), meningitis, brain abscess, viral infection HIV, TB
• Stroke in Elderlies - neurodegenerative
• cerebral vascular malformations - low blood perfusion in brain - ischaemic hypoxia

Question 3

Aetiology of epilepsy- metabolic

Answer 3

• cerebral folate deficiency
• pyridoxine deficiency
• GLUT1 transporter deficiency (hypog in brain, give ketone bodies as alternative E source)
• mitochondria disorder (avoid valproate)
• biotinase deficiency
  GIVE WHAT IS IN DEFICIET

Question 4

Aetiology of epilepsy- immune cells

Answer 4

auto-immune epilepsy
Limbic epi resulting from
- Paraneoplastic syndrome (unsual sub e.g. horomones, ab, circulate in body due to cancer)
- Voltage gated potassium channel (VGKC)complex antibodies
- NMDA receptor antibodies

Question 5

Aetiology and Precipitants – Drugs Lowering Seizure Threshold (bad)

Answer 5

• alcohol, w/d of alcohol
• substances misuse
• BZ
• bupropion - smoking cessation drug, NDSI
• antidepressants TCA, NSRI
• ABx
• antipsychotics

Question 6

Status epilepticus may present as:

Answer 6

1. Convulsive status epilepticus
2. Non convulsive status epilepticus – continuous or fluctuating epileptic twilight state
3. Repeated focal seizures not associated with altered awareness

Question 7

Possible Triggers of Seizures

Answer 7

poor sleep, stress, anxiety, fever, excessive alcohol consumption,
5% of cases, flashing/flickering lights
women- hormonal cycle.
Reading- diff colours on pages
Missing doses of anti-epileptic medication

Question 8

what are the possible trt for seizure?

Answer 8

• med
• surgery
• vagus nerve stimulation
• psychological trt CBT, relaxation therpay

Question 9

Slow sodium channel blockers:

Answer 9

Lacosamide

Question 10

Voltage gated potassium channel opener

Answer 10

retigabine

Question 11

Low voltage CA channel blocker

Answer 11

Ethosuximide
in generalised absence seizures. Calcium channel blockers inhibit slow depolarisations that are required to create spike bursts.

Question 12

High voltage calcium channel blockers

Answer 12

gabapentin & pregabalin

Question 13

Synaptic vesicle protein (SV2A) modulators

Answer 13

Brivaracetam and levetiracetam

Question 14

Fast sodium channel blockers include:

Answer 14

Carbamazepine, eslicarbazepine, oxcarbazepine phenytoin, and rufinamide.

Question 15

why is pyridoxine useful in treating seizure

Answer 15

Pyridoxine is a coenzyme for glutamic acid decarboxylase (GAD), the enzyme required for GABA synthesis. Pyridoxine deficient infants lack the capacity to synthesize GABA normally and are prone to seizures.

Question 16

selective non-competitive AMPA- receptor antagonist

Answer 16

Perampanel

Question 17

NMDA /KAINET antagonist

Answer 17

topiramate

Question 18

Broad Spectrum AED

is it important for pt to maintain on a specific brand for these med?

Answer 18

V NA C blockers
phenytoin, lamotrigine, valproate not carbamazepine
perampanel - ampa antag
topiramate - nmda and kainate antag
levetiracetam
phenobarbital
maintain on brand IS IMPORTNAT

Question 19

narrow spectrun for focal seizure
for generalised absence seizure
is it important for pt to maintain on a specific brand for these med?

Answer 19

carbamazepine 
V CA C blockers: pregabalin, gabapentin
GABA transaminase inhibitor: viagabatrin
GABA reuptake inhibitor: tiagabine 
ethosuxiamide for absence 
NOT important

Question 20

when to initiate AED?

what are the aim for medications

Answer 20

Start after second seizure!
Aim for monotherapy
Combination therapy should only be added on when monotherapy fails.

Question 21

Cochrane review concluded what

Answer 21

levetiracetam suitable for focal seizures
lamotrigine and levetiracetam suitable alternatives for generalised tonic-clonic seizures particularly for women of childbearing age for whom sodium valproate may not be an appropriate treatment option

Question 22

pt factors to look out for when rx AED

Answer 22

Be aware of patient factors, e.g. age, gender, type of seizure, concomitant medication, allergies
rash or hypersensitivity 
weight
RF
LF

Question 23

what are the well tolerated add-on therapy

Answer 23

levetiracetam, gabapentin, pregabalin

Question 24

Drugs that cause weight gain

Answer 24

(valproic acid, gabapentin, pregabalin, carbamazepine, retigabine and perampanel),

Question 25

Enzyme inducing AEDs

Answer 25

carbamazepine, phenobarbital, phenytoin and primidone (barbiturate class)

Question 26

Treatment withdrawal process req

Answer 26

Patients should have been seizure free for at least 2 years, done slowly (at least 2-3 months) and reducing one agent at a time.

Question 27

there are TDM established values for which two AED?

Answer 27

carbamazepine (some patients) and phenytoin.