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10 Cards in this Set
- Front
- Back
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What is epilepsy?
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Epilepsy is a brief disorder of brain function associated with sudden abnormal discharge of nerves
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Describe the classification of epilepsy.
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Partial:
- simple - complex (reduced consciousness) - secondarily generalised Generalised: loss of consciouness - Absence - Tonic-clonic - Tonic or Clonic or Atonic; Myoclonic Status epilepticus: continuous succession of fits |
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What are the symptoms of Partial Seizures?
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Motor: e.g. "Jacksonian march"
Sensory: e.g. hallucinations of smell, taste, hearing Psychic: e.g. "deja vu", automatism Sensory/psychic symptoms common in temporal lobe epilepsy |
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What are the symptoms of Tonic-clonic (grand mal) seizures?
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Mood change +/- aura
- Tonic muscle spasm, loss of consciousness - Clonic stage:jerking, salivation, +/- incontinence - Confusion/headache |
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What are symptoms of generalised seizures?
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Absence (petit-mal): starts in childhood, transient loss of consciousness but not posture (~10sec)
Myoclonic: jerking of limbs Atonic: loss of posture |
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List the mechanisms of action of anticonvulsants
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Potentiate GABA; benzodiaszepines, barbiturates, gabapentin (?)
- GABA analogue: tiagabine - Reduce GABA breakdown; vigabatrin, balproate (?) - Block Na+ channels; carbamazepine, phenytoin, topiramate |
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How do anticonvulsants work?
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Dose-related CNS depression (all anticonvulsants)
Cortical (sedation): e.g. benzodiazepines & barbiturates Cerebellar (ataxia, nystagmus, diplopia): e.g. phenytoin |
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Describe the uses of different anticonvulsants.
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Valproate - most types (often used for generalised)
Carbamazepine, phenytoin - most types, except absence (carbamazepine often used for partial epilepsies) Clonazepam - myoclonic, absence Ethosuximide - absence Vigabatrine, lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam - "add on" therapy |
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Carbamazepine
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- Also used for trigeminal neualgia
- Liver enzyme induction - Marrow depression, jaundice, gastrointestinal upset, rashes, hypersensitivity - need to monitor blood |
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Phenytoin
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- Narrow safety margin, cerebellar effects
- Phenytoin metabolism can become saturated with zero order kinetics - Liver enzyme induction: drug interactions; folate, Vit D & neonatal Vit K deficiency - Rashes, marrow depression, lymphadenopathy - Costmetic effects: gum enlargement, acne, hairiness, coarse features |
