Seizures and antiepileptics

Question 1

5ish causes of provoked seizures:

Answer 1

1. metabolic
2. infections
3. focal neuro deficits
4. meds, withdrawal
5. toxins (EtOH)

Question 2

Criteria for epilepsy dx:

Answer 2

primary seizures (non provoked)

chronic

at least 2 unprovoked seizures at least 24 hours apart

Question 3

Classify:

no LOC

one hemisphere

motor, sensory, autonomic, psychic

Answer 3

Focal, simple

***complex if LOC or impaired

Question 4

Classify:

both hemispheres

synchronized

tonic, clonic, or tonic-clonic (grand mal)

Answer 4

Generalized (like on TV)

convulsive

Question 5

Classify:

both hemispheres

syncronized

non-convulsive

“blank stair”

Answer 5

absence “french accent” (petit mal)

atonic (looks like syncope)

Question 6

Classify:

> 5 min

recurrent w/o recovery to baseline between

20% mortality

Tx?

Answer 6

Status Epilepticus

Give benzos!

Question 7

Two main principles of seizure tx:

Answer 7

1. decrease GLU and/or

2. increase GABA

Question 8

stabilizes “inactivated” state of VG Na+ channels –> decrease in repetitive firing (less GLU)

Answer 8

Carbamazepine

Question 9

Blocks VG T-type dependant Ca+ channel, disrupting pacemaker activity

works on thalamic neurons

treats absence seizures

Answer 9

Ethosuximide

Question 10

Affects synaptic vesicle protein SV2A

decreased GLU

increased GABA

Answer 10

Levetiracetam

Question 11

prolongs Inactivation of VG Na+ channels preventing rapid firing of APs

decreases GLU

Answer 11

Phenytoin

Question 12

Increases Inactivation of VG Na+ channels

blocks presynaptic Ca2+ channels

enhances GABAa receptor (not via benzo route)

limits activation of AMPA GLU receptors

Answer 12

Topiramate

Question 13

decreases receptive firing

blocks VG Na+ and NMDA receptors

Decreases GABA reuptake (GAT-1)

reduces flow of Ca2+ through T-type channels

Answer 13

Valproic acid