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Epilepsy > epilepsy > Flashcards

epilepsy Flashcards

1
Q

AED of choice in pregnancy

A

Lamotrigine

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2
Q

AED associated with weight loss

A

Topiramate

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3
Q

AED that is neither an enzyme inducer or inhibitor and therefore does not have many drug-drug interactions

A

Gabapentin

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4
Q

Gene associated with GEFS

A

SCN1A

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5
Q

Rasmussens syndrome/Encephalitis

A
  • Progressive unilateral hemispheric atrophy
  • Focal cortical atrophy
  • Treat with hemispherectomy
  • Antibodies to GluR3 subunit of gluatamate receptor (AMPA)
  • Perivascular cuffs and lymhpocytes + monocytes, glial nodules –> spongy tissue degenration
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6
Q

AEDs that can be used in myoclonic epilepsy

A
  • Valproic acid (first line)
  • Keppra
  • Topiramate
  • Zonisamide
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7
Q

AED that is a hepatic enzyme inhibitor

A

Valproic acid

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8
Q

Benign EEG patterns

A
  • Small sharp spikes
  • 6 Hz spike and wave
  • Wicket spikes
  • 14 and 6 positive spies
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9
Q

Adult EEG frequencies

A

Beta >13 Hz
Alpha: 8-13 Hz
Delta: 4-7 Hz
Theta <4 Hz

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10
Q

AEDs that aggrevate absence seizures

A
  • Phenytoin
  • Carbamazepine
  • Gabapentin
  • Lamotrigine
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11
Q

AEDs that interact with OCP (cause OCP failure)

A
  • Phenytoin
  • Carbamazepine and oxcarb
  • Phenobarbital
  • Topiramate > 200 mg/d
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12
Q

JME

A
  • Onset 8-24 years of age
  • Hx of myoclonic seizures/feeling clumsy on awakening
  • 4-6 Hz polyspike and wave
  • Valproc acid first line
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13
Q

Benign rolandic epilspy with centrotemporal spikes

A
  • Onset 2-13 years
  • Self resolving
  • Nocturnal seizures
  • Carbamazepine first line (if needed)
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14
Q

Infantile spasms

A
  • EEG with hypsarrythmia (chaotic appearing EEG)

- ACTH first line

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15
Q

West syndrome

A

Triad of infantile spasms, hypsarrythmia, psychomotor arrest

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16
Q

AED that has zero order kinetics

A

Phenytoin. Metabolized in liver

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17
Q

Formula for determining IV bolus for AED

A

(Target total level- current total level) x (body weight in kg x volume of distribution of AED)

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18
Q

Side effects of valproic acid

A
  • Hepatitis/pancreatitis
  • Weight gain
  • Hair thinning
  • PCOS
  • Acne
  • Tremor
  • Thrombocytopenia
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19
Q

Side effects of carbamazepine

A
  • Dizziness, vertigo
  • Fatigue, drowsiness
  • Diplopia, nystagmus
  • HA, N, V
  • Hyponatremia
  • Ataxia
  • Rash, steven-johnsons syndrome
  • Aplastic anemia
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20
Q

AED that induces its own metabolism

A

Carbamazepine

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21
Q

Active metabolite of carbemazapine responsible for its side effects

A

10, 11 carbamazepine epoxide

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22
Q

Oxcarbazepine

A
  • Derivative of carbamazepine
  • Does not undergo oxidation to epoxide and thus has less side effects
  • No autoinduction
23
Q

Benzodiazepine mechanism of action

A

GABAa agonist leads to activation of chloride channel, hyperpolarization and decreased neuronal excitation

24
Q

AED with least cognitive side effect

A

Lamotrigine

25
Topiramate side effects
- Kidney stones, acute angle closure glaucoma (carbonic anhydrase inhibitor) - Paresthesias - Weight loss - Dizziness/fatigue - Word finding difficulty
26
Lacosamide mechanism of action
- Enhances slow activation of Na channels - Stabalizes hyperexcitable membrane - Interferes with CRMP-2 protien
27
Rufinamide
- Prolongation of inactive state of Na | - FDA approved for LGS
28
Fencers posture/figure of 4 localization
Contralateral SMA to side of extended arm
29
Aicardi syndrome
- Infantile spasms - Chorioretinal lacunae blindness (pathognomic) - Agenesis of the corpus callosum
30
Doose syndrome/ Myoclonic-astatic epilepsy
- GTC/myoclonic/astatic seizures - EEG: Interictal bilateral synchronous irregular 2-3 Hz spike & wave complexes, pareital sythmic theta activity - Treat with Valproic acid
31
Dravet syndrome
- Severe myoclonic epilepsy of infancy - FS in first year of life - Multiple seizure types
32
Ohtahara syndrome
- Seizures begin in early infancy (1d-3mo) - Epileptic tonic spasms occuring multiple times a day - EEG with burst supression
33
Lennox-Gestaut syndrome
Triad of multiple seizure types, 1.5-2Hz epike wave complexes, cognitive impairement
34
Panayiotopoulos syndrome
- Tonic eye deviation, vomiting visual auras - EEG with high voltage occipital spike 1-3 Hz that dissapear with eye opening - Resolves within several years
35
Landau-Kleffner syndrome
- Acuired epileptic aphasia - Word deafness-->expressive aphasia - Variou sseizure types - EEG with multifocal cortical spikes biletrally
36
Nocturnal frontal lobe epilepsy (ADNFLE)
- Hypermotor seizures (thrashing/jerking) - Occur during NREM sleep - Treat with carbamazepine
37
Localaization of eye deviation and head versive seizures
-Contralateral frontal lobe involving the FEF
38
Left arm dystonic, right arm automatisms localization
-Right temporal lobe
39
Gelastic seizure localization
- Hypothalamus | - Associated with hypothalamic hemartomas
40
Risk factors ofor recurrance of febrile seizures
- FH of febrile seizures - Age <18 mo - Shorter duration of fever and lower peak temperature at time of FS *Complex FS and simple FS have similar rate of recurrance
41
Progressive myoclonic epilepsies (5)
- Unvericht-Lundborg syndrome - Lafora body disease - MERFF - Sialidosis - Neuronal ceroid lipofuscinosis
42
Unvericht-Lundborg syndrome
- EPM1 gene on chrom 21 | - Stimulus sensitive myoclonus, worsens over time--> multiple seizure types-->Ataxia, tremor, intellectual decline
43
Sialidosis
- Cherry red sot, vision loss | - Ataxia, action myoclonus
44
Lafora body disease
- EPM2A gene on chrom 6 - Occipital seizures with transient blindness and hallucinations - EEG with spikes and waves in occipital region - PAS positive intracellular inclusion bodies
45
Practise parameter for adult presenting with first time unprovoked seizure
- Routine EEG - MRI/CT - Immediate AED treatment for first time seizure reduces risk of second seziure in 2 year period but does not affect quality of life
46
Generalized periodic pattern with 1 Hz frequency
CJD
47
Widespread high amplitude beta acitvity
- Associated with BZD use - Treat with Flumazenil - Can be seen with barbiturate use as well
48
Normal EEG correlates of sleep
Stage I NREM: Slow rollind eye movements, attenuation of background alpha Stage II NREM: K complexes and sleep spindles Stage III/IV (slow wave): Delta REM: Sleep atonia+ rapid eye movements, Alpha activity. Sawtooth waves in central regions
49
How long does it take to enter REM sleep after sleep onset?
90 minutes
50
AHI
Mild: 5-15 Moderate: 15-30 Severe: >30
51
Kleine-Levin syndrome
- Recurrant hypersomnia lasting days to weeks occuring many times a year - Peak onset adolesence - Mood changes, hypersexuality, voracious apetite
52
Narcolepsy with cataplexy
Loss of hypocretin neurons in lateral hypothalamus
53
Antidepressant least likely to worsen RLS
Bupropion

Epilepsy (2 decks)

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