Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Epilepsy Board Study > Epilepsy Treatment > Flashcards

Epilepsy Treatment Flashcards

1
Q

Ketogenic Diet Mechanism

A

Uses long chain fatty acids > break down to acetyl-CoA –> ketone bodies (specifically acetoacetate) -> acetone + beta hydroxybutyrate
Ketone bodies cross BBB –> used for energy instead of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ratios of Ketogenic diet

A

3:1 or 4:1 (fat:protein +carb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medium Chain Triglyceride (MCT) diet

A

Uses MCT oil as source of MC FA
More effiecient in generating ketones
Can consume more protein and carbs

Cons: GI side effects, diarrhea, vomiting, and abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Modified Atkins Diet

A

0.9:1 ratio
60-65% of calories from fat
30% from protein
10% carbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Low Glycemic Index

A

allows high carbohydrates, but limits carbs to low glycemic index (foods that have lower postprandial index)
All carbs glycemic index <50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Indications for diet therapy

A

Strongly consider:
Failed 2-3 anticonvulsants
Symptomatic generalized epilepsies

Probable benefit:
MAE, Dravet sydnrome, TS, Retts, infantile sapasm

Possibly beneficial: LKS, Lafora body disease, SSPE, mitochondrial respiratory chain complex disorders, phosphofructokinase def, FIRES, LGS, HIE, focal malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Conditions where Keto diet is treatment of choice

A

GLUT1 deficiency

Pyruvate dehydrogenase deficiency (b/c pyruvate cannot be metabolized to acetyl-coA(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contraindications for Keto Diet

A

Disorders of FA metabolism defects:

  • Primary carnitine deficiency
  • Carnitine translocase deficiency
  • Beta oxidation defects (MCAD, LCAD, SCAD)
  • Pyruvate Caroxylase deficiency

Relative contraindications: FTT, if surgical focus, noncompliance, lack of parental readiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Labs to screen for contraindications for KD

A

CBC, Lytes, Mg, Phos, Zinc, Selenium, LFTs, UA, UCa/Cr, UOA, SAA, ACP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Duration of KD

A

Range of benefit 1 - 65 days, typically within 2 weeks
KD for 3 months
If seizure free x 2 years, can consider discontinuing
,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of KD

A

Short term: vomiting, dehydration, hypoglycemia, and excessive acidosis
Long term: growth limitations, kidney stones, dyslipidemia, GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Monitoring labs evert 3 months:

A 
Check weight/height
Fasting Lipid Panel
BMP, Ca, Mg, Phos, 
CBC, Free/total carnitine
Zinc
Selenium 
Vit D
Urine Ketones, 
BHOB
Bone density scan if on for >2 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Efficacy for diet therapy:

A

KD: 38% experience 50% reduction rate at 3 months

MAD:

  • 45-65% had at least >50% reduction of seizurse, 35-36% with >90% seizure reduction
  • 45% with 50-90% seizure reduction, 28% with >90% seizure reduction

LGIT:
38% of pts >50% decreased seizures
-24% with >90% seizure decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Meds with extended release formulations

A 
Gabapentin
Lamotrigine
Topiramate
Levetiracetam
Oxcarbazepine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Brivaracetam

A

Sodium blocking mechanism + SV2A binding

Similar SE profile, but higher potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cannabidiol

A

Indication for Dravet, LGS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Two main animal models in screening AED candidates:

A
  1. Maximal electroshock model (MES)

2. Subcutaneous pentylenetetrazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Maximal electroshock model (MES)

A

Electrical stimulation applied through the cornea –> elicits hind limb extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Subcutaneous Pentyenetetrazole Model

Description

A

PTZ is injected subcut at a dose to induce at least 5 s of clonic seizures activity in 97% animals.
-Predictive of efficacy against generalized tonic-clonic activity and absences seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Genetic mice model DBA/2

A

Model for audiogenic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GAERS mice models

A

Genetic model for absence seizures

22
Q

6Hz psychomotor seizure model

A

6Hz pulse of 0.2ms duration through the cornia for 3 sec results in limbic seizures

23
Q

Metylazoxymethanol acetate (MAM) model

A

Cortical dysplasia mouse model
MAM exposed in utero –> cortical dysplastic type lesions
Seizures inducted by kainate are drug resistant

Model for pharmacoresistant epilepsy

24
Q

Catamenial Epilepsy

A

C1 = increased seizures just prior to menses
-> Responds to progesterone 200mg TID on days 14-28
C2 = increased seizures during ovulation
C3 = increased seizures with anovulatory cycles

25
Hormones in Catamenial Epilepsy
Estrogen --> proconvulsant Progesterone --> Anticonvulsant Seizures more likely to occur when ratio of progesterone to estrogen decreases (usually during menstruation or at ovulation)
26
ACTH used in treatment for
Infantile Spasm Lennox Gastaut Syndrome Landau Kleffner Sydnrome
27
IVIG/Steroids | Used in treatment for
Rassmussens Limbic encephalitis Faciobrachial dystonic seizures Anti-LGI1 encephalitis (VGKC), anti GAD, anti thyroid, anti-NMDA
28
AED that REDUCE levels of OCPs
Phenytoin Carbamazepine Phenobarbital Primidone *Use alternative methods of contraception
29
AED that are affected by OCPs
Lamotrigine --> Estrogen reduces lamotrigine level
30
Teratogenicity and AED
Increased risk for major congenital malformations, 2-3x higher Risk for lower IQ VPA avoided in monotherapy or polytherapy in first trimester
31
Safest medications in Pregnancy
``` lamtorigine levetiracetam oxcarbazepine zonisamide Gabapentin ``` Less: CBZ, PHT
32
VNS Approval Indications
1. Adjunctive therapy for pts >/= 12 years with refractory focal onset epilepsy 2. Adjunctive therapy in pateints >/= 18 years with chronic or recurrent major depression episodes refractory to >4 adequate antidepressant
33
AED success rates in patients
Focal epilepsy 50% | Primary Generalized epilepsy 80%
34
Definition for refractory Epilepsy
Failure of adequate trials of two appropriate and tolerated doses of two appropriate and tolerated AED at maximum possible doses (in monotherapy or combination) for enough time Enough time = f/u period of 3x longest interseizure interval
35
Clinical Indications for VNS
``` Refractory focal seizures not eligible for brain surgery Multifocal epilepsy Unclear seizure focus Overlapping eloquent cortex Opposed to surgery ```
36
Efficacy of VNS
18.75% of patients had >/= 50% reduction in in seizure frequency
37
VNS Lead placement
Lead must be placed below where the superior and inferior cervical cardiac branches separate from the Left vagus nerve. - Stim of these nerves may cause bradycardia and/or asystole Main vagus nerve is the largest of the three nerves
38
VNS electrode polarity
Bipolar lead transmit stim from the generator to the left vagus nerve Lead consists of a pin that connects to the generator on one end and helices contain the stimulation and electrodes and anchor tether on the other end
39
VNS clinical trial
High group - signficant seizure reduction compared with baseline and LOW group In High group - 31% of pts had >50% seizure reduction In low group - 13% of pts had >50%
40
Side effects of VNS
In order of most common: 1. Hoarseness -> due to device malfunction, nerve constriction, nerve fatigue 2. Dyphagia/cough 3. Dyspnea -esp with COPD/asthma 4. OSA - esp during stim 5. Nerve damage/pain 6. Laryngeal irritation 7. Lead break 8. Trauma to VN 9. SUDEP = not any difference than population 10: Twiddler syndrome - damage or disconnect
41
VNS parameters
Output current Signal frequency Pulse width ON/OFF time
42
What VNS settings can cause degeneratve damage
High frequency (>50Hz) + ON time >> OFF time
43
Recommended starting parameters for VNS
Output current 0.25mA On time 30s Off time 5min Signal frequencies 20-30 Hz Pulse width 250-500u
44
How do you optimize VNS?
Increase output current | Modifying on or off time
45
How do you manage side effects?
Decreasing signal frequencies 30 ->20 Hz Decreasing output current (by 0.25mA) If this doesnt achieve tolerability, lowering the pulse width 500 > 250uS.
46
MRI and VNS
VNS is MRI compatible Before going to MRI --> need to set outptu current and magnet current to 0mA. When MRI is done --> need to reprogram
47
Mechanism of Action of VNS
Unknown, but possibly - Affect heart rated and respiratory rate - Vagus-initiated activity in the brain has been localsed through fos1 immunoreactivity - Regional brain glucose metabolism
48
Investigational neurostimulators
DBS and RNS
49
RNS
Responsive neurostimulation -short trains of electrical stim can stop after discharges Candidates: 1. Focal seizures in eloquent cortex 2. bilateral MTS
50
RNS Efficacy
Trials 12 weeks after: 37.9% had seizure reduction (compared to sham 17.3% 5 months postimplantation - 41.5% seizure reduction (compared 9.4%) Open label: 50% responder rate seen in 55% of patients 44% responders at 1 year 53% at 2 years
51
SANTE Trial for DBS
DBS in focal epilepsy patients (with baseline 19.5 sz/month) Implantation in the anterior nucleus of the thalamus 3months - 1/2 received stim vs no stim Last month, simulated group had 29% greater seizure reduction compared to control

Epilepsy Board Study (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions