Epilepsy Flashcards by Alex Matic

What is the recommended folate (folic acid) dose in pregnant women with epilepsy taking AEDs?

4 to 5 mg/d

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What AED medications are associated with weight gain?

Pregabalin
Gabapentin
Carbamazepine
Valproic Acid

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What are the side effects of Topiramate?

Weight loss, painful angle-closure glaucoma,
drowsiness, word-finding difficulties, cognitive impairment, confusion, impaired memory, paresthesias, dizziness, nervousness, and kidney stone

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Generalized epilepsy with febrile seizures plus (GEFS+) is a familial syndrome involving which gene? What is the most common?

SCN1A (most common), which encodes the pore-forming α- subunit of the sodium channel and comprises four transmembrane domains

Others: SCN1B, SCN2A, GABAA (GABRD and GABRG2)

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What is the age group involved in Febrile Seizure?

6months- 5 yrs of age

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What is the EEG finding in GFS+?

generalized spike–wave or polyspikes

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Patient presented with infantile spasms, chorioretinal lacunae, and agenesis of the corpus callosum. Diagnosis and mode of inheritance?

Aicardi Syndrome

X-linked dominant disorder

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Typical onset is between 1 and 5 years of age. Children are normal prior to the onset of seizures, and many continue to have normal cognitive development. Seizures are predominantly generalized with myoclonic or astatic components, in which the patient loses postural tone and falls, sometimes resulting in injuries.

The EEG demonstrates interictal bilateral synchronous irregular 2- to 3-Hz spike and wave complexes along with parietal rhythmic θ-activity.

Diagnosis and management?

Doose Syndrome

Valproic Acid

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Patient presents the following symptoms:

Febrile seizure (FS) in the first year of life; later, these patients develop other seizure types, including myoclonias, atypical absences, and tonic and tonic-clonic seizures, which could be generalized and/or unilateral.

Presence of developmental Delay
Diagnosis? Gene Involved?

Dravet syndrome

(Severe Myoclonic Epilepsy of Infancy)

SCN1A gene

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Patients have epileptic tonic spasms occurring multiple times per day. The EEG typically shows a burst suppression pattern that is present during wakefulness or sleep. Diagnosis?

Ohtahara Syndrome ( infantile epileptic encephalopathy)

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What is the EEG finding in Creutzfeldt Jakob Disease?

Repetitive pseudoperiodic discharges: high voltage-slow (1-2Hz) and sharp-wave complexes on an increasingly slow and low voltage background

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What is the EEG finding in Subacute Sclerosing Panencephalitis?

periodic bursts of 2-3 Hz/seconds high voltage waves; followed by flat pattern

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What is the EEG pattern of Absence Seizure?

generalized 3Hz-spike-and-wave pattern

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What kind of seizure does hyperventilation aggravate?

80% of Absence seizure

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What kind of seizures are activated by photic stimulation?

Juvenile Myoclonic Epilepsy
Dravet Syndrome
Gestaut Seizures (Occipital Seizures)

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What is the EEG finding in Lennox Syndrome?

slow (1-2Hz) spike-and-wave EEG pattern

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What is the triad of West syndrome?

triad of infantile spasm + hypsarrhythmia + arrest in mental development

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What AEDs are associated with OCP Failure?

Phenytoin
Phenobarbital
Carbamazepine
Oxcarbazepine
Lamotrigine
Topiramate

Phe-Phe_Ox_Ca-To

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Which AEDs associated with worsening of myoclonic seizures?

vigabatrin; Phenytoin, Lamotrigine, gabapentin, carbamazepine, pregabalin, and

Pre, Phe-Ca_V_Ga-La?

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What is the EEG finding of Juvenile Myoclonic Epilepsy?

4- to 6- Hz irregular polyspike and slow-wave complexes

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What is the EEG finding in a 3/Male; nocturnal tonic-clonic seizure with normal development?

Diagnosis: Benign Epilepsy of Childhood with Centrotemporal Spikes

high voltage spikes in the contralateral lower rolandic or centrotemporal area

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5/Male presenting with vomiting with lateral eye deviations; no intellectual delay. EEG findings are accentuated by sleep. Diagnosis?

Panayiotopolous (Epilepsy with Occipital Spikes)

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What are the risk factors for recurrent febrile seizure?

include a family history of FS
age younger than 18 months at the time of the first FS
lower peak temperature
shorter duration of fever prior to the FS

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What is the pathology involved in Rasmussen Syndrome?

antibodies to glutamate receptor-3 (GLUR3)

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What is the imaging associated in Rasmussen Encephalitis?

focal cortical atrophy

Give one instance at which Valproic Acid is contraindicated.

mitochondrial mutations, such as POLG gene mutations, because fulminant hepatic failure may result.

Medications that may worsen myoclonic epilepsies.

Lamotrigine, Gabapentin, carbamazepine, pregabalin, and vigabatrin

Compare Phenytoin to Fosphenytoin.

fosphenytoin is not associated with purple glove syndrome; it can be given more rapidly intravenously, its administration is associated with a lower occurrence of cardiovascular side effects, such as hypotension, and it can be given intramuscularly

What are the medications that can aggravate absence epilepsy?

Phenytoin carbamazepine gabapentin lamotrigine (PHE_CA_GA_LA) - absence; myoclonic

Which medication may increase metabolism of oral contraceptives?

Phenytoin, phenobarbital Carbamazepine, oxcarbazepine, and topiramate at doses >200 mg/d Phe-Phe _ Ox _ Ca_ To contraceptive failure

What is the EEG finding in Juvenile Myoclonic Epilepsy?

in 8-24yrs old: the presence of 4- to 6-Hz polyspike and wave discharges interictally, Aggravated by photic stimulation

What is the first-line treatment for Juvenile Myoclonic Epilepsy?

Valproic Acid

What is the EEG finding in Benign Rolandic Epilepsy of Childhood?

bilateral independent centrotemporal spikes on a normal background.

What is the mode of inheritance of Benign Rolandic Epilepsy of childhood?

an autosomal dominant trait with variable penetrance

What is the treatment AED for Benign Rolandic Epilepsy of Childhood?

Carbamazepine

What is the EEF finding in patients with infantile spasms?

Hypsarrhythmia is characterized by abnormal interictal high- amplitude slow waves on a background of irregular multifocal spikes. Disappears during cluster of spasm and REM sleep

What is the treatment for infantile spasms?

ACTH

What is the interaction of Lamotrigine and Valproic Acid?

Valproic acid significantly increases the half-life of lamotrigine by 24 to 48 hours. chronic lamotrigine users may necessitate an immediate 50% reduction in the dose of lamotrigine.

What is the principal metabolite of carbamazepine?

10,11-carbamazepine epoxide

What is the mechanism of action of benzodiazepine?

GABAA agonists subsequent activation of chloride channels

During depolarization of the cell membrane, the movement of sodium ions from the extracellular fluid into the intracellular fluid uses which of the following physiologic mechanisms? A. Active Transport B. Active Transport through voltage-gated sodium channel C. Facilitated Diffusion D. Passive Transport Through Voltage-gated sodium channel

B. Active Transport through voltage-gated sodium channel

What is the main channel that, in a feed-forward fashion, leads to the rapid depolarization intrinsic to the action potential? A. Voltage gated Na Channel B. Voltage gated Cl Channel C. Nicotininc Acetlycholine receptor D. Voltage gated K Channel

A. Voltage gated Na Channel

Which of the following is a defining EEG feature seen in Lennox-Gestaut Syndrome? A. Presence of diffuse, bilaterally synchronous paroxysmal fast activity (usually 15-20Hz) that are most prominent during NREM sleep B. Presence of diffuse bi-synchronous high amplitude 3-4Hz sharp and slow wave complexes during an absence seizure or clinical event C. The recurrent slow sharp and wave complex is frequent activated by photic stimulation D. Despite diffuse slow background activity during wakefulness, nonREM sleep architecture is mostly unremarkable with sleep stages easily identified.

A. Presence of diffuse, bilaterally synchronous paroxysmal fast activity (usually 15-20Hz) that are most prominent during NREM sleep B. Presence of diffuse bi-synchronous high amplitude 3-4Hz sharp and slow wave complexes during an absence seizure or clinical event (Absence Seizure) C. The recurrent slow sharp and wave complex is frequent activated by photic stimulation (Juvenile Myoclonic Epilepsy) D. Despite diffuse slow background activity during wakefulness, nonREM sleep architecture is mostly unremarkable with sleep stages easily identified.

Which childhood epilepsy syndrome is characterized by polymorphic intractable seizures, cognitive and behavioral abnormalities and an EEG showing paroxysma of fast activity and generalized slow spike and wave discharges? A. West Syndrome B. Lennox Gestaut Syndrome C. Panayiotopoulous Syndrome D. Gastaut Syndrome

Answer: B. Lennox Gestaut Syndrome ``` West Syndrome (Epileptic Spasms and Hypsarrhythmia) Panayiotopoulous Syndrome (Occipital Spikes and autonomic seizures: Pallor) Gastaut Syndrome (Occipital spikes with visual seizures: hallucination, shapes and colors) ```

Which among the following statement is true regarding West Syndrome A. The onset is during neonatal period B. Patient presents with rare focal motor seizure with impaired awareness C. Patient’s growth and development is at par with age D. The EEG is characterized by chaotic and asynchronous background activity that has very high voltages with generalized and multifocal epileptiform discharges

D. The EEG is characterized by chaotic and asynchronous background activity that has very high voltages with generalized and multifocal epileptiform discharges Explanation A. The onset is during neonatal period (INFANTILE PERIOD) B. Patient presents with rare focal motor seizure with impaired awareness (EPILEPTIC SPASM AS ITS CARDINAL FEATURE) C. Patient’s growth and development is at par with age (GROWTH and Development is not at par with age)

The epilepsy syndrome consists early onset infantile febrile clonic convsions, myoclonic jerks, atypical absences, and focal seizures and the patients eventually develop developmental regression. Which epilepsy syndrome is being described? A. Gastaut Syndrome B. West Syndrome C. Dravet Syndrome D. Watanabe-Vigevano Syndrome

C. Dravet Syndrome Explanation: Gastaut- Afebrile seizures with visual manifestations West Syndrome- characterized by spasms Watanebe-Vigevano Syndrome- self-limited seizure with focal and generalized seizure

Which AED? Blocks sodium channels. ``` A. Lamotrigine B. Tiagabine C. Gabapentin D. Ethosuximide E. Vigabatrin ```

A. Lamotrigine

Which AED? Irreversible Inhibitor of GABA-Aminotransferase. ``` A. Lamotrigine B. Tiagabine C. Gabapentin D. Ethosuximide E. Vigabatrin ```

E. Vigabatrin

Which AED? It alters GABA metabolism or its nonsynaptic release. ``` A. Lamotrigine B. Tiagabine C. Gabapentin D. Ethosuximide E. Vigabatrin ```

C. Gabapentin

Which AED? It blocks calcium currents. ``` A. Lamotrigine B. Tiagabine C. Gabapentin D. Ethosuximide E. Vigabatrin ```

D. Ethosuximide

Which AED? It blocks GABA transporter and prevents reuptake of GABA. ``` A. Lamotrigine B. Tiagabine C. Gabapentin D. Ethosuximide E. Vigabatrin ```

B. Tiagabine

Which of the following anti-epileptic drugs is NOT highly protein bound? A. Valproic Acid B. Diazepam C. Clonazepam D. Phenobarbital

D. Phenobarbital Highly Protein Bound PHEnytoin_TIAgabine_ VAlProate _DIAZepam_PERAmpa el Tia Val, Dian Phe Pera

Which of the following anti-epileptic drugs that have active metabolites that are clinically significant? A. Carbamazepine B. Phenytoin C. Phenobarbital D. Ethosuximide

A. Carbamazepine Metabolite: 10,11-Carbamazepine Epoxide

Which of the following anti-epileptic drug that is significantly excreted unchanged in the urine? A. Phenobarbtial B. Phenytoin C. Lorazepam D. Diazepam

A. Phenobarbtial

A patient with hepatic failure develops several episodes of generalized seizures. Based on pharmacokinetics, which of the following would best be suited for this patient? A. Ethosuximide B. Valproic Acid C. Carbamazepine D. Gabapentin

D. Gabapentin GV_not to to liver GABAPENTIN VIGABATRIN

Which of the following anti-epileptic drugs auto-induces its own metabolism after several weeks of use? A. Carbamazepine B. Phenytoin C. Topiramate D. Gabapentin

A. Carbamazepine

This is the only AEDs that may be used as anti-arrhythmic drug? A. Carbamazepine B. Phenytoin C. Topiramate D. Gabapentin

B. Phenytoin

This is the only AEDs that may have non-linear (zero-order) kinetics. A. Carbamazepine B. Phenytoin C. Topiramate D. Gabapentin

B. Phenytoin

Which of the following medication may be given with Phenytoin? ``` A. Chloramphenicol B. Cyclophosphamide C. Disulfiram D. Sulfamethoxazole E. Cefuroxime ```

E. Cefuroxime

What are the contraindications for hyperventilation? Give at least 3.

``` Contraindication severe cardiorespiratory diseases sickle cell disease or trait cystic fibrosis acute stroke Cardiovascular disease (MI) COPD recent intracranial hemorrhage documented moyamoya disease ```

What seizure types that can be induced by Photic Stimulation?

Juvenile Myoclonic Epilepsy Dravet Syndrome Gastaut Type

How attenuate Lambda Waves?

Ask patient to look at blank sheet of paper

How accentuate Lambda Waves?

Activated: | • Eye open in well-illuminated room or Person looking at patterned design

Adult Frequency is reached at what age?

Depends on the reference 8-10yrs old or 10-12yrs old

posterior dominant rhythm of 8Hz is reached at what age?

3yrs old