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Block 3: Pathophysiology and pharmacology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the main categories of epilepsy?

A

Focal
Generalised
Unknown

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2
Q

What is a focal aware seizure?

A

No loss of consciousness or post-ictal confusion

Symptoms dependent on focal site - commonly temporal lobe (due to plasticity leading to over-excitation)

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3
Q

What are the signs and symptoms of a seizure originating in the frontal lobe?

A

Motor seizures - often bilateral

Including kicking, cycling, violent movements

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4
Q

What are the signs and symptoms of a seizure originating in the parietal lobe?

A

Sensory (e.g. tingling or warm sensation)

Auras (e.g. nausea, sinking, choking, body distortion)

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5
Q

What are the signs and symptoms of a seizure originating in the occipital lobe?

A 
Visual hallucinations (can be simple or complex) 
Black outs 
Visuo-spatial distortion 
Headache 
Nausea
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6
Q

What is non-epileptic attack disorder (NEAD)?

A

Characterised by similar symptoms to a tonic-clonic seizure however with no physical reason/ change in electrical activity in brain

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7
Q

What are Jacksonian seizures?

A

Short-lasting rippling effect as activity passes over cortical region.
Can be motor or sensory.

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8
Q

What is a generalised tonic clonic seizure?

A

No warning of onset
Tonic phase can involve whole body stiffness, cyanosis, loss of bladder control
Clonic phase involves muscle jerks
Post-ictal phase can include unconsciousness, muscle relaxation, slow regain of consciousness, headaches, aching limbs, no recall of episode

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9
Q

What is a generalised absence?

A

Low level activity
Individual appears to ‘switch off’ and can not be alerted or woken up
More common in girls and tends to be most common in children (onset age 6-12)

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10
Q

What is a status epilepticus?

A

Generalised tonic clonic activity
Ictal period of more than 5 minutes OR repeated seizures with no recovery between for more than 30 minutes

MEDICAL EMERGENCY

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11
Q

What are the sub-types of generalised seizure according to the ILAE?

A

Motor or non-motor (absent) seizures

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12
Q

What are the characteristics of a focal to bilateral tonic clonic seizure?

A

Focal seizure progressing to a generalised seizure as activity from the thalamus projects to other regions.
Can experience auras prior to onset.
Can have unilateral motor effects.

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13
Q

How is status epilepticus classified?

A

Prolonged seizure state

ICD-10, G41

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14
Q

What is a generalised myoclonic seizure?

A

Sudden jerk movements

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15
Q

What is a generalised clonic seizure?

A

Repeated twitches and jerks (with no stiffness)

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16
Q

What is a generalised tonic seizure?

A

Whole body stiffness

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17
Q

What is a generalised atonic seizure?

A

Loss of muscle tone
‘Drop attacks’
Quick recovery

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18
Q

How can NEAD be diagnosed?

A

Video EEG

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19
Q

How does non-epileptic attack disorder appear on EEG?

A

Normal brain activity

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20
Q

What are the advantages of EEG?

A

Useful for investigating gross cortical activity
Non-invasive/ painless
Can be used over long periods of time (e.g. video EEG)
Cost effective

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21
Q

What is the aetiology of seizures?

A

Reduced GABAergic transmission and K+ channel activity
Increased ACh transmission and Na+ channel activity
Channelopathies - mutations in K+, Na+, ACh and GABA receptors linked to congenital forms of seizures

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22
Q

What are the signs and symptoms of a seizure originating in the temporal lobe?

A

Auras
Deja vu/ Jamais vu
Emotional changes
Oral automatisms

23
Q

What are the differences between epileptic seizures and a NEAD seizure?

A

Eyes: open (epileptic) vs closed (psychogenic/ NEAD)
Memory: no memory (epileptic) vs memory of seizure (NEAD)

24
Q

How can EEG be used to diagnose epileptic seizures?

A

Determines type through distinct patterns and pinpointing focal activity (and progression of seizure throughout brain)

25
Q

What are EEGs recording?

A

Changes in gross current flow

Levels of synchrony between neurons causes changes in patterns (firing together causes larger amplitude oscillations)

26
Q

What brain waves can be seen on EEG?

A 
Alpha 
Beta
Gamma 
Theta 
Delta
27
Q

How are alpha waves characterised?

A

8-13 Hz
Mainly occipital activity
Eyes shut/ meditation

28
Q

How are beta waves characterised?

A

> 14 Hz
Parietal and frontal activity
Slow wave sleep

29
Q

How are gamma waves characterised?

A

40 Hz

Learning and memory

30
Q

How are theta waves characterised?

A

4-7 Hz
Parietal and temporal activity
Alertness, learning and memory

31
Q

How are delta waves characterised?

A

<3.5 Hz
Cortical activity
Deep sleep or coma

32
Q

What are the treatment options for epilepsy?

A

Pharmacological (AEDs)
Surgical
Implants (VNS/ DBS)

33
Q

What is the best treatment for non-epileptic seizures?

A

CBT

Antidepressants or antipsychotics

34
Q

What are the disadvantages of surgical treatment for epilepsy?

A

Scar tissue can cause seizures

35
Q

What are the pharmacological options for treating epilepsy (focal/ focal to generalised/ generalised tonic clonic)?

A

Lamotrigine
Carbamazepine
Sodium Valproate

36
Q

When should sodium valproate not be used?

A

Women of child-bearing age (due to teratogenicity causing birth defects)

37
Q

What drug can be used only to treat absent seizures?

A

Ethosuximide

38
Q

What is the emergency treatment for status epilepticus?

A
  1. IV Lorazepam/ Diazepam or Buccal Midazolam (in resusc)
  2. Phenobarbital sodium (after 25 mins)
  3. Anaesthetise (after 45 minutes)
39
Q

What can be used instead of IV medication to treat status epilepticus (e.g. oustide of resusc)?

A

Buccal Midazolam

Rectal Diazepam

40
Q

What is the first line treatment for generalised myoclonic seizures?

A

Sodium valproate

41
Q

What types of seizures tend to respond poorly to typical AEDs?

A

Generalised absence atypical
Generalised atonic
Generalised tonic

42
Q

What is antiepileptic hypersensitivity syndrome?

A

Major side effects of AEDs including fever, rash and swollen lymph nodes (typical onset = 1-8 weeks from treatment initiation)

43
Q

What should you do in the case of Antiepileptic Hypersensitivity Syndrome?

A
  1. Withdraw treatment immediately
  2. Topical steroids and antihistamines
  3. Systemic corticosteroids (?)
  4. Be aware of potential rebound seizure activity
44
Q

What is the mechanism of action of Sodium channel blockers?

A

Block voltage-dependent Na+ channels

Only block in inactivated state

45
Q

Which AEDs are sodium channel blockers?

A

Lamotrigine
Carbamazepine
Sodium valproate

46
Q

What are the potential side effects of sodium channel blockers?

A 
CNS effects
Peripheral neuropathy 
Skin problems 
Gum hyperplasia 
Anaemia/ blood disorders
Osteomalacia (bone weakness) 
Teratogenicity
47
Q

How do GABA targets work?

A

Indirectly enhance activation of GABA mediated channels via:

  • action at co-agonist site
  • inhibition of GABA breakdown
  • inhibition of GABA uptake
  • GABAmimetics
48
Q

What drugs are GABA targets?

A

Gabapentin
Pregabalin
(both GABAmimetics)

49
Q

What is the mechanism of action of Benzodiazepines?

A

Co-agonist of GABA receptor (gamma subunit) to increase activity
Reduces neuronal transmission by enhancing inhibition

50
Q

What is the mechanism of action of Barbiturates?

A

Co-agonist of GABA receptor (beta subunit) to increase activity
Reduces neuronal transmission by enhancing inhibition

51
Q

What are the side effects of Benzodiazepines and Barbiturates?

A

Tolerance/ dependency (should only be used short term)
Withdrawal
Impaired motor coordination/ decreased muscle tone
Impaired cognitive performance
Sedation
Disturbed sleep
Retrograde amnesia

52
Q

What is the mechanism of action of calcium channel blockers?

A

Blocks voltage dependent or low threshold Ca+ channels

53
Q

What are some common calcium channel blockers?

A

Ethosuximide
Gabapentin
[Possibly lamotrigine]

54
Q

What are possible future targets that could be used to treat epilepsy?

A 
Glutamate antagonists 
Gap junction inhibitors
Enzymes
Cannabinoids 
Steroids
CO2

Block 3: Pathophysiology and pharmacology (16 decks)

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