Therapeutics Flashcards
(30 cards)
Causes of secondary headache
- Trauma or injury to head/neck
- Cranial / cervical vascular disorder
- Non-vascular intracranial disorder
- Infection
- Homeostasis disorders
- Disorders of the cranium, neck, any parts of the face / head
- Psychiatric disorders
Red flags for headaches
- Systemic symptoms including fever
- Neoplasm in history
- Neurologic deficit or dysfunction
- Onset is sudden
- Older age > 50 y.o.
- Pattern change or recent onset of headache
- Positional headache
- Precipitated by sneeze, cough, exercise
- Papilledema
- Progressive headache with atypical presentation
- Pregnancy or puerperium
- Painful eyes with autonomic features
- Post-traumatic onset
- Pathology of immunocompromised
- Painkiller overuse
Infrequent episodic TTH
at least 10 episodes so far and average <1 episode/month
Frequent episodic TTH
1-14 days/month for more than 3 months
Chronic TTH
15 or more days/month for more than 3 months
Episodic migraine
At least 5 migraine attacks in a lifetime, lasting 4-72 hours
Chronic migraine
At least 15 MHDs and at least 8 MMDs, for more than 3 months
Etiology of acute symptomatic seizures
Metabolic:
- Hyponatremia, hypocalcemia, hypomagnesemia, hypoglycemia
Toxic substances/drugs:
- Illicit drugs
- Medications (TCA, carbapenems, baclofen)
- Alcohol
- Benzo withdrawal
Structural damage:
- Stroke
- Traumatic brain injury
Infection/inflammation:
- CNS infections
- Febrile illnesses
Etiology of epilepsy
Structural:
- Hippocampal sclerosis
- Brain tumours
- Vascular malformation
- Glial scarring
Genetic:
- Dravet syndrome with SCN1A mutation
Neurodegenerative:
- Alzheimer’s
Metabolic:
- Inborn errors of metabolism
- Mitochondrial disorders
Infectious:
- Bacterial meningitis, encephalitis, neurocysticerosis
Symptoms of focal onset seizure
Motor:
- Clonic movements of the arm, shoulder, face, leg
- Speech arrest
Sensory:
- Numbness and tingling
- Visual disturbance, flashes of light
- Epigastric sensation
Autonomic:
- Sweating, salivation, pallor
- BP, HR deranged
Psychic:
- Flashbacks
- Hallucinations
- Affective symptoms (fear, depression, anger)
Symptoms of generalised tonic-clonic seizures
Tonic phase (beginning of GTC):
- Stiffening of limb, rigid posture
- Loss of consciousness
- Breathing may decrease/cease
- Cyanosis of nails, lips & face
- Usually lasts 10-20 seconds
Clonic phase:
- Jerking of limb & face that is asymmetrical and irregular
- Return from cyanosis
- Usually lasts 1 min
Across both phases:
- Incontinence, biting of tongue and mouth
- Noisy, laboured breathing
Subsequently:
- Brain is hyper polarised and insensitive to stimuli
- Lethargy, confusion, headache
- Full recovery may take a few hours
Symptoms of absence seizures
- Lapse in awareness
- Usually lasts a few seconds
- More in children
- Not associated with aura
- Produces characteristic 3Hz spike waves
Symptoms of atonic seizures
- All postural tone is suddenly lost
- Short duration
- Occurs in any age
- Associated with diffuse cerebral damage & learning disability
Triggers for epilepsy
- Hyperventilation
- Photostimulation
- Physical & emotional stress
- Sleep deprivation
- Sensory stimuli
- Infections
- Hormonal change
- Drugs (theophylline, alcohol, high-dose phenothiazines, antidepressants e.g. bupropion, tramadol, carbapenems)
Drugs that can precipitate epilepsy
- Theophylline
- Alcohol
- Benzodiazepine withdrawal
- High dose phenothiazines
- Antidepressants (bupropion, TCA)
- Carbapenems
- Tramadol
- Baclofen
First-line agents for focal onset epilepsy
- Carbamazepine
- Phenytoin
- Valproate
- Levetiracetam
- Lamotrigine
- Topiramate
- Gabapentin
Agents for refractory focal onset epilepsy
- Clobazam
- Pregabalin
- Perampanel
First-line agents for GTC
- Carbamazepine
- Valproate
- Lamotrigine
- Topiramate
Agents for refractory GTC
- Clobazam
- Levetiracetam
Agents to be avoided in GTC
(If there is myoclonic or absence seizures or in juvenile myoclonic seizure)
- Carbamazepine
- Phenytoin
- Pregabalin
- Gabapentin
- Vigabarin
First-line agents for tonic or atonic seizures
- Valproate
- Lamotrigine (2nd line)
Agents to be avoided for tonic or atonic seizures
- Carbamazepine
- Pregabalin
- Gabapentin
- Vigabatrin
First-line agents for absence seizures
- Valproate
- Lamotrigine
Agents to be avoided for absence seizures
- Carbamazepine
- Phenytoin
- Pregabalin
- Gabapentin
- Vigabatrin
