Epilipsy Flashcards
بسم الله الرحمن الرحيم
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>= 2 unprovoked seizures within 24 hours apart this is?
Epilipsy
Abnormal excessive neuronal electricaly activity in the brain with suden onset and offset
Transinet recurrent neurological symptoms ?
Epilipetic seizures
symptoms of epilipsy depends on ?
site of origin of the abnormal elctrical activity
if in motor cortex may cause motor seizures and abnormal movements
The most common origin of seizures and abnormal electrical activity is ?
Temporal
Frontal
Epilipsy may be ?
Focal motor in precentral gyrus
somatosensory in post central gyrus
Visaul
Auditory
Autonmoinc with raising epigastirum in insula
Define convulsion
Abnormal involuntary muscle contraction.
Motor seizures
Mention causes of epilipsy
Primary Idiopathic may be genetic
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T3I2VF
Secondary :
Trauma
Tumors
Toxins or drugs ICTI
Inuslin - cocaine - TCAs -Ii
Infection:Meningitis - encephalitis
Vascular: Cerebrovascular disorders+ Stroke
Fever in Children called Febrile Convulsions
Types of epilipsy
Patiral simple or complex
Generalized : Absecne -Tonic-clonic -Myoclonic
Mechanism of Epilipsy>
Increased Glutamate Tranismission
Decreased GABA transmission
with increased Na & Ca channels activity for depolarization
Mechanism of antirpliptic drugs
Drugs working on :
1-Neurotranmsitters
Glutamate decreasing its action : Topiramate
GABA increasing its action :
Phenobarbital-Benzodiazepines
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2-Membrane channels ?
Na channels : Carbamzine+Phenytoin
Ca channel :? Ethosuximdie
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Valporate works on ?
Na channels
Ca of T TYPE Post synaptic
with ethoxuisimde
V NMDA of glutamat
Increasing GABA amount with Vigbatrin
Topimerate works on ?
Na channels
T AMPA of glutamate
GABA A receptors with benzo and barbit
Lamotrigine works on ?
Na channel
Ca channels presynaptic with Gabapentin + Pregaballin
Levetiracetem
Vesicular protein Vs2A.
Antiepleiptics working on Na channels are?
Phenytoin
carabamazepine
oxcarabamazeipine
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VTL
Valporate
Topiramate
Lamotrigine
Decrasing repetitive firing of neurons
Vigabatrin working on
GABA-Transmaminase decreasing catabolism
Effective in absence seizure ?
Blokcing T Ca channels decreasing brain ryhtmic activity
Incrasign GAD?
Valporate + Gabapentin
Classification of antiepileptics
Classicial agents :
VCPE Phe benzoفكبي فيه بنزين في الكتاب واحرقه طبعا
Valporate
Carbamazpine
Phenytoin
Ethosuixmidie
Phenobarbiutate
Benzodiazepines
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Newer agents :-
Tol2 GABA
Topiramate
Lamotrigine
Levetiracetam
Pragabaillin-gabapenitn
Mention Broad spectrum antiepeliptics and GR
لا لي فيه لاخفيه ايه رايك في الافيه ؟
La Le V
Lamotrigine
Levetiractam
Valoporate
Mention Broad spectrum antiepeliptics and GR
لا لي فيه لاخفيه ايه رايك في الافيه ؟
La Le V
Lamotrigine
Levetiractam
Valoporate
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due to multiple mechanism of actions in brain transmitters and channels so used in partial and generalized epilipsy
Sodium valporate + valporioc acid =
Divalporex
converted to valporate ion in GIT For improving GIT tolerance Of valporic acid
how to detect epilpist?
EEG
Choices of antieplitptic in types of epipilsy
Valporats firs line in all except in Partial is second line
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Levetiracetam is second line in all except ? Absence seizure
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First line of Partial is ?Carbamazpine + Lamotrigine while the second line :
Valporate + Oxcarabamzaine + levetiracetam
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First line Tonic-clonic ?
Valporate - lamotrigine while second :
Levetiracetam -Carabamzpeine+ox
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First line Absnces ::?
Ethousimide + Valporate
Second is :
Lemotrigine
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First line in Myoclonic ?
Valporate
Secondline :
Topiramate +
Levetiracetam
IF patient has Tonic clonic + Absence seizure the preferrd antiepilpetic is ?
Valporate due to multiple meahncims
Contraindicated antiepileptics in absence and myoclonia seizures
CarGaP2
Carbamazepine
Gapapetnite
Pregabalin
Phenytoin
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Contr in absence ?
the above 5+ Phenobarbital and Levetiracetam
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Cont in myclonic :
the 5 above + Lamotrigine
Due to sedation and tolerance Benzo and phenobarbital are used mainly in ?
Acute fits and status epilipticus
Phenobarbital is used in ?
Tonic clonic & partial
Clonezpam is used as ? in epilipsy
2nd line broad spectrum
Adverse effects of Phenytoin as antiepliptic?
Cosmetic + pharmacokinetic disturbances :Cinteic
=Irregular BA
=Saturation kinetic if serum level increased to a level liver cannot control
=CYP inducer: causing drug interactions
Indications of phenytoin
Contraindications ?
in partial and Tonic-clonic
In Status epilipticus
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CI : Absecne + Myoclonic and carbazmaepine also CI
Fosphenytoin Characteristics
Given IM in oppoiste of Phenytoin
Given IV less irritant
has higher rate of infusion than pheytoin100BA
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PCB-Less phelibitis
-Less Cardiotoxic hypotension and arrythmia
-Increased BA Faster infusion not ppt
it is the prodrug of phentoion
compare between fosphenytoin and phenytoin in tissue side effect?
Phenytoin if extravasates may cause purple glove syndorme and tissue necrosis
But
Fosphenytion less tissue side effects
Oxcarbaepine compared to carbamazepine is ?
Less potent with
less side effects ( enzyme induction and blood dyscriasis )
Hypersensitivity appear more in ?
Valoporate causing skin rash
GIT diusturbances appear more in ?
valproate
Neurological disutrbances of Phenytoin ,carbamazepine and valproate ?
Phenytoin :
Nystagmus - dipolopia -ataxia -drowiness- decrasing learninig in children
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Carbamazpeine : diplopia -ataxia -doriwsness
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Valproate :
Fine hand termores + ataxia
Less sedation
Hepatic CYP 450 Affected by anitepliptic show ?
Phenytoin enzyme inducer causing increeaing metabolism of other antieplieotics and Vit D causing decreasd Ca in bones casuing Osteomalacia
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Carbamazpine enzyme iducer of other anti epiliptics causing induction of metabolism of Warfatin = thrombosis
Oral contraceptives = pregnan
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Valproate is enzyme inhibitor
Megaloblastic anemia can occur by,,,,while lecopenia and Agranulocyotsis by ,,,,,,, ?
Phenytoin megalo
Agranulo ? = Carbmazepine
Thromboctosis can occur by?
Valproate
Spina bifida and Neural tube defects occur by ?
Valproate
Cleft + lip palate + Heart anomalies can occur by ?
Phenytoin
Adverse effect of phenytoin ?
Cosmetic + Unpredictible level
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Cosmetic :GFH
Gingival Hyperplasia
Coarse features
hirsutism +acne
Mention avdverse effects of Valproate
HAPO Valproate
Hepatoxic
Alopecia hair loss
Polycystic ovaries
Overwieht with increased appetite
Water intoxication with Diltional hyponatermia is due to ?
Carabamazepine increasing ADH
eTHOSUXMIDE indication + adverses
Narrow specrtum for Abscnese
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GIT symtpms
Skin rash
Diziness -Drowsness -headache
Steven johnison syndrome caused by?
it is fatal hypersensitivty dermaititis by ?
Lamotrigine
Never ever give lamotrigine with ? valproate why?
Due to valproate enzyme inhibtion causing increased level of lamotrigine pericptating Steven johnoson sundorme
adjust Lamotrigine dose if given with Oral contaceptive and Carbamazepine why ?
As they are enzyme inductors
casuing its level to be decreased
Levetiracetam with renal patients
should be adjusted beacuse it is renally excreted
Levetiracetam is broad spectun exept ?
abscence seizures
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It casues mood and behavioral changesa
Aggession agitaiton and depression
Gapapetinoids used in focal epilpisy
indications ?
with adverses of
Dizzness dowinsness sedation atxia
Wiegh gain
NAR
Neuropathic pain
restless leg syndrome
Antianxiety
Mention adverses of Gapapetioids
PRA
=Peripheral edema
=Excreted renally only as levetiracetam
=Risk of abuse due to euphoric effect in Nucleus accumbnes
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Mention adverse effects of Topiramate
RMHW
1-Renal stones
2-Myopia + glacuoma
3-weight loss
4-hypohidrosis with less sweat causing hyperthermia
Topiramate indication
Broas spectrum antiepiletoic &Migrane
Renal stones occur with ?
taz
Topiramate
Acetazolamide = CAI
Zonisamide
dose adjustment of antipeplitoics should be done in elderly why ?
=Decreased clearance : Carbamazepine and Lamotrigine
=Decreased protein binding : phenytoin and Valproic acid
Drug perferred in elderly ?
Carbamazpine
Levetiracetam
Lamotrigine
Gabapentin
CL bagL
anitepilptics with no enzyme interactions
Levetiracetam
Gapapetint and Pregabalin
maily renal excretion
Monotherapy is perferred
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Long treatment 2 years
gradual withdrawal over 6 months to avoid status epilipticus
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serum level monitoring
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Mention use of antiepliptics
Epilipsy WOW!? ^_^
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-Mood stabilizer in bipolar
CVL :Carbamazepine -valproate-Lamotrigine
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-Neuropathic pain : Carbamazpine + gabapentin +pregabalin
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-Migarane : valproate + Topiramate
vault valt
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Arrythmia as phenytoin class ib for ventricualr-Digitalis -torsade arrythmia
AM2N
pREGNANCY Recommendations
-Folic acid 5 mg/day before and after prenancy decrsanig teratogenic
-Monotherapy
-Decrasing AEDs to lowes doeses
-Women 2-5 years withous seizures then gradual withdrwawl over 6 months
-Cannot withdraw?
replace AEDs with
Carbamazeoine -lamotrigine -levetiracetam
Vit K 10 mg in third 1/3 decreasing newborn pospartum hge
Prgancny increasing epilipsy
due to increasing metabolism of antiepiliptics with
Hemodilution
adjust dose ! increase the dose
guided with plasma level
Prolonged or repeated tonic clonic seizures
Convulsive status epilipticus
time is BRAIN
How to detect convulsice status epilipticus ?
Active toinc clonic sezure with duration of 5 minutes
of more
Tonic clonic seizure repeated after 30 or less mintuts
Withous recovering consciousness from first seizure
Withdraw of antiepliptic may lead to ?
Status epilipticus
Why status epilipticus ?
TMSAHW
Withdraewal of antiepilieptic
Trauma
Metabolic
Stroke
Hypoxia
Alcohol or drug abuse
HMST WITH ALCHOLO
wHY STATUS EPILIPTICUS IS FATAL ?
2hrb lab
1-HYPERTHERMIA
2-Brain damage due to hypoxia and metabolic dis
3-Pulmonary edema
4-Heart arryht
5-renal failure with myoglobinuria and dehydration
6-Lactic acidosis ! main causie of death
Main cause of Death from status epilipticus is ?
Lactic Acidosis
Mangemt of status epilitucs
first step ABCDE
aspiration -breathing-circulation-dextrose-electrolytes
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Second step :-
BZD midazolam IM
diazepam IV RECTAL
Lorazepam IV
Fosphenytoin or pheytoin or !
Phenobarbital 2ndry
IV anitepipetics Valproate -levetiracetam
IV or inhalation anstheisa
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الحمدلله رب العالمين
Simple partial seziure cc by?
The patient is conscoius
Motor or sensort visual pscychi changes
Which seizure cc by aure ? describe
Complex partial seizure
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Visual olfactory sensory hallucination
Senes of fear
unusual abdominal sensations
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The seizures has automatism in ?
Complex partial seizure as
repeated involunarry movements last for 2-5 minutes
The seizures has automatism in ?
Complex partial seizure as
repeated involuntary movements
postictal means and appears in ?
Confusion with amneisa except the aura
in complex partial seizure
Absenece sieure CC by ? called petiti mal
no postictal
Loss of consicuosness as it is genrealized seizures the child stares to space blankly eyes rolling up for few second for 50 -100 times /perday after the seizure the patients if fully alert
Describe tonic clonic sieures
Genralized with loss of consousness
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Tonic : Arching of back and extension of limbs
Epiliptic cry +pallor and cyanosis
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Clonic : Jerks +
up Rolling open eye
Biting tongue + frothing from mouth
Urine incontinence
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Postiictal ? Confusiion with gradual regain of consiucouness
Myoclonic
Genralized seizure with Affecte muscle or group of muscle doing alternating contraction and relaxation
Jerking or twithcing of muscle
