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(UNI) Neuropharmacology (3rd Year) > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What percentage of the population suffers from epilepsy?

A

0.5-1%.

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2
Q

What percentage of the population suffers at least one seizure in their lifetime?

A

At least 2%.

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3
Q

How many new epilepsy cases present each year?

A

30,000.

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4
Q

What percentage of epilepsy cases are refractory to drug treatment?

A

30%.

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5
Q

What percentage of epilepsy cases arent improved by surgery?

A

20-30%.

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6
Q

Hoe many epilepsy related deaths are there per year?

A

1000.

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7
Q

What percentage of epilepsy deaths are sudden death in epilepsy (SUDEP)?

A

50%.

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8
Q

What percentage of epilepsy cases go undiagnosed or untreated in developing countries?

A

60-90%.

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9
Q

What is reflex epilepsy?

A

Their seizures are triggered by TV, sunlight through leaves, strobe lighting, sunlight on water. 0.001% of sufferers have musicogenic seizures. Their triggers include eating, tooth brushing, certain smells, playing chess, writing, reading, or doing sums/puzzles.

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10
Q

What percentage of epilepsy sufferers are affected by reflex epilepsy?

A

7%.

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11
Q

Why do seizures happen?

A

Sub-clinical changes in patterns of network activity drive maladaptive processes in susceptible networks. At a critical point, spontaneous recurrent seizures manifest. Epileptogenesis continues through maladaptation in target networks. ‘Seizures beget seizures’ – Gaddum.

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12
Q

How is behaviour affected by epilepsy?

A

Epilepsy is also associated with changes in behaviour that vary according to the part of the brain affected and severity and can include involuntary muscle contraction and a temporary loss of consciousness.

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13
Q

In most cases can the cause of epilepsy be determined?

A

No.

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14
Q

How is epilepsy studied?

A

To study epilepsy, we make an animal model. To do this the animal is injected with a chemoconvulsant, a brain region is stimulated, and an acute preparation is used.
Models of a system are not ever exactly perfect for the system they are trying to replicate, and this should be kept in mind.

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15
Q

What antiepileptic drugs act at glutamatergic synapses?

A

Iamotrigine, phenytoin, carbamazepine, sodium valporate, gabapentin, pregbalin.

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16
Q

What antiepileptic drugs block sodium channels in glutamatergic synapses?

A

Iamotrigine, phenytoin, carbamazepine, sodium valporate.

17
Q

What antiepileptic drugs block calcium channels in glutamatergic synapses?

A

Gabapentin, pregbalin.

18
Q

What antiepileptic drugs act at GABAergic synapses?

A

Vigabatrin, sodium valporate, tiagabine, benzodiazepines, barbiturates.

19
Q

How do the antiepileptic drugs vigabatrin and sodium valporate work in GABAergic synapses?

A

By blocking GABA transaminase action, preventing GABA breakdown, increasing GABA levels and GABA release.

20
Q

How does the antiepileptic drug tiagabine work in GABAergic synapses?

A

Blocks GABA reuptake, increasing GABA concentration in the synaptic cleft.

21
Q

How do benzodiazepines and barbiturates (used for epilepsy) work in GABAergic synapses?

A

Increase postsynaptic response by prolonging channel opening time.

22
Q

The choice of anti-epileptic drug is based upon which factors?

A
  • Seizure type.
  • Epilepsy syndrome – special syndromes (West Syndrome, Dravet).
  • Pharmacokinetic profile with regards to the patient.
  • Interactions/other medical conditions.
  • Efficacy.
  • Expected adverse effects.
  • Cost.
23
Q

Define partial onset seizures.

A

This is where the electrical disturbance is limited to a specific area of one cerebral hemisphere.

24
Q

What drugs are used to treat partial onset seizures?

A
  • Carbamazepine.
  • Phenytoin.
  • Felbamate.
  • Primidone.
  • Gabapentin.
  • Tiagabine.
  • Lamotrigine.
  • Topiramate.
  • Levetiracetam.
  • Valproate.
  • Oxcarbazepine.
  • Zonisamide.
  • Phenobarbital.
25
Q

Define absence seizures.

A

Absence seizures are a type of generalised onset seizure, meaning both sides of your brain are affected from the start. In the past absence seizures used to be called petit-mal seizures. The 2 most common types of absence seizure are typical and atypical.

26
Q

What antiepileptic drugs are used to treat absence seizures?

A
  • Ethosuximide.
  • Lamotrigine.
  • Levetiracetam.
  • Topiramate.
  • Valproate.
  • Zonisamide.
27
Q

Define myoclonic seizures.

A

Myoclonic seizures are brief shock-like jerks of a muscle or group of muscles. They occur in a variety of epilepsy syndromes that have different characteristics. During a myoclonic seizure, the person is usually awake and able to think clearly.

28
Q

What entiepileptic drugs are used to treat myoclonic seizures?

A
  • Clonazapam.
  • Lamotrigine.
  • Levetiracetam.
  • Topiramate.
  • Valproate.
  • Zonisamide.
29
Q

Define tonic-clonic seizures.

A

During a generalized tonic-clonic (formerly grand mal) seizure, electric discharges instantaneously involve the entire brain. The person loses consciousness right from the beginning of the seizure.

30
Q

What antiepileptic drugs are used to treat tonic-clonic seizures?

A
  • Carbamazepine.
  • Phenytoin.
  • Felbamate.
  • Topiramate.
  • Lamotrigine.
  • Valproate.
  • Levetiracetam.
  • Zonisamide.
  • Oxcarbazepine.
31
Q

What three categories can adverse effects to anti-epileptic drugs be broken into?

A
  • Acute dose-related – reversible,
  • Idiosyncratic – uncommon, potentially serious or life threatening.
  • Chronic – reversibility and seriousness vary.
32
Q

What acute, dose related adverse effects may be seen with antiepileptic drugs?

A 
•	Neurologic/Psychiatric – most common.
o	Sedation, fatigue.
o	Unsteadiness, lack of coordination, dizziness.
o	Tremor.
o	Paraesthesia – tingling.
o	Diplopia, blurred vision (esp. carbamazepine).
o	Mental/motor slowing or impairment
o	Mood or behavioural changes.
o	Changes in libido or sexual function.
•	Gastrointestinal (nausea, heartburn).
•	Mild to moderate laboratory changes.
o	Hyponatremia (may be asymptomatic).
o	Increases in ALT or AST.
o	Leukopenia.
o	Thrombocytopenia.
•	Weight gain/appetite changes.
33
Q

What idiosyncratic adverse effects may be seen with antiepileptic drugs?

A

• Rash, Exfoliation.
• Signs of potential Stevens-Johnson syndrome.
o Hepatic Damage.
o Early symptoms: abdominal pain, vomiting, jaundice.
o Laboratory monitoring probably not helpful in early detection.
o Patient education.
o Fever and mucus membrane involvement.
• Hematologic damage - (marrow aplasia, agranulocytosis - CBZ).
o Early symptoms: abnormal bleeding, acute onset of fever, symptoms of anemia.
o Laboratory monitoring probably not helpful in early detection.
o Patient education.

34
Q

What long term adverse effects may be seen with antiepileptic drugs?

A

• Neurologic:
o Neuropathy.
o Cerebellar syndrome (PHT) – irreversible – phenytoin.
• Endocrine/Metabolic Effects.
o Vitamin K/D – bleeding (HDN), osteomalacia, osteoporosis.
o Folate – Anemia, teratogenesis.
o Altered connective tissue metabolism or growth.
 Facial coarsening.
 Hirsutism – hair growth.
 Gingival hyperplasia.

35
Q

Foetal abnormalities in mothers with epilepsy can be down to what factors?

A
  • Drug effects.
  • Consequences of the mothers underlying diseases.
  • Consequences of maternal seizures during pregnancy.
36
Q

How should epileptic women who want to become pregnant be educated?

A

The patient should be properly educated on the risks they are presented with. All women of child-bearing potential should receive education and carefully considered management before and during pregnancy to optimize the chances of a good outcome for both mother and child.

37
Q

What should epilepsy education for pregnant mothers include?

A
  • Most women with epilepsy have normal children.
  • Risk of fetal malformations is increased.
  • AED teratogenicity is related to exposure in the first trimester of pregnancy.
  • Prenatal diagnosis of fetal malformations is possible.
  • Seizures may be deleterious to the fetus.
  • Compliance with AED treatment is important.
38
Q

Before pregnancy in an epileptic mother, what should one do?

A
  • Attempt anti-epileptic drug monotherapy with the lowest effective dose.
  • Offer folate supplementation (5mg/day orally) – to prevent spina bifida etc.
39
Q

During/after pregnancy in an epileptic mother, what should one do?

A
  • Monitor AED dose requirements to maximize seizure control.
  • Continue folate supplementation.
  • Consider prenatal diagnosis of fetal malformations.
  • Vit K (1mg at delivery).

(UNI) Neuropharmacology (3rd Year) (20 decks)

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