Epilepsy Flashcards
(31 cards)
What is the pathophysiology of epilepsy in terms of ESPS AND ISPS and in general
- Low GABA high glutamate
2.Release of glutamate enacting on receptors to change the membrane from -70 to -40 - Na channels open increasing action potential
- GABA receptors become dysfunctional and do not react to GABA
Name some risk factors of epilepsy
Genetic
Trauma
stroke
Alcohol abuse
Photosensitivity
MOST CAUSES ARE UNKNOWN
What is used to diagnose epilepsy
EEG scans
Measurement off voltage fluctuations between and during seizures
What are the different types of epilepsy
GENERALISED
Tonic clonic
Tonic
Atonic
Absence
Myoclonic
FOCAL SEIZURES
simple
Complex
Where do focal seizures take place
Temporal lobe
Describe a tonic clonic seizure
Biting, bladder control
Breathing, saliva
Jerks
Describe a tonic seizure
Stiff and falls to the ground backwards
Describe atonic seizures
Flopping forwards
Describe absent seizures
Pause and stare into space
Describe myoclonic seizures
Jerky movements and loss of consciousness
Describe a simple seizure
Consciousness is retained
Describe a complex seizure
Loss of consciousness spreads to brain stem reticular formation
What is status epilepticus
State of constant excitation without recovery which can cause death
What treatments in general are used for epilepsy
AEDs
Surgery if lesion is identified
Name three mechanisms of action for AEDs
- Use of dependant blockade of depolarising NA+ channels
- Inhibiting T type calcium channels
- Enhancing inhibitory action of GABA
How does use dependant blockade work
When the channels are inactive the drug binds to them keeping them inactive so it becomes more potent
How does inhibiting t type calcium channels work
Selectively block the t type low voltage activated ca2+ channel. Inhibits 3/5 spike wave burst firing
Name the three types of ways to enhance GABAs inhibitory action
Inhibition of GABA reuptake
Inhibition of GABA metabolism
Inhibition of calcium reuptake
What AEDs need TDM and why
Carbamazepine and phenytoin because they have 0 order metabolism kinetics , a narrow therapeutic range, and a highly plasma protein bound to albumin
What monitoring is needed
Bloods
What is the first line for use dependant blockade depolarising sodium channel drugs
Valproate
Phenytoin
Carbamazepine
Add ins
Lamotrageine
Topirimate
Oxycarbamazepine
What is the first line for inhibiting t type calcium channels
Ethosuximide
Valproate
Clonazapam
Lamotrageine - mono therapy
What is used for the enhancement effect of GABA
Benzodiazepines
Diazepam
Lorazepam
Cloneazapam
Midazalam
What types of drugs are used in status epilepticus
Benzodiazepines
