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The Patient (Y3-2) > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

Condition of recurrent, spontaneous seizures caused by abnormal and sustained electrical activity in the brain

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2
Q

What is the role of EEGs in diagnosing epilepsy?

A

Classify epilepsy. Should never be used alone

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3
Q

What are the two main types of seizures?

A

Partial seizures

Generalised seizures

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4
Q

Name some common triggers of seizures

A 
Fatigue
Lack of sleep
Alcohol 
Stress
Excitement
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5
Q

What is the first-line treatment for focal seizures?

A

Carbamazepine

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6
Q

Which drug can be used as first-line in many different seizure types?

A

Sodium valproate

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7
Q

What is levetiracetam used for in epilepsy?

A

Partial seizures and adjunctive therapy for myoclonic seizures and tonic-clonic seizures

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8
Q

What is phenytoin used for in epilepsy?

A

Mainly used if patient has tried everything else. Not first line treatment

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9
Q

How is status epilepticus treated?

A

IV lorazepam repeated once after 10-20 mins if seizure continues.
If still seizing after 2 doses of lorazepam, give IV phenytoin over 20 mins (or phenobarbital if already on phenytoin)
Give general anaesthesia if above doesn’t work

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10
Q

What happens if treatment with first-line anti-epileptic fails?

A

Check patient compliance, diagnosis, alcohol abuse etc. if none of these causing lack of efficacy then move to second line drug. This is done by increasing dose to therapeutic level before reducing dose of first-line drug. Abrupt withdrawal should be avoided due to risk of rebound seizures

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11
Q

When can treatment withdrawal be considered in epilepsy?

A

Done under guidance of specialist and joint decision with patient and family
Must be seizure free for 2 years. Withdrawal must be carried out over months and one drug withdrawn at a time if on combination therapy.
Failure plan must be in place in case seizures recur

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12
Q

What are some causes of childhood epilepsy?

A

Non-epileptic
- febrile seizures - increase in temp -> fit
- trauma
- metabolic - hypoglycaemia, hyponatremia
Epileptic
- primary idiopathic (genetic)
- secondary - tumour, structural abnormality
- neurodegenrative disorders

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13
Q

What are febrile seizures?

A

Increase in temperature -> fit

Febrile seizures are not epilepsy. They are harmless but distressing. They are self-resolving

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14
Q

How are febrile seizures treated?

A

Reassure and comfort parents
Cool child - remove excess clothing, turn heating down
Antipyretics don’t prevent febrile seizures
Maintenance antieplieptics not appropriate - self-resolving by age of 5
Management of prolonged seizures should follow status epilepticus algorithm

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15
Q

What is the most common gene mutation in Dravets Syndrome?

A

SCN1A

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16
Q

At what age is Dravets syndrome evident in?

A

1st year of life

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17
Q

What is the first line treatment for Dravets Syndrome?

A

Sodium valproate and adjuvants clobazam and stiripentol

18
Q

What is the mode of action of steripentol?

A

Increases the amount of GABA - as this is an inhibitory neurotransmitter, transmissions in the brain are down-regulated and so seizure effects are reduced
Inhibits the metabolism of other AEDs thereby reducing the doses that need to be taken by patients - good

19
Q

What age is steripentol licensed for?

A

> 3 years

20
Q

What formulations is steripentol available in and can patient switch between the two?

A

Oral suspension and capsule

Oral suspension has greater Cmax therefore they are not bioequivalent and dose adjustment required when switching

21
Q

What is the recommended dosage for a child taking steripentol for first week?

A

10mg/kg BD or 15mg/kg BD - regardless of age

22
Q

Why can the dose of steripentol be increased much quicker in children than in adults?

A

Because paediatric PK means that steripentol has faster extraction so gets cleared faster

23
Q

How does gastric pH in children differ to adults?

A

Gastric pH increased in children - oral bioavailability of phenytoin is therefore <75% so higher doses needed

24
Q

How does gastric motility differ in children and adults?

A

Gastric motility slower in children

25
Q

How does hepatic extraction differ between children and adults?

A

Liver is larger by surface area in children than adults and so there is increased first-pass metabolism meaning higher doses are required in children than adults - carbemazepine and sodium valproate

26
Q

What is the Lennox-Gastaut Syndrome?

A

Most common form of intractable epilepsy
Characterised by several different seizures - “drop attacks” - generalised absence seizures, atypical focal absence seizures and tonic seizures

27
Q

What is the first-line choice of treatment for Lennox-Gastaut?

A

Sodium Valproate

28
Q

What are the second line treatment options for Lennox-Gastaut?

A

Lamotrigine
Clobazam
Phenytoin

29
Q

What can corticosteroids be used for in Lennox Gastaut syndrome?

A

Reduce inflammation and neuronal damage. They reduce the longevity of seizures but not the severity

30
Q

What is the mechanism of action of sodium valproate?

A

Inhibits reuptake of GABA in the CNS therefore reducing seizures

31
Q

What is the most effective antiepileptic drug?

A

Sodium valproate. It is cheap, well tolerated and broad spectrum

32
Q

What are the notable toxicities of sodium valproate?

A

Liver - as it is a fatty acid, it can accumulate in the liver
Pancreatitis

33
Q

What monitoring is required with sodium valproate?

A

Monitor LFTs, bilirubin, ALT, gammaGT

34
Q

How is sodium valproate cleared?

A

Kidneys

35
Q

What happens if unplanned pregnancy takes place when taking sodium valproate?

A

Remind patient to continue therapy until a decision is made
Use the smallest dose possible - consider a prolonged release formulation
Refer to specialist obstetrician for prenatal monitoring

36
Q

What is the mechanism of action of carbamazepine?

A

Dose dependent voltage-gate sodium channel antagonist - prevents repetitive action potentials, down-regulates seizures directly at the nerve
Also a GABA agonist

37
Q

In which types of epilepsy is carbemazepine contraindicated?

A

In epilepsy syndromes with sodium channel involvement
Dravet’s syndrome
Myoclonic seizure disorder

38
Q

What is the mechanism of action of lamotrigine?

A

Direct effect on voltage gated sodium channels

39
Q

What are the four main categories in which anticonvulsants work in, in relation to their mechanisms of action?

A
  • Drugs that inhibit sodium channels
  • Drugs that inhibit calcium channels
  • Drugs that inhibit glutamate receptors
  • Drugs that enhance GABA-mediated inhibition
40
Q

How do anticonvulsants that inhibit Na+ channels work?

A

They prevent the return of Na+ channels to the active state by stabilising them in the inactive state

41
Q

Drugs that inhibit calcium channels are particularly useful for controlling which type of seizures?

A

Absence seizures

42
Q

What are the ways in which anticonvulsants that enhance GABA-mediated inhibtion work?

A

GABA receptor agonists - mimic GABA
GABA reuptake inhibitors - keep GABA in synaptic cleft for longer
GABA transaminase inhibitors - inhibit breakdown of GABA

The Patient (Y3-2) (8 decks)

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