SM_85b: Neurological Disease in Women Flashcards
Migraine is more common in ____
Migraine is more common in women
_____ migraine is migraines that regularly occurs 2 days before to 3 days after menstrual period but can occur at other times
Menstrual-related migraine is migraines that regularly occurs 2 days before to 3 days after menstrual period but can occur at other times
____ migraine is migraine that only occurs 2 days before to 3 days after menstrual period
Pure menstrual migraine is migraine that only occurs 2 days before to 3 days after menstrual period
Rapid withdrawal of ____ is responsible for hormone fluctuations in migraine
Rapid withdrawal of estrogen is responsible for hormone fluctuations in migraine
Migraine frequency ____ in pregnancy and menopause
Migraine frequency decreases in pregnancy and menopause
Describe treatment for hormone-sensitive migraine
Treatment for hormone-sensitive migraine
- Abortive therapy: NSAIDs, triptans
- Perimenstrual NSAIDs
- Prophylactic therapy: B-blocker, calcium channel blocker, topiramate, tricyclics
____ and ____ may greatly influence susceptibility to seizures in some
Estrogen and progesterone may greatly influence susceptibility to seizures in some
(incidence same in men and women)
____ is a sex hormone that is excitatory like glutamate
Estrogen is a sex hormone that is excitatory like glutamate
____ is a sex hormone that is inhibitory like GABA
Progesterone is a sex hormone that is inhibitory like GABA
Progresterone modulates _____ which upregulates GABA
Progresterone modulates allopregnalone which upregulates GABA (-)
____ upregulates glutamate and downregulates GABA
Estradiol E2 upregulates glutamate and downregulates GABA
Serum ____ is high and ____ is low in catamenial epilepsy
Serum estrogen is high and progesterone is low in catamenial epilepsy
Describe treatment options for catamenial epilepsy
Treatment options for catamenial epilepsy
- Anti-epileptic medications or surgery
- Pulse doses of anti-epileptics: benzodiazepines, acetazolamide
- Oral progesterone
- Depo-medroxyprogesterone
- GnRH agonists
Multiple sclerosis is more common in ____
Multiple sclerosis is more common in women
In females, TH0 cells become ____ cells which are responsible for ____
In females, TH0 cells become TH1 cells which are responsible for intracellular immunity
Low estrogen favors maturation of TH0 cells into ____ cells which are responsible for ____
Low estrogen favors maturation of TH0 cells into TH1 cells which are responsible for intracellular immunity
Pregnancy estriol or high estrogen favor maturation of TH0 cells into ____ cells which are responsible for ____ and ____
Pregnancy estriol or high estrogen favor maturation of TH0 cells into TH1 cells which are responsible for extracellular immunity and immune tolerance
Major cogenital malformations occur early in the ____ and can result from ____
Major cogenital malformations occur early in the 1st trimester and can result from AEDs
____ is the AED with greatest risk of fetal malformations
Valproic acid is the AED with greatest risk of fetal malformations
AED levels and seizure control are affected by ____, ____, and ____
AED levels and seizure control are affected by increased fluid volume, increased urine output, and changes in drug metabolism
Most women demonstrate a ____ in lamotrigine clearance during pregnancy
Most women demonstrate a marked increase in lamotrigine clearance during pregnancy
Describe syptomatic management of migraine in pregnancy
Symptomatic anagement of migraine in pregnancy
- 1st line: non-pharmacologic measures, acetaminophen
- 2nd line: NSAIDs (1st and 2nd trimester only), metoclopromide
- 3rd line: sumatriptan
Prophylactic treatment is ____, and ____ and ____ should be avoided
Prophylactic treatment is rarely required / indicated in pregnancy, and valproic acid and topiramate should be avoided
____ for disease modification of MS is acceptable for pregnant women
Glatimer acetate for disease modification of MS is acceptable for pregnant women
_____ for disease modification of MS should be AVOIDED for pregnant women
Teriflunamide for disease modification of MS should be AVOIDED for pregnant women
____ reduce the effect of hormonal contraception
Enzyme-inducing antiepileptic drugs reduce the effect of hormonal contraception
____, ____, and ____ are effective for contraception in women on AEDs
Depo-provera, IUD, and condoms are effective for contraception in women on AEDs
_____ may increase seizure frequency after starting combined oral contraceptives
Lamotrigine may increase seizure frequency after starting combined oral contraceptives
Women who take ____ for migraines are at massively increased risk for stroke
Women who take combined oral contraceptives for migraines are at massively increased risk for stroke
Use ____ for contraception in women with MS
Use IUDs for contraception in women with MS
