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Week A12 - Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What factors lead to excitation/stimulation of neuron transmission? [4]

A
  1. Excitatory amino acids (EAA)
  2. Action on glutamate receptors (NMDA/AMPA/Kainate)
  3. Na+/Ca2+ influx
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2
Q

What factors lead to inhibition of neuron transmission? [4]

A
  1. GABA/Glycine
  2. Action on GABA receptor
  3. Cl- influx
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3
Q

Define seizure [1]

A

A sustained and synchronised electrical discharge in the brain causing symptoms or signs

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4
Q

What are the types of seizures? [2]

A
  1. Generalised tonic-clonic (Bilaterally convulsive)
  2. Partial seizures
    • with loss of awareness
    • with motor phenomena
    • with sensory phenomena
    • with psychological phenomena
    • with cognitive phenomena
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5
Q

Define epilepsy [1]

A

A tendency to have recurrent unprovoked seizures

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6
Q

Define status epilepticus [2]

A
  1. ≥2 seizures without full recovery of neurological function between them
  2. or continuous seizure activity for >30mins
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7
Q

What are the causes of epilepsy? [9]

A
  1. Unknown (most common)
  2. Vascular
  3. Hippocampal sclerosis
  4. Infection
  5. Trauma
  6. Other
  7. MCD
  8. Tumour
  9. Degenerative
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8
Q

What are the 2 classifications of epilepsy? [2]

A
  1. Localised onset: Focal Seizures
  2. Generalised onset: Generalised Seizures
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9
Q

Where does localised onset epilepsy/focal seizures originate from? [2]

A

originates within networks linked to one hemisphere and often seen with underlying structural disease

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10
Q

Where does generalised onset epilepsy/generalised seizures originate from? [1]

A

originating at some point within, and rapidly engaging bilaterally distributed networks leading to simultaneous onset of widespread electrical discharge with no localizing features referable to a single hemisphere

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11
Q

What investigations would you do on a patient with suspected epilepsy? [3]

A
  1. Imaging
    • MRI scan
    • CT scan
  2. Electroencephalography (EEG)
    • measures brainwaves
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12
Q

Under what circumstances would you prescribe a patient an anti-epileptic drug (AED)? [6]

A
  1. confirmed epilepsy diagnosis and ≥2 seizures
  2. unless risk of recurrence is high, e.g.
    • structural brain lesion,
    • focal CNS deficit,
    • unequivocal epileptiform EEG
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13
Q

What anti-epileptic drugs (AEDs) should be given if the epilepsy was of:

  1. localised onset? [3]
  2. generalised onset? [3]
A
  1. If localised onset:
    • lamotrigine,
    • carbamazepine,
    • levetiracetam
  2. If generalised onset:
    • valproate,
    • levetiracetam,
    • lamotrigine
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14
Q

Describe the mechanism of action of the AEDs: Lamotrigine, Carbamazepine and Oxcarbazepine [2]

A
  1. Targets pre-synaptic excitability
  2. by inhibiting the voltage-gated Na+ channel, which normally causes Na+ influx, which increases excitability and drives action potentials
    • so by inhibiting this, it decreases excitability of neuronal impulses
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15
Q

Describe the mechanism of action of the AED: Retigabine [2]

A
  1. Targets pre-synaptic excitability
  2. by enhancing the action the voltage-gated K+ channel (increases K+ efflux), which reduces neuronal excitability
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16
Q

Describe the mechanism of action of the AED: Levetiracetam [2]

A
  1. targets pre-synaptic excitability
  2. by inhibiting SV2A which is normally required for the release of neurotransmitters from vesicles
17
Q

Describe the mechanism of action of the AED: Pregabalin and Gabapentin [2]

A
  1. targets pre-synaptic excitability
  2. by inhibiting the voltage-gated Ca2+ channel which normally causes Ca2+ influx, driving neurotransmitter release
18
Q

Describe the mechanism of action of the AED: Tiagabine [2]

A
  1. Targets the GABAergic system
  2. by inhibiting the GABA transporter, which normally removes GABA from the synapse (i.e. tiagabine elevates GABA levels in synapse)
19
Q

Describe the mechanism of action of the AEDs: Vigabatrin and Valproate [2]

A
  1. targets the GABAergic system
  2. by inhibiting the degradation of GABA, to elevate GABA levels in synapse
20
Q

Describe the mechanism of action of the AEDs: Benzodiazepines, Barbiturates, Felbamate, Topiramate [2]

A
  1. enhances the GABAA receptor
  2. this reduces neuronal excitability

Week A12 - Neurology (15 decks)

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