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BB2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

A neurological disorder representing a brain state supporting recurrent unprovoked seizures

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2
Q

What are seizures?

A

Abnormal, paroxysmal changes in electrical activity of the brain
- reflect large synchronous discharges of neuronal networks

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3
Q

What is elieptogenesis?

A

Where normal brain function generates abnormal electrical activity

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4
Q

What is a focal onset epileptic seizure?

A

Initially affects one hemisphere of the brain

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5
Q

What is a generalised onset epileptic seizure?

A

seizures affecting both sides of the brain

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6
Q

What are the features of a tonic-clonic seizure?

A
  • premonition
  • pre-tonic-clonic phase (myoclonic jerks)
  • tonic phase
  • clonic phase
  • postictal period (lethargy, decreased muscle tone, headaches, muscle soreness)
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7
Q

What does the tonic phase consist of?

A

Tonic contraction of axial musculature

  • upward eye deviation and pupillary diltation
  • tonic limb contraction
  • cyanosis
  • respiratory muscle contraction
  • epileptic cry (tonic contraction of jaw muscles)
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8
Q

What is clonic?

A

Arms and legs jerk rapidly and rhythmically followed by relaxation

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9
Q

What are myoclonic jerks?

A

Brief shock like jerks of a muscle group

person usually awake

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10
Q

What is atonic jerk?

A

Muscles suddenly become limp

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11
Q

How does a clinical history help you diagnose epilepsy?

A
  • occurrence of 2 or more seizures

- account of witnesses is essential

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12
Q

What are the main structural changes in epilepsy?

A
  • reorganisation of tissue in temporal lobe epilepsy
  • sprouting of mossy fibres of granule cells (reverbant excitatory circuits)
  • neurogenesis (new neuron formation changes circuits)
  • loss of chandelier cells (increases abnormal excitatory activity)
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13
Q

How does reorganisation of tissue in temporal lobe epilepsy manifest?

A
  • loss of CA2 and CA3 hippocampal areas

- sclerotic hippocampus

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14
Q

What are chandelier cells?

A

Special population of interneurons which are GABAergic cells

- control activity of cortical pyramidal cells by synapsing on axons

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15
Q

Which conditions have a high risk of developing epilepsy?

A
  • craniotomy
  • traumatic brain injury
  • stroke
  • aneurysm
  • brain tumour
  • CNS infection
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16
Q

Which cellular mechanisms are linked to epilepsy development?

A
  • abnormal neuronal excitability (ion channels)
  • decreased neuronal inhibition (GABA-dependent)
  • increased neuronal excitation (glutamate dependent)
  • glial abnormalities
17
Q

What do glial cells do to glutamate?

A

Help transport/clear it through glutamate transporters -EAAT1 and 2

18
Q

What is a channelopathy?

A
  • genetic cause of epilepsy
  • deficiency of sodium/potassium/calcium/GABA channels
  • imbalance in influx/efflux = paroxysmal electrical activity
19
Q

Which drugs work on the sodium channels?

A
  • phenytoin
  • carbamazepine
  • sodium valproate
  • lamotrigine
  • topiramate
  • lacrosamide
20
Q

What is the mechanism of action of phenytoin?

A
  • stabilises inactivated state of channels
  • zero order: constant amount of drug eliminated per time units (saturation easy but toxicity risk)
  • teratogenic
  • liver enzyme induction
  • DO NOT USE IN ABSENCE SEIZURES
21
Q

What is the mechanism of carbamazepine?

A
  • stabilises inactivated state of channels
  • liver enzyme induction
  • DO NOT USE IN ABSENCE SEIZURES
22
Q

When is sodium valproate used?

A

In all types of seizures

23
Q

How does lamotrigine work?

A
  • presynaptic inhibition of glutamate release
24
Q

How does topiramate work?

A

Increases GABA transmission and inhibits glutamate (AMPA)

25
Q

How does lacrosamide work?

A

Binds to inactivated state of channels

26
Q

Which drugs are benzodiazepines?

A

Clonazepam - sedation

27
Q

What do benzodiazepines do?

A
  • positive allosteric modulators

- enhance functioning of GABA receptors

28
Q

Which drugs act on barbiturates? (GABA receptor)

A

Phenobarbitone - liver enzyme induction

29
Q

Which drugs acts on calcium channels?

A

Zonisamide
Ethosuximide
Gabapentin (Pregabalin)

30
Q

How does zonisamide work?

A

Blocks calcium channels

31
Q

How does ethosuximide work?

A
  • used in absence seizures

- blocks T-type calcium channels

32
Q

How does gabapentin work?

A

Blocks alpha2delta2 subunit of calcium channels

- pregabalin increases GABA levels

33
Q

Which drugs affect neurotransmitter release?

A

Levetiracetam - bonds to synaptic proteins SV2a which modulates neurotransmitter release

34
Q

Which drugs affect neurotransmitter uptake?

A

Tiagabine - inhibits GAT-1 transporter for GABA (involved in removing GABA from synaptic cleft)

35
Q

Which drugs affect neurotransmitter synthesis?

A

Vigabatrin - inhibits GABA transaminase, protects GABA

36
Q

Which drugs affect neurotransmitter receptors?

A

Perampanel - selective non-competitive antagonist of AMPA receptors
Felbamate - NDMA receptors

37
Q

What surgery options are there?

A

Love resection
Corpus callostomy
Functional hemispherectomy

38
Q

What other treatment methods are there?

A

Vagal nerve stimulation
Deep brain stimulation
Ketogenic diet

39
Q

What is status epilepticus?

A

medical emergency

- treatment of lorazepam and diazepam

BB2 (31 decks)

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