Anti-epileptic

Question 1

Rxs of choice

Answer 1

Carbamezepine
Lamotrigine
Levetiracetam
Oxcarbazepine
Ethosuximide
Valproic Acid
Diazepam

Question 2

Epilepsy

Answer 2

• RECURRENT seizures
• abnormal, excessive, synchronous discharges from CNS poulation
• often focus

Question 3

1ary epilepsy

Answer 3

No cause or incident

Question 4

2ary epilepsy

Answer 4

Trauma, neoplasm, developmental abnormalities, Cereberovascular dz

Question 5

Status epilepticus

Answer 5

Convulsions more than 30 mins

Question 6

Focal seizures

Answer 6

No consciousness loss

Question 7

Focal dyscognitive seizure

Answer 7

Confusion stumbling, falling

Consciousness impaired

Question 8

Partial seizures secondarily generalized

Answer 8

From local to thalamus to whole brain

GTC

Question 9

GTC seizure - grand mal

Answer 9

Tonic rigidity + tremor

Question 10

Absence seizure (petit mal)

Answer 10

10-45 secs (maybe 100 day)
Consciousness altered
Start in childhood - intellectual disability

Question 11

Myclonic seizure

Answer 11

Isolated clonic jerks w/ multiple spikes in EEG,

ryhtmic clonic seizures

Question 12

Atonic seizure

Answer 12

Sudden loss of posture leading to collapse

Question 13

Infantile spasms

Answer 13

Bilateral attacksof brief recurrent myoclonal jerks
Most start before 1 year
Intellectual disability common

Question 14

Brain malformations that cause epilepsy

Answer 14

• Focal cortical dysplasia
• Double cortex
• heteropia

Question 15

Seizures arise in

Answer 15

Cortex

Also generalized through thalamic inputs

Question 16

Hippocampus involved in

Answer 16

Temporal lobe epilepsy

• repetitive action potentials
• –>limbic system + temporal lobe
• severe memory deficits + cognitive problems

Question 17

Rx Mechs

Answer 17

• Decrease Depolarization by Na+ , Ca channels
• Reduce synaptic vesicle fusion
• Modulate GABA receptor
• multiple mechs

Question 18

Epilepsy

Path

Answer 18

*imbalance b/w excitation(too much) vs. inhibition (too little)

Question 19

Anti-epileptic Rx target

Answer 19

• Down Glu/Glu at receptors
• UP Gaba receptor activty
• UP GABA release
• DOWN Gaba-T (gaba breakdown)

Question 20

Problem with removing Glutamate?

Answer 20

Many SE

Question 21

Target Gaba A receptor

Answer 21

Barbituate

Benzos

Question 22

Benzos

Uses

Answer 22

for STATUS EPILEPTICUS
*Diazepam, Lorazepam

For ABSENCE, TONIC-CLONIC, MYOCLONIC

Question 23

Simple / Complex Partial Seizure?

Rx

Answer 23

• Carbamezepine
• Phenytoin

Recent

• Gabapentin, Topiramate
• Lamotrigine, Lacosamine

Question 24

Generalized Tonic-Clonic Seizures

Rxs

Answer 24

• Carbamazepine
• Phenytoin
• Valproic acid

Recent

• Gabapentin, Topiramate
• Lamotrigine, Lacosamide

Question 25

Absence Seizure? Rx

Answer 25

* Ethosuximide * Valproic Acid Recent *Lamotrigine

Question 26

Myoclonic Seizure? Rx

Answer 26

* Valproic Acid | * Clonazepam

Question 27

Status Epilepeticus? Rx

Answer 27

* Lorazepam/Diazepam * Fosphenytoin/Phenytoin * Phenobarbitol

Question 28

``` Phenytoin Carbamazepine Lamotrigine Lacosamide Zonisamide Ethosuximide ``` Mech?

Answer 28

Effect on ION CHANNELS

Question 29

Benzos Vigabatrin Tiagabine Mech?

Answer 29

Effects on GABA mechs

Question 30

``` Valproic acid (GABA) Gabapentin (Ca2+, GABA) Pregabalin (Ca2+, GABA) Levetiraetam (Ca2+; GABA) Topiramate (Ca2+; GABA) Felbamate (Ca2+; GABA) Rufinamide Phenobarital (GABA) ``` Mech?

Answer 30

Mixed Actions

Question 31

Epilepsy Path

Answer 31

Initiation * High freq AP * Hypersychronization *UP intracell K --> Depole, UP Ca2+ in Synapse, NMDA (Glutamate) -->excite

Question 32

Acquired Brain conditions that cause epilepsy

Answer 32

* Stroke * GSW - trauma * tumor