epilepsy Flashcards
AED of choice in pregnancy
Lamotrigine
AED associated with weight loss
Topiramate
AED that is neither an enzyme inducer or inhibitor and therefore does not have many drug-drug interactions
Gabapentin
Gene associated with GEFS
SCN1A
Rasmussens syndrome/Encephalitis
- 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
AEDs that can be used in myoclonic epilepsy
- Valproic acid (first line)
- Keppra
- Topiramate
- Zonisamide
AED that is a hepatic enzyme inhibitor
Valproic acid
Benign EEG patterns
- Small sharp spikes
- 6 Hz spike and wave
- Wicket spikes
- 14 and 6 positive spies
Adult EEG frequencies
Beta >13 Hz
Alpha: 8-13 Hz
Delta: 4-7 Hz
Theta <4 Hz
AEDs that aggrevate absence seizures
- Phenytoin
- Carbamazepine
- Gabapentin
- Lamotrigine
AEDs that interact with OCP (cause OCP failure)
- Phenytoin
- Carbamazepine and oxcarb
- Phenobarbital
- Topiramate > 200 mg/d
JME
- Onset 8-24 years of age
- Hx of myoclonic seizures/feeling clumsy on awakening
- 4-6 Hz polyspike and wave
- Valproc acid first line
Benign rolandic epilspy with centrotemporal spikes
- Onset 2-13 years
- Self resolving
- Nocturnal seizures
- Carbamazepine first line (if needed)
Infantile spasms
- EEG with hypsarrythmia (chaotic appearing EEG)
- ACTH first line
West syndrome
Triad of infantile spasms, hypsarrythmia, psychomotor arrest
AED that has zero order kinetics
Phenytoin. Metabolized in liver
Formula for determining IV bolus for AED
(Target total level- current total level) x (body weight in kg x volume of distribution of AED)
Side effects of valproic acid
- Hepatitis/pancreatitis
- Weight gain
- Hair thinning
- PCOS
- Acne
- Tremor
- Thrombocytopenia
Side effects of carbamazepine
- Dizziness, vertigo
- Fatigue, drowsiness
- Diplopia, nystagmus
- HA, N, V
- Hyponatremia
- Ataxia
- Rash, steven-johnsons syndrome
- Aplastic anemia
AED that induces its own metabolism
Carbamazepine
Active metabolite of carbemazapine responsible for its side effects
10, 11 carbamazepine epoxide
Oxcarbazepine
- Derivative of carbamazepine
- Does not undergo oxidation to epoxide and thus has less side effects
- No autoinduction
Benzodiazepine mechanism of action
GABAa agonist leads to activation of chloride channel, hyperpolarization and decreased neuronal excitation
AED with least cognitive side effect
Lamotrigine
Topiramate side effects
- Kidney stones, acute angle closure glaucoma (carbonic anhydrase inhibitor)
- Paresthesias
- Weight loss
- Dizziness/fatigue
- Word finding difficulty
Lacosamide mechanism of action
- Enhances slow activation of Na channels
- Stabalizes hyperexcitable membrane
- Interferes with CRMP-2 protien
Rufinamide
- Prolongation of inactive state of Na
- FDA approved for LGS
Fencers posture/figure of 4 localization
Contralateral SMA to side of extended arm
Aicardi syndrome
- Infantile spasms
- Chorioretinal lacunae blindness (pathognomic)
- Agenesis of the corpus callosum
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
Dravet syndrome
- Severe myoclonic epilepsy of infancy
- FS in first year of life
- Multiple seizure types
Ohtahara syndrome
- Seizures begin in early infancy (1d-3mo)
- Epileptic tonic spasms occuring multiple times a day
- EEG with burst supression
Lennox-Gestaut syndrome
Triad of multiple seizure types, 1.5-2Hz epike wave complexes, cognitive impairement
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
Landau-Kleffner syndrome
- Acuired epileptic aphasia
- Word deafness–>expressive aphasia
- Variou sseizure types
- EEG with multifocal cortical spikes biletrally
Nocturnal frontal lobe epilepsy (ADNFLE)
- Hypermotor seizures (thrashing/jerking)
- Occur during NREM sleep
- Treat with carbamazepine
Localaization of eye deviation and head versive seizures
-Contralateral frontal lobe involving the FEF
Left arm dystonic, right arm automatisms localization
-Right temporal lobe
Gelastic seizure localization
- Hypothalamus
- Associated with hypothalamic hemartomas
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
Progressive myoclonic epilepsies (5)
- Unvericht-Lundborg syndrome
- Lafora body disease
- MERFF
- Sialidosis
- Neuronal ceroid lipofuscinosis
Unvericht-Lundborg syndrome
- EPM1 gene on chrom 21
- Stimulus sensitive myoclonus, worsens over time–> multiple seizure types–>Ataxia, tremor, intellectual decline
Sialidosis
- Cherry red sot, vision loss
- Ataxia, action myoclonus
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
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
Generalized periodic pattern with 1 Hz frequency
CJD
Widespread high amplitude beta acitvity
- Associated with BZD use
- Treat with Flumazenil
- Can be seen with barbiturate use as well
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
How long does it take to enter REM sleep after sleep onset?
90 minutes
AHI
Mild: 5-15
Moderate: 15-30
Severe: >30
Kleine-Levin syndrome
- Recurrant hypersomnia lasting days to weeks occuring many times a year
- Peak onset adolesence
- Mood changes, hypersexuality, voracious apetite
Narcolepsy with cataplexy
Loss of hypocretin neurons in lateral hypothalamus
Antidepressant least likely to worsen RLS
Bupropion
