Epilepsy

Question 1

Epileptic seizure definition

Answer 1

Seizure from excessive/hypersynchronous activity of neurones in the brain

Question 2

Epileptic disorder

Answer 2

Chronic neurological condition characterised by recurrent epileptic seizures

Question 3

Symptomatic epilepsy vs idiopathic

Answer 3

symptomatic indicates a probable cause exists, idiopathic indicates no obvious cause so usually genetic

Question 4

Simple partial seizure

Answer 4

Consciousness preserved, can develop into other seizure

Question 5

Seizure definition

Answer 5

Sudden, short event with change in a person’s awareness, what they’re doing, their feelings or behaviour

Question 6

Convulsion definition

Answer 6

Form of seizure involving excessive abnormal muscle contractions

Question 7

Complex partial seizure

Answer 7

Unconscious seizure, can involve automatic movements and may not remember it
Often temporal lobe epilepsy

Question 8

Secondary generalised seizure

Answer 8

Partial seizure spreads to involve both hemispheres, unconscious

Question 9

Primary generalised seizure types

Answer 9

Tonic - sustained inc in muscle contraction
Atonic - sudden loss of muscle tone
Myoclonic- sudden involuntary muscle contraction
Tonic-Clonic- alternating tonic, clonic phases
Absence seizure- brief consciousness interruption, involves thalami-cortical circuits (petit-mal)

Question 10

Status epilepticus

Answer 10

Prolonged/clustered seizures can develop into non-stop, requires hospital intervention to stop

Question 11

Ictus on EEG

Answer 11

Sudden event such as seizure

Question 12

Interictal spike EEG

Answer 12

Brief EEG spike occurring between seizure activity

Question 13

Paroxysmal depolarising shift

Answer 13

sustained suprathreshold terminated by prolonged afterhyperpolarisation

Question 14

Epileptogenesis (PDS) causes

Answer 14

Changes in Ca/Na/K channel activities
Inc EPSPs or dec IPSPs
Changes in synapse connectivity e.g. more than normal

Question 15

Voltage + use-dependent Na channel inhibitors MOA

Answer 15

Phenytoin, carbamazepine, valproate, topiramate, lamotrigine block Na channels depending on use so block high-frequency discharge only

Question 16

Voltage-gated Ca channel blocker MOA

Answer 16

Ethosuximide inhibits T-type Ca channels in thalamic neurones

Question 17

Ca channel blocker use

Answer 17

Ethosuximide used in absence epilepsy

Question 18

Valproate MOA

Answer 18

Inhibits GABA-transaminase which breaks down GABA, also blocks Na channels

Question 19

BDZ MOA

Answer 19

Diazepam, clonzepam allosterically modulate GABA receptors at BDZ site to increase Cl entry

Question 20

Barbiturates MOA

Answer 20

Phenbarbitone increases Cl flux directly and enhances GABA effect

Question 21

Tiagabine MOA

Answer 21

Inhibits GABA uptake

Question 22

Partial seizure treatment

Answer 22

Carbamazepine, valproate (lamotrigine in women of childbearing potential), phenytoin

Question 23

Generalised tonic-clonic treatment

Answer 23

Valproate (lamotrigine in women of childbearing potential), carbamazepine

Question 24

Generalised absence treatment

Answer 24

Ethosuximide

Question 25

Status epilepticus treatment

Answer 25

Clonazepam, lorazepam

Question 26

Valproate SE

Answer 26

Teratogenic, more so than other AEDs

Question 27

Carbamazepine SE

Answer 27

mild neurotoxicity (dizziness, nausea, drowsiness, ataxia)
Liver enzyme inducer (other drugs metabolised quicker)

Question 28

Liver enzyme inducers (metabolises other drugs quicker e.g. oral contraceptives)

Answer 28

phenytoin, phenobarbital, carbamazepine