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PA20023 > Epilepsy and anticonvulsants > Flashcards

Epilepsy and anticonvulsants Flashcards

1
Q

What is epilepsy?

A

The name for occasional, sudden, excessive, rapid and local discharges of grey matter. It is a sudden, excessive high frequency neuronal discharge.

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2
Q

What is the ictal phase?

A

The actual seizure or convulsion.

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3
Q

What is the interictal phase?

A

The inactive state between seizures, however some abnormal activity spikes can be recorded.

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4
Q

What is epileptogenesis?

A

The underlying process that leads to the development of epilepsy.

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5
Q

What is epilepsy a disorder of?

A

The cerebral cortex.

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6
Q

What percentage of the population does epilepsy effect?

A

0.5-1%.

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7
Q

What does drug refractory mean?

A

The condition does not respond to treatment.

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8
Q

What percentage of cases of epilepsy are drug refractory?

A

30%.

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9
Q

How many new cases of epilepsy are diagnosed per year?

A

30,000.

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10
Q

What does it mean that epilepsy is largely idiopathic/cryptogenic?

A

The cause is unknown/it arises spontaneously.

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11
Q

What percentage of cases of epilepsy are idiopathic/cryptogenic?

A

70%.

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12
Q

What is one of the causes of epilepsy?

A

From birth due to structural abnormalities in the brain.

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13
Q

What is a non-genetic cause of epilepsy?

A

Birth trauma such as a reduced blood supply to the brain.

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14
Q

What is the one of the causes of epilepsy in the elderly?

A

Neurological/neurodegenerative processes.

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15
Q

What is one of the causes of epilepsy in young adults?

A

Head trauma that may be penetrating or non-penetrating.

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16
Q

What is one of the metabolic causes of epilepsy?

A

Glucose or electrolyte imbalance.

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17
Q

What are some of the diseases that can cause epilepsy?

A

Meningitis, tumours or abcesses.

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18
Q

What can be used to record epilepsy?

A

EEGs.

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19
Q

What does EEG stand for?

A

Electro-encephalography.

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20
Q

What else can be used to record epilepsy?

A

MEGs.

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21
Q

What does MEG stand for?

A

Magento-encephalography.

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22
Q

What do MRIs measure?

A

Structure and volume.

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23
Q

What does fMRI do?

A

It relates activity to structure.

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24
Q

What does PET measure?

A

It monitors local metabolism.

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25
Q

What are some invasive approaches to monitor epilepsy?

A

Dural electrode arrays and implanted depth electrodes.

26
Q

Where do seizures arise?

A

Rarely in the subcortical region, mostly in the cortical region such as the frontal, parietal, occipital and temporal lobes.

27
Q

What is the most prevalent region of the brain where seizures arise?

A

The temporal lone in the cortical region - 30-40% of seizures arise here.

28
Q

What areas of the temporal lobes are involved in seizures?

A

The hippocampus, entorhinal cortex and the amygdala.

29
Q

How do temporal lobe seizures respond to treatment?

A

They do not respond to drugs but can be treated with surgical removal of parts of the lobe involved in the seizures.

30
Q

What is radical temporal lobectomy?

A

A surgery that can lower the number of seizures patients have.

31
Q

What causes seizures to arise?

A

The activity in the cortex. There is usually a dynamic balance between inhibition and excitation.

32
Q

What are the potential disturbed balances of activity in the brain?

A

More excitation with normal inhibition, decreased inhibition with normal excitation and decreased inhibition with increased excitation.

33
Q

What causes excitation and inhibition of neurons in the brain?

A

Glutamate and GABA.

34
Q

What can initiate and prolong a seizure?

A

Synaptic and intrinsic factors such as sub-threshold voltage gated Na+ channels and voltage gated Ca2+ channels.

35
Q

What causes seizures to stop?

A

K+ channel activation, Na+ channel inactivation, glutamate receptor desensitization and glutamate depletion.

36
Q

How can epilepsy be treated?

A

Blocking destabilizing currents, increasing stabilizing currents, reducing synaptic excitation (blocking glutamate receptors and release) and increasing synaptic inhibition (increasing GABA release and potentiating GABA receptors).

37
Q

What are some drugs that block voltage gated Na channels?

A

Phenytoin, carbamazepine, lamotrigine, sodium valproate.

38
Q

How do anticonvulsants work?

A

They bind to sodium channels in their inactive state.

39
Q

What drugs block voltage gated calcium channels?

A

Ethosuximide, gabapentin and phenytoin.

40
Q

How can drugs block glutamate release?

A

Block sodium and calcium channels in glutamate neurons.

41
Q

What drugs can be used to reduce glutamate vesicle fusion?

A

Levetiracetam.

42
Q

What drugs can increase GABA levels?

A

Vigabatrin and sodium valproate.

43
Q

What does GABA transaminase do?

A

It blocks GABA breakdown, increases GABA levels and increases GABA release.

44
Q

How can GABA inactivation be decreased?

A

Tigabine.

45
Q

How can GABA postsynaptic responses be increased?

A

Benzodiazepines and barbiturates.

46
Q

What is an absence seizure?

A

Epileptic activity occurs throughout the entire brain. It is a milder type of activity that causes unconsciousness without convulsions. After the seizure the person has no memory of it.

47
Q

What is a tonic-clonic seizure?

A

Electric discharges instaneously involved the entire brain. Consciousness is lost from the beginning of the seizure.

48
Q

What are the classifications of partial seizures?

A

Focal and localized.

49
Q

What is a simple partial seizure?

A

No loss of awareness.

50
Q

What is a complex partial seizure?

A

Loss of awareness.

51
Q

What is ictogenesis?

A

The process of transition from the interictal phase to the actual seizure.

52
Q

What are 5 alternative anticonvulsants?

A

Felbamate, topiramate, retigabine, levetiracetam, losigamone.

53
Q

How does felbamate act?

A

It blocks NMDA receptors.

54
Q

How does topiramate act?

A

It blocks AMPA/kainate receptors.

55
Q

How does retigabine act?

A

It activates K-currents.

56
Q

How does levetiracetam act?

A

It modifies vesicle release machinery.

57
Q

How does losigamone act?

A

It blocks low threshold Na- currents.

58
Q

What drugs are used to treat tonic-clonic seizures?

A

Phenytoin, carbamazepine, valproate, levetiracetam, vigabatrin, lamotrigine, felbamate, gabapentin.

59
Q

What are used to treat partial/focal seizures?

A

Carbamazepine, valproate, levetiracetam, sometimes phenytoin and benzodiazepines.

60
Q

What are used to treat absence seizures?

A

Ethosuximide, valproate.

61
Q

What are used to treat myoclonic seizures?

A

Benzodiazepines.

62
Q

What is used to treat status epilepticus?

A

Benzodiazepines.

PA20023 (17 decks)

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