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🧠📖💯 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Gelastic seizures + precocious puberty

A

Hamartoma of the hypothalamus

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2
Q

The condition that presents with jacknife seizures w/ hypsarrhythmia is responsive to…

A

ACTH, corticosteroids, benzos

If 2/2 TS, vigabatrin

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3
Q

West Syndrome can progress to..

A

Lennox-Gastaut Syndrome

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4
Q

Main (3) features of Typical Absence

A

Typical 3/s spike & wave
Rapid onset and offset
Complete loss of awareness

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5
Q

Atonic, astatic seizures (falling attacks)

Minor motor t-c and partial seizures

Progressive intellectual impairment

Onset: 2-6 yo

EEG Slow 1-2 Hz spike and wave

A

Lennox-Gastaut Syndrome

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6
Q

Most common form of idiopathic generalized epilepsy in older children and young adults

A

Juvenile Myoclonic Epilepsy

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7
Q

Masticatory, salivation, speech arrest

A

Amygdaloid nuclei, opercular

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8
Q

Head & eye turning a/w arm movement, athetoid-dystonic postures

A

Supplementary motor cortex

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9
Q

Vertiginous

A

Superior temporal

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10
Q

Olfactory

A

Mesial temporal

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11
Q

Gustatory

A

Insula

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12
Q

Visceral:autonomic

A

Insular-orbital-frontal cortex

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13
Q

Automatism

A

Temporal and frontal

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14
Q

Head turning ipsilaterally, then contraversive turning

A

Temporal lobe

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15
Q

Fencing posture

A

SMC, High medial frontal

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16
Q

Most frequently reported color (visual sz)

A

Red

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17
Q

Palpitation, tachycardia at the beginning of the attack

A

Temporal

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18
Q

Psychomotor triad of temporal lobe seizures

A
  1. Motor changes
  2. Automatic behavior
  3. Alterations in psychic function
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19
Q

1) Prolonged disorientation for time and place suggests a ____(left/right)-sided source
2) Post ictal nose wiping carried out by hand ______ (ipsi/contra) to the seizure focus

A

1) Prolonged d/o to time & place: RIGHT-sided

2) Post-ictal nose wiping: IPSILATERAL to the sz focus

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20
Q

Triad of behavioral abnormalities for pts w/ temporal lobe origin

A
  1. HYPOsexuality
  2. HYPERgraphia
  3. HYPERreligiosity
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21
Q

EEG finding in pts w/ jacknife seizures

A

(Jacknife seizures / infantile spasms: West Syndrome)

EEG: Hypsarrhythmia (mountainous dysrhythmia)

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22
Q

Treatment for West Syndrome

  • and those w/ TS
A

ACTH, corticosteroids, benzodiazepines

Vigabatrin for those w/ Tuberous Sclerosis!

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23
Q

Common virus associated w/ Febrile Seizures

A

Herpesvirus 6

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24
Q

Rasmussen Syndrome has antibodies against:

A

GluR3 (glutamate receptors)

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25
Q

What is kindling?

A

Special mechanism that creates a secondary sz focus

Repeated stimulation w/ subconvulsive electrical pulses from a focus elsewhere

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26
Q

Most common associated histologic finding in Mesial Temporal Sclerosis

A

Loss of neurons in the CA1 segment (Sommer sector)

Pyramidal layer, hippocampus

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27
Q

Give the involved

1) Channel
2) Gene
3) Protein

Familial generalized sz w/ febrile sz plus

A

1) Sodium channel
2) SCN1A,B (GABAa)
3) Na channel subunits > GABA receptor

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28
Q

Give the involved

1) Channel
2) Gene
3) Protein

Dravet Syndrome

A

1) Sodium channel
2) SCN1A
3) Sodium channel a-subunit

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29
Q

Give the involved

1) Channel
2) Gene
3) Protein

Episodic ataxia type 1 w/ partial epilepsy

A

1) Potassium channel
2) KCNA1
3) K channel subunits

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30
Q

Give the involved

1) Channel
2) Gene
3) Protein

Episodic ataxia type 2 w/ spike-wave sz

A

1) Ca channel
2) CACNA1A
3) Ca channel subunit

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31
Q

Give the involved

1) Channel
2) Gene
3) Protein

Juvenile Myoclonic Epilepsy

A

1) Ligand-gated channel
2) GABRA1 (CACNB4)
3) GABAa receptor subunit > Ca subunit

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32
Q

Give the involved

1) Pathology
2) Gene
3) Protein

Fukuyama muscular dystrophy, lissencephaly, generalized epilepsy

A

1) Malformations of Cortical development
2) FCMD
3) Fukutin

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33
Q

Give the involved

1) Pathology
2) Gene
3) Protein

Angelman syndrome

A

1) Malformations of cortical development
2) UBE3A
3) Ubiquitin-protein ligase

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34
Q

Give the involved

1) Gene
2) Protein

Lafora body disease w/ PME

A

EPM2A

Laforin, protein tyrosine phosphatase

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35
Q

Give the involved

1) Gene
2) Protein

Autosomal dominant lateral temporal lobe epilepsy

A

LGI1

Leucine-rich glioma inactivated protein

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36
Q

Most common lesions underlying status epilepticus in late adult life

A

Previous infarcts

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37
Q

Which among the ff antibiotics that cause sz can result in status epilepticus

A. Imipinem
B. Penicillin
C. Cefepime
D. Linezolid

A

C.

“Cefepime can result in SE”

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38
Q

What do you call the chronic intention myoclonus state pos HIE?

A

Lance-Adams Syndrome

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39
Q 
Which of the following is NOT safe for breastfeeding mothers:
A. Phenobarbital
B. Valproate
C. Phenytoin
D. Carbamazepine
A

Ans: Phenobarbital (NOT SAFE for breastfeeding - high concentration)

Carbamazepine, Phenytoin, Valproate have low concentrations. SAFE

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40
Q

Characteristic of anticonvulsant exposure

A

Mid-face hypoplasia

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41
Q

Effect of

1) Phenytoin
2) Phenobarbital/Carbamazepine

On Warfarin:

A

Phenytoin INCREASES warfarin levels

Phenobarbital/Carbamazepine DECREASE warfarin levels

“phengy pa ng warfarin”
“phenobaba ang levels”

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42
Q

Which AEDs (2) have effects on T-type Ca channel inhibition?

A

Ethosuximide

Valproic Acid

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43
Q

Which AED does NOT cause weight LOSS?

A. Valproic Acid
B. Topiramate
C. Zonisamide

A

A. Valproic Acid
- causes weight GAIN

Topiramate and Zonisamide cause weight loss (and nephrolithiasis!!)

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44
Q

What is the notable side effect of Vigabatrin?

A

Retinal toxicity

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45
Q

What is the MOA of Levetiracetam?

A

SV2A modulation

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46
Q

Which among the following is NOT a Na Channel inhibitor?

A. Phenytoin
B. Phenobarbital
C. Lamotrigine
D. Carbamazepine

A

B. Phenobarbital - GABA potentiation

Na Channel:
Carbamazepine, Oxcarbazepine
Phenytoin
Lacosamide
Lamotrigine
Valproic Acid
Topiramate
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47
Q

Which among Valproic Acid and Topiramate have NMDA inhibition?

A

Valproic Acid.

Both have:

  1. GABA potentiation
  2. Na channel inhibition

VA: NMDA, T-type Ca channel inhibition
Topi: AMPA (TAMPA), Ca channel inhibition

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48
Q

Initial choice of AED for absence seizures:

A

Valproate

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49
Q

Initial choice of AED for Focal seizures (2)

A

Carbamazepine, phenytoin

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50
Q

Initial choice of AED for Infantile Spasms

A

ACTH, Vigabatrin

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51
Q

Initial choice of AED for Lennox-Gastaut

A

Valproate

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52
Q

Which AED has “autoinduction”

A

Carbamazepine

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53
Q

Which AED causes duyputren contractures?

A

Phenobarbital

PhBaDuy

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54
Q

Which gene is mutated in Dravet Syndrome?

A

SCN1A

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55
Q

In which age group can the first seizure most likely take the form of status epilepticus?

A

Early childhood

56
Q

Which AEDs have high concentrations in breast milk?

A

Phenobarbital
Benzodiazepines
Ethosuximide, Zonisamide, Primidone

PhenoBarest milk
Bezp milk

57
Q

Which AEDs have low concentrations in breast milk?

A

Phenytoin
Carbamazepine
Valproate

Pheny Can Vouch for these meds

58
Q

Most common teratogenic effect of AEDs

A

Cleft lip, cleft palate

59
Q

Risk of neural tube defects is greatest with the use of which AED during pregnancy?

A

Valproate

60
Q

If a woman with epilepsy has not required meds for a long tome before getting pregnant and has a seizure during pregnancy, what would be the best choice of medication?

A

Phenytoin

61
Q

What are the AEDs that INDUCE hepatic enzymes?

A

Carbamazepine
Phenytoin (phenynduce)
Topiramate

62
Q

What is Kindling?

A

Special mechanism that creates a SECONDARY seizure focus

Repeated stimulation w/ subconvulsive electrical pulses from an established focus ELSEWHERE

63
Q

What would you find on EEG during the clonic phase of seizures?

A

Spikes mixed with slow waves -> polyspike and wave

64
Q

Focal type of seizure is more common:

a. On awakening
b. During sleep

A

Ans: B

Generalized sz - on awakening
Focal sz - during sleep

65
Q

Which of the ff is NOT TRUE of TYPICAL absence?

A. 1/2 will at some time have GTCs
B. Patients can at times fall
C. They are able to continue complex acts
D. 1/3 have myoclonic jerks w/o LOC

A

B. Patients can at times fall

Patients DO NOT FALL in TYPICAL absence

66
Q

Main (3) features of atypical absence

A

LOC is less complete
Myoclonus is prominent
EEG: 2-2.5/s SW or irregular 4-6Hz polySW

67
Q

Regarding pharmacotherapy for JME:

A) What is the treatment?
B) Which AEDs should you avoid?

A

A) Valproic Acid

B) Carbamazepine, Phenytoin

68
Q

What is the semiology of the jacksonian march?

A

Hand -> arm -> face -> leg

Or

Leg -> arm -> face

69
Q

LGI1 gene mutation is associated with what condition?

A

Autosomal Dominant Partial Epilepsy with Auditory Features

70
Q

Unfamiliarity in a familiar circumstance

A

Jamais vu

71
Q

Depersonalization

Dream-like state, pt views himself as an external observer

A

Autoscopy

72
Q

Objects in the environment may perseverate as the head is moved

A

Palinopsia

73
Q

[Automatisms]

Patient walks repetitively in small circles

a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania

A

a. Volvular Epilepsy

74
Q

[Automatisms]

Patient wanders aimlessly

a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania

A

c. Poriomania

75
Q

[Automatisms]

Patient runs

a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania

A

b. Epilepsia Procursiva

76
Q

What is the epidemiology and clinical presentation of Rolandic/Sylvian Epilepsy or Benign Epilepsy of Childhood w/ Centrotemporal Spikes?

A

5-9 years old

Nocturnal focal TC -> clonic contractions u/l face > extremity

77
Q

What “greatly accentuates spikes” in Panayiotopoulos Syndrome?

A

Sleep

78
Q

How would you differentiate temporal lobe seizures from absence? (aura vs automatism?)

A

Temporal seizures have DISTINCT ictal and post-ictal phases.

In absence, there’s INSTANTANEOUS return post-ictal

79
Q

What is the most common type of reflex epilepsy?

A

Visually-induced seizures

Other evocative stimuli:
Auditory
Somatosensory
Writing/reading
Eating
80
Q

Associated factors for Sudden Unexplained Death in Epilepsy?

A

Inc duration and severity of epilepsy
History of GTC
In children: tx-resistant ep, devt delay, syndromes

81
Q

5-9 years of age, AD

Nocturnal tonic-clonic seizures w/ focal onset

Progress to clonic contractions of one side of the face

EEG: high voltage spikes in contralateral lower rolandic/centrotemporal area

Controlled by single AED. Disappears during adolescence.

A

Rolandic/Sylvian Epilepsy

Benign Epilepsy of Childhood w/ centrotemporal spikes

82
Q

True or False: Intelligence is usually preserved in Infantile Spasms (West Syndrome)

A

False

Most are left mentally impaired

83
Q

True or false: medial temporal lobe epilepsy is more common in patients with complex febrile seizures

A

True

84
Q

Psychogenice states that generate pseudoseizures

A

Panic disorder
Dissociative disorders
Malingering

85
Q

Notable details of psychogenic seizures

4 clinical features, 2 diagnostic

A

Clinical

  1. Eyes closed
  2. Rapid breathing
  3. Tongue biting, front
  4. Highly resistant epilepsy w / normal cognitive function and imaging

Diagnostic

  1. Normal CK post ictus
  2. Normal EEG during attack
86
Q

True or false: epileptic foci are aensitive to Acetylcholine

A

True

87
Q

Percentage of abnormal EEGs

A) 1 EEG during interictal state
B) several recordings

A

A) 30-50%

B) 60-70%

88
Q

Imaging abnormalities in sz;

A) Focal post ictal
B) prolonged sz
C) withdrawal of AEDs

A

A) Focal: cortical swelling
B) prolonged: restricted diffusion hippocampi, posterior thalamus
C) AEDs withdrawal: changes in WM, splenium of CC

89
Q

3 lab findings (serum) post seizure

A

Increased serum prolactin
Increased CK
Lactic acidosis

90
Q

Which antibiotics cause seizures?

A) Imipenem
B) Penicillin congeners
C) Linezolid
D) Cefepime
E) All of the above
A

E) all of the above

91
Q

Which of the following psychiatric meds are associated with seizures?

A) TCAs
B) Bupropion
C) Lithium
D) All of the above

A

D) All of the above

92
Q

Which AED has non-linear kinetics once serum concentration exceeds 10mg/ml?

A

Phenytoin

93
Q

Which AED is known to induce its own metabolism?

A

Carbamazepine

94
Q

[AED interactions]

This drug reduces phenytoin concentration

A

Antacid

95
Q

[AED interactions]

This drug increases phenytoin concentration

A

Antihistamine

96
Q

[AED interactions]

This drug reduces warfarin levels

A

Phenobarbital or carbamazepine

PaBABA) (caBABA

97
Q

[AED interactions]

This drug increases warfarin levels

A

Phenytoin

PhenyToin - PaTaas

98
Q

[AED interactions]

This antibiotic increases levels of carbamazepine

A

Erythromycin

99
Q

[AED interactions]

This antibiotic causes accumulation of phenytoin and phenobarbital

A

Chloramphenicol

100
Q

[AED interactions]

This AED causes accumulation of phenytoin and phenobarbital

A

Valproate

101
Q

[AED interactions]

These drugs decrease estradiol (3)

A

Phenytoin
Carbamazepine
Barbiturates

102
Q

This gene is associated with increased skin eruptions from AEDs

A) in asians
B) in caucasians

A

A) asians: HLA-B*1502

B) caucasians: HLA-A*3101

103
Q

Name the aed:

GABA potentiation
Na channel inhibition
T-type Ca Channel inhibition
NMDA inhibition

A

Valproic Acid

104
Q

Name the aed:

GABA potentiation
Na channel inhibition
Ca Channel inhibition
AMPA inhibition

A

Topiramate

105
Q

Give the MOA of this AED:

Valproic Acid

A

GABA potentiation
NMDA inhibition
Na channel inhibition
Ca (T-type) channel inhibition

106
Q

Give the MOA of this AED:

Phenytoin

A

Na channel inhibitor

107
Q

Give the MOA of this AED:

Carbamazepine

A

Na channel inhibitor

108
Q

Give the MOA of this AED:

Phenobarbital

A

GABA potentiation

109
Q

Give the MOA of this AED:

Lamotrigine

A

Na Channel inhibitor

110
Q

Give the MOA of this AED:

Levetiracetam

A

SC2A modulation

111
Q

Give the MOA of this AED:

Topiramate

A

GABA potentiation
AMPA inhibition
Na channel inhibition
Ca channel inhibition

112
Q

Give the MOA of this AED:

Lacosamide

A

Na channel inhibition

113
Q

Give the MOA of this AED:

Ethosuximide

A

Ca channel (T-type) inhibition

114
Q

Give the MOA of this AED:

Gabapentin
Pregabalin

A

Ca channel inhibition

115
Q

Give the MOA of this AED:

Perampanel

A

Glutamate (AMPA) inhibition

116
Q

Give the MOA of this AED:

Vigabatrin

A

GABA potentiation

117
Q

Give the MOA of this AED:

Propofol

A

GABA potentiation

NMDA inhibition

118
Q

Which AEDs cause Nephrolothiasis (2)?

A

Topiramate

Zonisamide

119
Q

Which AED is a hepatic enzyme inhibitor?

A

Valproic Acid

120
Q

Which AED causes weight loss? (2)

A

Topiramate

Zonisamide

121
Q

Which AED causes weight gain?

A

Pregabalin

122
Q

Which AED causes retinal toxicity?

A

Vigabatrin

123
Q

Initial choice for GTC?

A

Valproate

Carbamazepine

124
Q

Initial choice for Myoclonic sz?

A

Valproate

Levetiracetam

125
Q

Initial choice for Absence?

A

Valproate

126
Q

Initial choice for focal sz?

A

Carbamazepine

Phenytoin

127
Q

Initial choice for infantile spasms?

A

ACTH

Vigabatrin

128
Q

Initial choice for Lennox-Gastaut?

A

Valproate

129
Q

Which AEDs induce hepatic enzymes?

3

A

Phenytoin
Carbamazepine
Topiramate

130
Q

Most common cause of seizure for the ff age groups:

Age groups:
0-14
15-34
35-64
>65
Causes:
Congenital
Trauma
Infection
CV
Tumor
Degenerative
A

0-14: Congenital
15-34: Trauma
35-64: Cerebrovascular
>65: Cerebrovascular

131
Q

AED which causes gingival hyperplasia

A

Phenytoin

132
Q

AED that has autoinduction

A

Carbamazepine

133
Q

AED with weight gain, PCOS, pancreatitis as SE

A

Valproic Acid

134
Q

Mental dullness, drowsiness, dupuytren contractures are SEs of which AED?

A

Phenobarbital

135
Q

AED with the longest half life

A

Phenobarbital

136
Q

AED with the shortest half life

A

Fosphenytoin

🧠📖💯 (20 decks)

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