antiseizure

Question 1

is epilepsy just 1 disorder

Answer 1

no, it encompasses many disorders

Question 2

what characterizes epilepsy

Answer 2

recurrent seizures (chronic disease) - heretogenous (several root causes) symptom complex

Question 3

what is a seizure

Answer 3

finite period of brain dysfunction resulting from abnormal discharge of cerebral neurons

Question 4

how do you figure out the degree of neural activity with electroencephalograms

Answer 4

you compare between pairs of electrodes (this allows a degree of localization of neuronal activity)

Question 5

what are all seizures cause by

Answer 5

an imbalance between excitation and inhibition in brain

Question 6

what are 2 types of partial seizures

Answer 6

simple and complex

Question 7

what characterizes partial seizures

Answer 7

they have a localized onset

Question 8

what are simple seizures like (3)

Answer 8

abnormal discharge with minimal spread - consciousness preserved

Question 9

what are complex seizures like (4)

Answer 9

localized discharge with wide bilateral spread, usually limbic, loss of consciousness

Question 10

is consciousness preserved in complex partial seizures

Answer 10

no

Question 11

what is an aura

Answer 11

a sense that the seizure is starting

Question 12

what are automatisms and when do they happen (which seizure type)

Answer 12

fragmented behaviours (like lip smacking, swallowing…) - complex partial seizures

Question 13

can you have a partial seizure that then generalizes to a tonic clonic seizures

Answer 13

yes

Question 14

what are 2 types of generalized seizures

Answer 14

generalized tonic clonic and absence (petit mal)

Question 15

what do generalized tonic clonic seizures look like

Answer 15

full blown attack with rigidity (tonic), followed by alternating relaxation and rigidity, and jerking of body (clonic)

Question 16

what do absence seizures look like

Answer 16

staring, altered consciousness, sometimes mild jerking of eyelids and extremeties

Question 17

whats a heterogenous syndrome

Answer 17

where there are many diff symptoms possible, not just one thing

Question 18

how do most of the anti-seizure drugs nowadays work (3)

Answer 18

reduce sympathetic excitation, enhance synaptic inhibition, block ion channels

Question 19

what do anti-seizure drugs do to the sodium channel (2)

Answer 19

prolong inactivation to make repetitive firing more difficult

Question 20

which kind of seizures do drugs that target Na+ channels work well for

Answer 20

partial seizures

Question 21

which 4 drugs affect sodium channels

Answer 21

phenytoin, carbamazepine, lamotrigine, topiramate

Question 22

how do drugs that target Ca2+ channels work

Answer 22

suppress activity of t-type Ca2+ channels, stopping oscillatory bursts

Question 23

give 3 drugs that supress T-type Ca2+ channels

Answer 23

ethosuxamide, valproate, lamotrigine

Question 24

what does ethosuxamide do

Answer 24

block t type ca channel to stop oscillatory behaviour/ bursts

Question 25

what kind of seizure are ca2+ channel inhibitors good for

Answer 25

absence (eg. ethosuxamide)

Question 26

what do anti-seizure drugs want to do to GABA A receptors DIRECTLY

Answer 26

potentiate their action (GABA binds, channels open for longer)

Question 27

what do anti-seizure drugs want to do to GABA A receptors INDIRECTLY

Answer 27

reduce GABA uptake or metabolism

Question 28

which 2 drugs directly potential GABA A receptor action by either acting as an agonist/positive allosteric modulator

Answer 28

benzos and barbs

Question 29

which 3 drugs indirectly increase GABA levels by reducing the uptake/breakdown of GABA

Answer 29

gabapentin, tiagabine, vigabatrin

Question 30

which 2 drugs reduce glutamate action

Answer 30

phenobarbital and topiramate (they reduce excessive excitation)

Question 31

where does phenytoin act (which receptors)

Answer 31

Na+ K+ Ca++

Question 32

how does phenytoin do use dependent block of Na+ channel

Answer 32

it binds preferentially to inactive state of channel

Question 33

what does phenytoin do to Ca+ AND what does this cause

Answer 33

blocks influx so there is less ca-dependent secretory processes

Question 34

which kind of seizures in phenytoin best for

Answer 34

partial and generalized tonic clonic

Question 35

which 3 drugs are good for partial and generalized seizures

Answer 35

phenytoin, carbamazepine, phenobarbital

Question 36

what is the action of carbamazepine

Answer 36

similar to phenytoin (blocks K+ Ca+ Na+)

Question 37

what drug is used for trigeminal neuralgia

Answer 37

carbamazepine

Question 38

how does phenobarbital work (2)

Answer 38

suppresses (heavily) excitatory transmission, potentiates GABA A receptor activation (since it's a barbituate)

Question 39

what are 3 main drugs just for generalized seizures

Answer 39

ethosuximide valproid acid benzos

Question 40

how does ethosuximide work

Answer 40

supresses T type Ca++ channels

Question 41

what is the type of seizure that ethosuximide is best for

Answer 41

absence seizures

Question 42

what is the mechanism of action for valproic acid

Answer 42

increase neuropeptide Y levels in brain (an antiseizure peptide)

Question 43

what kind of seizures is valproic acid good for (3)

Answer 43

absence, myoclonic, primary general tonic clonic

Question 44

when are benzos good for seizures

Answer 44

for acute seizure (status epilepticus), not for long term

Question 45

why dont you want to use benzos long term for seizures (2)

Answer 45

tolerance and sedation

Question 46

what is the mechanism of action of vigabatrin (2)

Answer 46

irreversible inhibitor of GABA-transaminase (breaks down GABA) AND inhibits GABA transporter

Question 47

what kind of seizures is vigabatrin good for

Answer 47

partial seizures

Question 48

what is the mechanism of action of tiagabine

Answer 48

GABA uptake inhibitor (GAT-1)

Question 49

what is the mechanism of action of lamotrigine

Answer 49

like phenytoin on Na+, also Ca+ (blocks)

Question 50

what kind of epilepsy is lamotrigine best used for

Answer 50

partial epilepsy and absence

Question 51

what is the main drawback for lamotrigine

Answer 51

rash can be life threatening especially for kids!!!

Question 52

what is the mechanism of action of felbamate

Answer 52

blocks NMDA on glycine sites (NR1 and NR2B)

Question 53

what kind of seizure is felbamate best for

Answer 53

focal/partial

Question 54

what are 2 really bad adverse effects for felbamate

Answer 54

aplastic anemia and severe hepatitis

Question 55

what is the mechnamism of action for topiramate

Answer 55

inhibits Na+ channels, potentiates GABA effects, inhibits AMPA receptors (Glu receptor)

Question 56

what is the unique structure like of topiramate

Answer 56

substituted monosaccharide