How should the dose of Lamictal be adjusted in pregnancy?
increased since pregnancy increases lamictal clearance.
what are symptoms of temporal lobe seizures?
altered consciousness, atomotisms, deja vu, complex partial seizures, olfactory hallucinations.
When a patient has the fencer's posture during a seizure, where does their seizure usually come from.
frontal lobe- supplementary motor cortex.
What is proposed mechanism of action of gabapentin and pregabalin?
binding to L-type Ca channels, modulate presynaptic neurotransmitter release.
How is Gabapentin excreted?
What are advantages and disadvantages of Gabapentin?
Advantage: does not interact with other drugs. Disadvantages: can worsen generalized epilepsy, absorption is non-linear.
Which medications can exacerbate myoclonic epilepsy?
Lamictal, Carbamazepine, Gabapentin, Pregabalin, Vigabatrin.
Which anti-convulsants are hepatic enzyme inducers?
Phenytoin, Carbamazepine, Phenobarbital, Primidone, Oxcarbamazepine and Topirimate >200mg/day.
Which anti-convulsants are hepatic enzyme inhibitors
at what age does the posterior dominant alpha rhythm develop to the adult frequency?
which medications can aggravate absence seizures?
phenytoin, carbamazepine, gabapentin, lamictal.
what is the mechanism of action of Benzodiazepines?
what is the interaction between oral contraceptives and Lamotrigine?
OCP's containing ethinylestradiol increase Lamotrigine clearance.
How is Topirimate metabolized?
Excreted in urine.
What is the mechanism of action of Lacosamide?
inactivation of slow voltage Na channels- leads to decreased membrane hyperexcitability. Also interacts with CRMP2- involved in neuronal differentiation and axon guidance.
What is the mechanism of action of Rufinimide?
prolongation of inactive state of Na channels.
How is Rufininide metabolized?
enzymatic hydrolysis of carboxylamide group (NOT via cyp system), elimination in urine.
What is inheritance of Aicardi syndrome?
what is the pathomenumonic eye findings in Aicardi syndrome?
What are the characteristics of Unverricht Lundborg Syndrome?
stimulus induced progressive myoclonic epilepsy that is action related, various seizure types, neurologic decline, ataxia and tremor.
What gene is involved in Unverricht Lundborg Syndrome and what chromosome is it on?
EPM1 on Chr 21q22. Encodes Cytasin B which regulates apoptosis.
What are the clinical features of Sialadosis Type I?
progresive action myoclonus, pregoressive ataxia, vision loss, cherry red spot. Onset in adolescence or adulthood.
What is the enzyme deficiency in Sialadosis Type I?
What are the clinical features of Sialadosis Type II?
myoclonus, coarse facial features, corneal clouding, hepatomegaly, skeletal dysplasia, learning disability. Onset between birth and 20s.
what is the enzyme defect in Sialadosis Type II?
N-acetyl neuroaminidase and beta-galactosialidase
what is the inheritence of the sialadoses?
what gene is implicated in sialadoses and what chromosome is it on?
Neu1 on Chr6p
what are the clinical features of Lafora body disease?
onset in adolescence, progressive myoclonic seizures and other seizure types. Ataxia, dysarthria and progressive dementia.
what gene is involved in Lafora Body disease and what chromosome is it on?
EPM2A on Chr6q.
what is the pathologic finding in Lafora body disease?
PAS positive Lafora body inclusions in skin biopsy.