SM_85b: Neurological Disease in Women

Question 1

Migraine is more common in ____

Answer 1

Migraine is more common in women

Question 2

_____ migraine is migraines that regularly occurs 2 days before to 3 days after menstrual period but can occur at other times

Answer 2

Menstrual-related migraine is migraines that regularly occurs 2 days before to 3 days after menstrual period but can occur at other times

Question 3

____ migraine is migraine that only occurs 2 days before to 3 days after menstrual period

Answer 3

Pure menstrual migraine is migraine that only occurs 2 days before to 3 days after menstrual period

Question 4

Rapid withdrawal of ____ is responsible for hormone fluctuations in migraine

Answer 4

Rapid withdrawal of estrogen is responsible for hormone fluctuations in migraine

Question 5

Migraine frequency ____ in pregnancy and menopause

Answer 5

Migraine frequency decreases in pregnancy and menopause

Question 6

Describe treatment for hormone-sensitive migraine

Answer 6

Treatment for hormone-sensitive migraine

• Abortive therapy: NSAIDs, triptans
• Perimenstrual NSAIDs
• Prophylactic therapy: B-blocker, calcium channel blocker, topiramate, tricyclics

Question 7

____ and ____ may greatly influence susceptibility to seizures in some

Answer 7

Estrogen and progesterone may greatly influence susceptibility to seizures in some

(incidence same in men and women)

Question 8

____ is a sex hormone that is excitatory like glutamate

Answer 8

Estrogen is a sex hormone that is excitatory like glutamate

Question 9

____ is a sex hormone that is inhibitory like GABA

Answer 9

Progesterone is a sex hormone that is inhibitory like GABA

Question 10

Progresterone modulates _____ which upregulates GABA

Answer 10

Progresterone modulates allopregnalone which upregulates GABA (-)

Question 11

____ upregulates glutamate and downregulates GABA

Answer 11

Estradiol E2 upregulates glutamate and downregulates GABA

Question 12

Serum ____ is high and ____ is low in catamenial epilepsy

Answer 12

Serum estrogen is high and progesterone is low in catamenial epilepsy

Question 13

Describe treatment options for catamenial epilepsy

Answer 13

Treatment options for catamenial epilepsy

• Anti-epileptic medications or surgery
• Pulse doses of anti-epileptics: benzodiazepines, acetazolamide
• Oral progesterone
• Depo-medroxyprogesterone
• GnRH agonists

Question 14

Multiple sclerosis is more common in ____

Answer 14

Multiple sclerosis is more common in women

Question 15

In females, T_H0 cells become ____ cells which are responsible for ____

Answer 15

In females, T_H0 cells become T_H1 cells which are responsible for intracellular immunity

Question 16

Low estrogen favors maturation of T_H0 cells into ____ cells which are responsible for ____

Answer 16

Low estrogen favors maturation of T_H0 cells into T_H1 cells which are responsible for intracellular immunity

Question 17

Pregnancy estriol or high estrogen favor maturation of T_H0 cells into ____ cells which are responsible for ____ and ____

Answer 17

Pregnancy estriol or high estrogen favor maturation of T_H0 cells into T_H1 cells which are responsible for extracellular immunity and immune tolerance

Question 18

Major cogenital malformations occur early in the ____ and can result from ____

Answer 18

Major cogenital malformations occur early in the 1st trimester and can result from AEDs

Question 19

____ is the AED with greatest risk of fetal malformations

Answer 19

Valproic acid is the AED with greatest risk of fetal malformations

Question 20

AED levels and seizure control are affected by ____, ____, and ____

Answer 20

AED levels and seizure control are affected by increased fluid volume, increased urine output, and changes in drug metabolism

Question 21

Most women demonstrate a ____ in lamotrigine clearance during pregnancy

Answer 21

Most women demonstrate a marked increase in lamotrigine clearance during pregnancy

Question 22

Describe syptomatic management of migraine in pregnancy

Answer 22

Symptomatic anagement of migraine in pregnancy

• 1st line: non-pharmacologic measures, acetaminophen
• 2nd line: NSAIDs (1st and 2nd trimester only), metoclopromide
• 3rd line: sumatriptan

Question 23

Prophylactic treatment is ____, and ____ and ____ should be avoided

Answer 23

Prophylactic treatment is rarely required / indicated in pregnancy, and valproic acid and topiramate should be avoided

Question 24

____ for disease modification of MS is acceptable for pregnant women

Answer 24

Glatimer acetate for disease modification of MS is acceptable for pregnant women

Question 25

_____ for disease modification of MS should be AVOIDED for pregnant women

Answer 25

Teriflunamide for disease modification of MS should be AVOIDED for pregnant women

Question 26

____ reduce the effect of hormonal contraception

Answer 26

Enzyme-inducing antiepileptic drugs reduce the effect of hormonal contraception

Question 27

____, ____, and ____ are effective for contraception in women on AEDs

Answer 27

Depo-provera, IUD, and condoms are effective for contraception in women on AEDs

Question 28

_____ may increase seizure frequency after starting combined oral contraceptives

Answer 28

Lamotrigine may increase seizure frequency after starting combined oral contraceptives

Question 29

Women who take ____ for migraines are at massively increased risk for stroke

Answer 29

Women who take combined oral contraceptives for migraines are at massively increased risk for stroke

Question 30

Use ____ for contraception in women with MS

Answer 30

Use IUDs for contraception in women with MS