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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Types of focal seizures

A

Auras - simple partial
Focal dyscognitive seizures - complex partial
Focal seizures evolving into generalised seizures

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2
Q

Types of generalised seizures

A 
Tonic-clonic seizures
Absence seizures
Myoclonic seizures
Tonic seizures
Clonic seizures
Atonic seizures
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3
Q

Recurrence risk after a first seizure?

A

50% recurrence risk

Usually within the first 6 months

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4
Q

Investigations for first seizure?

A

EEG

MRI

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5
Q

Treatment of status epilepticus

A

ABCs
Benzodiazepine
Phenytoin load

Identify the cause

Failure of therapy = thiopentone

EEG monitoring

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6
Q

Non pharacological management of epilepsy

A 
Education
Restriction on triggering activities
Warning about showering and bathing
Establishing regular sleep patterns
Decrease alcohol intake

Driving - must be 6 months seizure free

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7
Q

Drug therapy

A

Must assess cause of seizures and impact of further seizures and impact of therapy prior to starting

Valproate
Lamotrigine
Gabapentin
Topiramate
Oxcarbazepine
Levetriacetam
Lacosamide
Zonisamide
Perampanel
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8
Q

Treatment of choice for generalised seizures?

A

Valproate

Young women = Lamotrigine

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9
Q

Treatment of choice for focal seizures?

A

Carbamazepine

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10
Q

Lamotrigine - When to use it and side effects?

A

Broad spectrum of efficacy

When to use it?

  • Generalised epilepsy in young women or adjunct to valproate
  • Add on for focal epilepsy

Side effects:

  • Rash - increased with valproate
  • Increases carbemazepine toxicity
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11
Q

Mechanism of action of lamotrigine

A

Blocks voltage dependent sodium channels

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12
Q

Mechanism of action of gabapentin

A

Unknown ?calcium channel effects

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13
Q

Gabapentin - when to use and side effects?

A

Well tolerated and easy to use
NO interactions or inductions

When to use:

  • Add on for focal epilepsy
  • Useful in the elderly

Requires TDS dosing
Moderate efficacy

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14
Q

Mechanism of action of topiramate?

A

Blocks sodium channels
Enhances GABA transmission
Blocks AMPA glutamate channels

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15
Q

Topiramate - when to use and side effects?

A

When to use:

  • Add on for focal and generalised epilepsy
  • Helpful for obese or patients with migraines

Side effects:

  • Weight loss
  • Neurotoxicity
  • Renal stones
  • Teratogen
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16
Q

Carbemazepine and Oxcarbazepine mechanism of action?

A

Use-dependant blocker of voltage-gated sodium channels

Also a GABA receptor agonist

17
Q

Mechanism of action of levetiracetam?

A

Binds to synaptic vesicular protein SV2A –> glutamate and GABA effects

18
Q

Levetiracetam - when to use and side effects?

A

Highly effective in focal and generalised seizures
Use as an early add on for both

Side effects:
- CNS –> agitation and psychosis

19
Q

Mechanism of action of Lacosamide?

A

Selectively enhances sodium channel slow inactivation

20
Q

Lacosamide - when to use and side effects?

A

Use as a late add on for focal epilepsy

Side effects:
- Dizziness

21
Q

Mechanism of action of Perampanel?

A

Blocks post-synaptic AMPA receptors

22
Q

Perampanel - when to use and side effects?

A

Use as a late add on of focal epilepsy

Side effects:

  • DIzziness
  • Somnolence
  • Aggression
23
Q

Carbemazepine and SJS?

A

Han Chinese and south-east Asians

HLA-B 1502

24
Q

Carbemazepine and DRESS

DRESS = drug reaction with eosinophila and systemic symptoms

A

Asians and Caucasians

HLA-A 3101

25
Q

Phenytoin and SJS and DRESS

A

CYP2C93

26
Q

Autoimmune limbic encephalidities

A

Anti-potassium channel antibody - Anti-LGI1 - older males

Anti-NDMA antibody - young women with teratomas

27
Q

Appearance of seizure on EEG?

A

Rhythmic spikes

28
Q

Appearance of CJD on EEG?

A

Spike and wave pattern

29
Q

Appearance of hepatic encephalopathy on EEG

A

Triphasic waves

Neurology (6 decks)

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