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CPT > Epilepsy & Anti-epileptic Drugs > Flashcards

Epilepsy & Anti-epileptic Drugs Flashcards

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1
Q

What is epilepsy?

A

Neurological disorder caused by abnormal electrical activity in the brain, associated with sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions.

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2
Q

What is a convulsion?

A

Uncontrolled shaking movements of the body due to repeated contraction and relaxation of muscles, occurs when the part of the brain responsible for movement is affected by a seizure.

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3
Q

What is a seizure?

A

A sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions.

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4
Q

What is status epilepticus?

A

Medical emergency when epileptic seizures occur continuously without recovery of consciousness in between, the patient can become unable to breathe.

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5
Q

What is the difference between a partial and general seizure?

A

Partial is when a single area of the brain is affected by seizure, general is when seizures are occurring all over the brain.
Seizures can start as partial and progress to become general.

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6
Q

Name the 5 types of general seizure.

A 
Tonic
Tonic-clonic
Myotonic
Atonic
Absence
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7
Q

What are the 2 types of partial seizures?

A

Simple - same consciousness

Complex - loss of consciousness

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8
Q

What is temporal lobe epilepsy?

A

Common type of partial seizure, associated with auras such as auditory hallucinations or rush of memories as the temporal lobe is associated with hearing, language and memory.

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9
Q

What is frontal lobe epilepsy?

A

Common type of partial seizure where patient has abnormal movements on the contralateral side of the body, because the frontal lobe is associated with movement.

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10
Q

What is an absence?

A

Daydreaming like seizure.

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11
Q

What is a tonic seizure?

A

Increased tone in the muscles, muscles stiffen and relax (but not the same as muscle contraction).

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12
Q

What is a tonic-clinic seizure?

A

Has 2 parts, 1st part is tonic where there is increased muscle tone, 2nd part is clonic where they have convulsions.

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13
Q

What is a myotonic seizure?

A

Patient experiences muscle jerks similar to tonic clonic, but there is no increase in tone.

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14
Q

What is an atonic seizure?

A

When patient is without tone and has a ‘drop attack’ when they suddenly just drop.

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15
Q

What is an EEG and what is it used for?

A

Electroencephalogram - when electrodes are put on the head and they are stimulated with things that may induce a seizure - not diagnostic but is useful to support a diagnosis of epilepsy.

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16
Q

What are the 2 types of causes of epilepsy?

A

Primary - idiopathic

Secondary - there is a known cause for the epilepsy

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17
Q

Can epilepsy be inherited?

A

Yes, therefore you should always ask someone about family history.

18
Q

What are the main classes of anti-epileptic drugs?

A
  • Na+ channel blockers
  • Ca2+ channel blockers
  • GABA potentiators
19
Q

Name 4 Na+ channel blockers used to treat epilepsy.

A

Carbamazepine
Lamotrigine
Phenytoin
Sodium valproate

20
Q

What anti-epileptic would you give for status epilepticus?

A

Phenytoin

21
Q

How do Na+ channel blockers treat epilepsy?

A

Blocking Na+ channels prevents action potentials from firing, preventing seizures.

22
Q

What is the MOA of barbiturates and benzodiazepines and what are they used for?

A

Anti-epileptic drugs

GABA potentiators - enhance effects of inhibitory neurotransmitter GABA.

23
Q

What is the MOA of sodium valproate?

A

Acts as both a Na+ and Ca2+ channel blocker - prevents depolarisation and action potential firing.

24
Q

What anti-epileptic drug is used for general seizures?

A

Sodium valproate

25
Q

What is gabapentin used for and what is its MOA?

A

Anti-epileptic drug

Inhibits GABA-transaminase, preventing breakdown of GABA and increasing inhibition of neuronal activity.

26
Q

What is levetiracetam used for and what is its MOA?

A

Anti-epileptic drug

Binds to pre-synaptic vesicles and inhibits pre-synaptic Ca2+ activity, which prevents exocytosis and neurotransmission.

27
Q

How are anti-epileptic drugs initiated?

A

Start with mono therapy and if ineffective, change to a different AED. If still ineffective, may need to add another AED.

28
Q

How would you go about changing an anti-epileptic drug

A

New drug is titrated up to achieve therapeutic range, then old drug is slowly withdrawn over 6 weeks (drugs need to overlap).

29
Q

When are anti-epileptics considered?

A

Usually considered after multiple similar seizures, but can be considered after only one if there is also:

  • neurological deficit
  • risk of further seizure is unacceptable
  • EEG shows epileptic activity
  • imaging reveals a structural abnormality
30
Q

When should anti-epileptics be stopped?

A

Consider cessation if patient has been seizure free for at least 2 years, but consider patient’s livelihood (operating machinery).

31
Q

Which anti-epileptic drugs are liver enzyme inducers?

A

Carbamazepine

Phenytoin

32
Q

Which anti-epileptic drug is a liver enzyme inhibitor?

A

Sodium valproate

33
Q

What are the general side effects of all anti-epileptic drugs?

A
  • dizziness
  • fatigue
  • ataxia
  • diplopia
34
Q

Name some side effects specific to levetiracetam and gabapentin.

A
  • irritability

- behaviour change

35
Q

Name a side effect specific to carbamazepine.

A

Weight gain

36
Q

Name side effects specific to lamotrigine.

A
  • tics

- insomnia

37
Q

Name some specific side effects of sodium valproate.

A
  • weight gain

- very teratogenic - decreases serum folate leading to neural tube defects

38
Q

Which of the AEDs is safest in pregnancy?

A

Carbamazepine, although there are still some risks.

39
Q

Name some specific side effects of phenytoin.

A
  • cleft lip and palate

- congenital heart defects

40
Q

Which AED is a cardiac depressant and can cause arrhythmias?

A

Phenytoin

41
Q

What drugs are given for the initial management of seizures?

A

Benzodiazepines e.g. Lorazepam or midazolam (given PR if pre-hospital and IV if in hospital).

42
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy

CPT (24 decks)

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