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INTERGRATED STUDIES IN MENTAL HEALTH > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

define convulsion

A

Sudden attack of involuntary muscular contractions and relaxations.

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2
Q

define seizure

A

Abnormal central nervous system electrical activity

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3
Q

define epilepsy

A

A group of recurrent disorders of cerebral function characterised by both seizures and convulsions.

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4
Q

Epidemiology: when does epilepsy present

A

> usually in childhood or adolescence but may occur for the first time at any age

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5
Q

Epidemiology: what population of people suffer from a single seizure at some time

A

5%

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6
Q

Epidemiology: what % of people have epilepsy

A

0.5 - 1%

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7
Q

Epidemiology: what % of the population are well controlled with drugs and partially resistant to drug treatment

A

> 70% well controlled

> 30% are partially resistant to drug treatment

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8
Q

what is it called when you’re resistant to drug treatments

A

INTRACTABLE (pharmaco-resistant) EPILEPSY

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9
Q

describe some clinical features of seizures

A

> > not life threatening
brain almost always stops seizures on its own
breathing may cease for a few secs
its usually painless

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10
Q

what are the 2 broad classifications of seizures based on

A

nature of the seizures rather than the presence or absence of an underlying cause

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11
Q

what are the 2 classifications of seizures

A
  1. Focal seizures (partial seizures
  2. Generalised seizures
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12
Q

how many subtypes are in each broad categories

A
  1. focal seizures : 3
  2. generalised seizures: 6
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13
Q

which brain section does partial (Focal seizures) occur?

A

Excessive electrical activity in one cerebral hemisphere -> Affects only part of the body.

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14
Q

what are the 3 subtypes of partial (focus) seizures

A

simple partial
complex partial
secondary generalised seizures

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15
Q

describe simple partial seizures

A

> > Patients has sudden clonic jerking of one extremity lasting 60-90 seconds.

> > Patients is completely aware of the attack and can describe it in detail –> Key feature: preservation of consciousness.

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16
Q

describe complex partial seizures

A

> > Localised onset, but discharge can spread

> > Loss of awareness at seizure onset :Impairment of consciousness, although consciousness is not fully lost

> > Typically originate in frontal or temporal lobes (e.g. Temporal lobe epilepsy) making it Difficult to treat with drugs so Surgical resection is used.

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17
Q

describe secondary generalised seizures

A

> > Focal seizures -> generalised Seizures.

> > Often preceded by an AURA or warning sign -> the senses of taste, smell or vision are heightened,

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18
Q

what is generalised seizures

A

Excessive electrical activity in both cerebral hemispheres

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19
Q

where in the brain does generalised seizures originate

A

thalamus or brainstem

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20
Q

where in the body do generalised seizures affect

A

> the entire body
loss of consciousness is common

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21
Q

what are the 6 subtypes of generalised seizures

A

> myoclonic
atonic
tonic seizures
clonic seizures
tonic - clonic (glnd mal ) seizures
absence (petit mal)
status epilepticus

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22
Q

describe myoclonic seizures

A

Brief shock-like muscle jerks generalized or restricted to part of one extremity

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23
Q

Describe atonic seizures

A

sudden loss of muscle tone

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24
Q

Describe tonic seizures

A

sudden stiffening of the body, arms of legs

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25
Q

Describe clonic seizures

A

rhythmic jerking movements of the arms and legs without a tonic component

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26
Q

describe tonic - clonic seizures

A

Tonic phase followed by clonic phase

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27
Q

what is grand mal seizure also called

A

tonic - clonic seizures

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28
Q

describe absence seizure

A
  • rapid and brief loss of consciousness
  • can include the blinkng of the eye lids or lip movements
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29
Q

which group of people is absence seizures most common in

A

young children

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30
Q

what is absence seizures also known as

A

petit mal

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31
Q

describe features status epilepticus

A

> seizure lasting longer than 30 min or 3 seizures without a normal period in between

> may be fatal

> emergency intervention requird

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32
Q

list the 7 epileptic syndromes associated with neurological conditions

A

> west syndrome

> lennox - gastaut syndrome

> juvenile myoclonic epilepsy

> Doose syndrome

> Dravet syndrome

> Benign neonatal convulsions

> Temporal lobe epilepsy.

Lennox, Doose and Dravet are Juveniles in West Temporal Benign

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33
Q

what is the neurobiology explanation of epilepsy of the 19th century neurologist

A

a sudden excessive disorderly discharge of CEREBRAL neurons

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34
Q

who was the 19th century neurologist

A

hughlings jackson

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35
Q

what is the recent neurobiology explanation of epilepsy

A

> > a central role for the excitatory neurotransmiter glutamate (increased in epilepsy)

> > inhibitory gamma amino butyric acid (GABA) (decreased)

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36
Q

what are the causes of epilepsy

A

> genetic (autosomal dominant genes)
congenital defects (8%)
severe head trauma
ischemic injury , tumor
drug abuse
unknown (65%)

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37
Q

what are antiepileptic drug (AED)

A

a drug which decreases the frequency and/or severity of seizures in people with epilepsy

> it treats symptoms not cure

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38
Q

do AED prevent development of epilepsy individuals with acquired risk for seizures (e.g after head trauma, stroke)

A

NO

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39
Q

What happens when patient do not respond to drug therapy

A

surgery

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40
Q

what is the goal of drug therapy

A

maximise quality of life by eliminating seizures (or diminish seizure frequency) while minimizing adverse drug effects

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41
Q

what are the 3 mechanism of actions of AED

A
  1. Inhibition of voltage-gated Na+ channels to slow neuron firing.
  2. Enhancement of the inhibitory effects of the neurotransmitter GABA.

3.Inhibition of calcium channels.

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42
Q

do some drugs fall into more than 1 of these categories of MOA

A

YES, and some drugs dont fall into any of these categories

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43
Q

which AED is the oldest and what year

A

Phenytoin 1938

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44
Q

what is Phenytoin

A

A non sedative AED

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45
Q

describe the MOA of phenytoin

A
  1. Use-dependent block of sodium ion channels
  2. Prolongs their inactive state -> prevents further action potential generation
  3. Reduces the synaptic release of glutamate and enhances the release of GABA
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46
Q

which seizure is phenytoin not effective

A

absence

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47
Q

why is drug monitoring essential for phenytoin

A

> > it is highly bound to plasma protein s( about 90%)

> > there is a non linear relationship between dose and plasma conc

> > therefore extreme variation in plasma conc

> > this could lead to toxic effects

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48
Q

list the adverse effects of phenytoin

A
  1. Nystagamus (involuntary and jerky repetitive movements of the eyeballs)  occur early in treatment
  2. .Gingival hyperplasia = increase in the size of the gingiva (gums)
  3. Hirsutism = excessive body hair
  4. Diplopia = double vision (dose related)

5.Ataxia = lack of voluntary coordination of muscle movements (dose related)

6.Sedation = dose related
foetal abnormalities when taken by the mother during pregnancy

49
Q

What is carbamazepine structurally related to

A

Tricyclic antidepressants

50
Q

what are the MOA of carbamazepine

A
  • Inhibition of voltage-gated Na+ channels to slow neuron firing.
  • Enhancement of the inhibitory effects of the neurotransmitter GABA.
51
Q

When is carbamazepine chosen

A

partial and generalised seizure

52
Q

When is carbamazepine not effective

A

absence seizures

53
Q

which conditions is carbamazepine also effective in

A

trigeminal neuralgias

mania

54
Q

what are the main side effects of carbamazepine

A

> sedation

> ataxia = a term for a group of disorders that affect co-ordination, balance and speech

> mental disturbances

> water retention

55
Q

what is Oxcarbazepine

A
  • a drug that is structurally and functionally related to carbamazepine but follows a different metabolic pathway so its better tolerated and has more advantages
56
Q

what are the MOA of sodium valproate

A
  • Suppress repetitive neuronal firing through inhibition of voltage-sensitive sodium ion channels
  • Suppresses thalamic excitability by inhibiting transient low threshold calcium ion channels
  • Enhances GABA in CNS by inhibiting the catabolic enzyme GABA transaminase.
57
Q

which seizure sodium valproate the drug of choice

A

absences seizures

58
Q

is sodium valproate effective in al forms of epilepsy

A

YES

59
Q

what are the side effects of sodium valproate included in jerom’s slides

A

alopecia
liver damage (rare )
teratogenic (affects fetus )

60
Q

what are the common side effects of soidum valproate in the bnf

A

Abdominal pain; agitation; alopecia (regrowth may be curly); anaemia; behaviour abnormal; concentration impaired; confusion; deafness; diarrhoea; drowsiness; haemorrhage; hallucination; headache; hepatic disorders; hypersensitivity; hyponatraemia; memory loss; menstrual cycle irregularities; movement disorders; nail disorder; nausea; nystagmus; oral disorders; seizures; stupor; thrombocytopenia; tremor; urinary disorders; vomiting; weight increased

61
Q

which seizure is ethosuximide the drug of choice

A

absences seizures

62
Q

what is the MOA of ethosuximide

A

it reduces low threshold calcium ion currents ( T- type Ca2+ channels#) in thalamic neurons

63
Q

what are the side effects of ethosuximide ( according to slides)

A

nausea and anorexia

64
Q

what are the bnf side effects of ethosuximide not required to know

A

Aggression; agranulocytosis; appetite decreased; blood disorder; bone marrow disorders; concentration impaired; depression; diarrhoea; dizziness; drowsiness; erythema nodosum; fatigue; gastrointestinal discomfort; generalised tonic-clonic seizure; headache; hiccups; leucopenia; libido increased; lupus-like syndrome; mood altered; movement disorders; nausea; nephrotic syndrome; oral disorders; psychosis; rash; sleep disorders; Stevens-Johnson syndrome; suicidal behaviours; vaginal haemorrhage; vision disorders; vomiting; weight decreased

65
Q

which seizure is GABAPENTIN the drug of choice

A

partial seizures

66
Q

what is the MOA of gabapentin

A
  • Blocks glutamate stimulated Ca ion channels
  • inhibits depolarisation induced calcium influx at nerve terminals which decreases glutamate release
67
Q

what are the side effects of gabapentin ( according to slides

A

nausea and sedation

68
Q

which seizures is LAMOTRIGINE the drug of choice

A

partial seizures

tonic- clonic seizures

absences seizures

69
Q

what is the MOA of LAMOTRIGINE

A
  • inhibits release of glutamate
  • suppresses repetitive neuronal firing by inhibition of voltage sensitive sodium ion channels
70
Q

what are the side effects of lamotrigine

A

nausea , sedation, ataxia, skin rashes

71
Q

which seizure is TIAGABINE the drug o choice

A

partial seizures

72
Q

what is the MOA of tiagabine

A

inhibits the GABA transporter responsible for removing extracellular levels of GABA

therefore:
- increased levels of GABA in synapses
- increased inhibitory transmission

73
Q

what are the side effects of tiagabine

A

nausea , sedation , ataxia

74
Q

which seizure is LEVETIRACETAM the drug of choice

A

partial seizures

75
Q

what is the MOA of Levetiracetam

A

binds to synaptic vesicular protein SV2A and this alters synaptic neurotransmitter release

76
Q

what are the side effects of levetiracetam

A
  1. somnolence : sleepiness
  2. asthenia : abnormal physical weakness or lack of energy
  3. Dizziness
77
Q

which seizures is TOPIRAMATE the drug of choice

A

> Effective against partial and generalised tonic-clonic seizures and absence seizures

> Broad effectiveness against a range of epilepsy syndromes (Lennox Gastaut; West’s syndrome

78
Q

what condition is topiramate also approved for

A

migraine headaches

79
Q

how is topiramate different from other AEDs

A

it has a monosaccharide structure

80
Q

what is the MOA of topiramate

A
  • blocks voltage gated sodium channel s
  • potentiated the effects of GABA (similar to benzodiazepines but has distinct binding site on GABAA receptors)
  • depresses excitatory effect of kainate on glutamate receptor
81
Q

what are the side effects of topiramate according to slides

A
  • Somnolence,
  • fatigue,
  • dizziness,
  • paraesthesia
    -nervousness,
  • confusion
    -Acute myopia (near-sightedness)
    -glaucoma> rare, but requires immediate withdrawal
82
Q

which seizure is VIGABATRIN the drug of choice

A

partial seizures

83
Q

what is the MOA of vigabatrin

A

Irreversible inhibitor of the enzyme GABA aminotransferase, the enzyme that degrades GABA

this causes:
> Increased levels of GABA released at synaptic sites
> Enhanced neuronal inhibition

84
Q

what are the side effects of vigabatrin

A

Drowsiness
Dizziness
Weight gain

85
Q

what is cannabidiol ~(CBD)

A

major component of the cannabis sativa plant

86
Q

does CBD have psychoactive properties

A

NO, it’s THC that has that

87
Q

what are the methods of retrieving CBD

A
  • synthesized to make synthetic cbd
  • Plant derived
88
Q

which 2 boards approve cbd

A

FDA
EMA

89
Q

which syndrome is CBD used in

A
  • Dravet syndrome
  • lennox - gastaut syndrome
90
Q

what is the first line treatment of focal seziures

A

Carbamazepine
lamotrigine

91
Q

what is the second line treatment of focal seizures

A

levetiracetam

oxcarbazepine

sodium valproate

92
Q

what are the cautions for focal seizures

A

be aware of the potential effect of sodium valproate in pregnancy

93
Q

what is the adjunctive treatment (if firt and second line is not effective or tolerated)

A

carbamazepine, clobazam, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate, topiramate

94
Q

what is the action if adjunctive treatment is not effective or tolerated

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

such as :
eslicarbazepine acetate, lacosamide, phenobarbital, phenytoin, pregabalin, tiagabine, vigabatrin and zonisamide

95
Q

what is the first line treatment for tonic clonic seizures

A

sodium valproate

lamotrigine (if sodium valproate is not suitable)

96
Q

what are the cautions to be aware of for the first line treatment of tonic clonic

A

be aware of potential effect of sodium valproate in pregnancy.

If the person has myoclonic seizures or may have juvenile myoclonic epilepsy lamotrigine may worsen myoclonic seizures

97
Q

what is the second line treatment for tonic clonic seizures

A

carbamazepine, oxcarbazepine

98
Q

what is the second line treatment of tonic clonic seizures

A

carbamazepine

oxcarbazepine

99
Q

what are cautions of second line treatment of tonic clonic seizures

A

may worsen myoclonic or absence siezures

100
Q

what is the adjunctive treatment (if first or second line is not effective or tolerated) of tonic clonic seizures

A

lamotrigine, levetiracetam, sodium valproate, topiramate

101
Q

which drugs do you not offer when the patient also has absences or myoclonic seizures or juvenile myoclonic epilepsy

A

carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin

102
Q

what is the first line treatment of absence seizures

A

ethosuximide, sodium valproate (offer first if additional tonic clonic seizures are likely

103
Q

when do you offer sodium valproate first in absence seizures

A

if patient may have tonic clonic seizures

104
Q

what is the second line treatment of absence seizures

A

lamotrigine

105
Q

what is the adjunctive treatment of absence seizures

A

consider a combination of ethosuximide, lamotrigine or sodium valproate.

106
Q

which drugs do you avoid in a patient with absence siezures

A

carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine, vigabatrin

107
Q

what is the next step if adjunctive treatment is not effective or tolerated in absence seizure

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

108
Q

what is the first line treatment of myoclonic seizures

A

sodium valproate

109
Q

what is the caution for the first line treatment of myoclonic seizure

A

aware of potential effects in pregnancy

110
Q

what is the second line treatment of myoclonic seizure

A

levetiracetam, topiramate

111
Q

what is the caution of topiramate in use of myoclonic seizure

A

has poorer side effects than levetiracetam and sodium valproate

112
Q

what is the adjunctive treatment for myoclonic seizures

A

levetiracetam, sodium valproate, topiramate

113
Q

what is the next step if adjunctive treatment is not effective or tolerated in myoclonic seizure

A

consider referral to tertiary epilepsy services (where other AEDs may be tried)

such as: Clobazam, clonazepam, piracetam, zonisamide

114
Q

which medications do you not offer in patients with myoclonic seizures

A

carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin

115
Q

what is the first line treatment of tonic and atonic seizures

A

sodium valproate

116
Q

what is the second line treatment of tonic and atonic seizures

A

none

117
Q

what is the adjunctive treatment of tonic and atonic seizures

A

lamotrigine

118
Q

what is the next step if adjunctive treatment is not effective or tolerated in tonic and atonic seizures

A

consider referral to tertiary epilepsy services (where other AEDs may be tried):

such as: rufinamide, topiramate

119
Q

which medications do you not offer in patients with tonic and atonic seizures

A

carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin

INTERGRATED STUDIES IN MENTAL HEALTH (16 decks)

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