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32 Cards in this Set
- Front
- Back
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Causes of pediatric epilepsy
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Perinatal and neonatal insults
genetic susceptibility |
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Causes of Adult epilepsy
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status epilepticus
Idiopatic trauma complex febrile seizures |
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Causes of elder epilepsy
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tumor
idiopatic neurogenerative disorder cerebrovascular incidence |
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Functions of different areas of brain
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occipital - vision
parietal - primary somatosensory temporal - memory, language and emotion frontal - motor, impulsive behavior, apathy, psychomotor retardation corpus callosum - separates cerebral hemispheres |
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What area of the brain is the primary and secondary location of seizures
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Temporal and frontal
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Types of seizure
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generalized (bilateral) and partial (unilateral)
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Generalized seizures breakdowns
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Absence - occur in childhood, gives blank stares and looks like not paying attention
Myoclonic- muscle jerkiness Tonic/Clonic- increase tone/stiffness, increase rhythm Tonic -increase tone Atonic - jerkiness that leads to crashing on heads |
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Partial seizures subcategories
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1. simple partial seizures - awareness and mentation is not impaired
2. complex partial seizures- awareness and mentation is impaired. |
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Juvenile Myoclonic Epilepsy
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Onset is during puberty and happens in the morning with a muscle twitch and leads to seizures later that day
-preventable with benzodiazepene, keppra, depakote, lamictal |
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Lennox gastaut syndrome
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combination of all seizures, hard to treat, goal is unable become seizure free
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characteristics of primary generalized epilepsy
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begins in both hemisphere
hereditary link onset associated with age, mainly children often an abnormal EEG generally no structural leison typically normal IQ and neurological exam |
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Characteristics of partial seizures
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begin focally
no hereditary link, idiopathic onset has a bimodal distribution (<20 and >60 yrs old) EEG generally normal inter-ictally may or may not have structural leison or MRI |
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major receptors in epilepsy
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GABA
Ion Channels - Na, K and Ca Amino Acid -Glutamate |
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GABA Receptors
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Formed within the axon terminal by decarboxylation of glutamate
- inhibitory neurotransmitter - regulate Cl flux - multiple binding sites |
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Levels of GABA
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Normal level - increase levels of Cl intracellulary
Low GABA levels - increase levels of Na intracellulary |
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Ion Channel receptors
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Na - voltage controlled gating
Maintains intracellular Na concentration much lower (more neg) than extracelluar, via Na/K ATPase pump -channels open via membrane depolorization, allowing influx of Na ions |
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Amino Acid Receptors
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Glutamate is an excitatory neurotransmitter
Receptor subtypes -NMDA: fluxes Na and Ca -AMPA :fluxes Na |
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Vigabatrin
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Enhances GABA levels by inhibiting GABA transaminase
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Tiagabine
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Blocks the reuptake of GABA
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Barbituates (phenobarbital and primidone)
Benzodiaepines, clobazam, valproate, felbamate, topiramate |
Enhances Cl conductance through GABA-A receptors, which enhances GABA
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Drugs that block fast sodium channels
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Phenytoin, fosphenytoin,carbamazepine,valproate, felbamate,lamotrigine,topriamate, oxcarbazepine, zonisamide, rufinamide
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Drugs that enhances sodium channel slow inactivation
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lacosamide
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Drugs that reduce t-type calcium current in the thalamic cortical pathway.
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Ethosuximide, valproate and zonisamide
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Drugs that affect calcium channels in an unknown fashion
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Felbamate, oxcarbazepine, and lamotrigine
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Drugs that reduces l-type calcium current
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Topiramate
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Drugs that bind to the alpha- 2 delta subunit of the voltage gated calcium channel, modulating the release of glutamate, noradrenaline and substance P Can also be used for pain
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Pregabalin
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Drugs that bind to alpha 2 delta auxiliary subunit of voltage sensitive calcium channels and reduces excitatory inward L type calcium current
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Gabapentin
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Ezogabine
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opens K channels in the brain
Adverse effects: neurogenic bladder, people can't tell when need to urinate. |
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Amino Acid Receptor
- Glutamate |
Felbamate - blocks NMDA
Topiramate - blocks kainate Lamotrigine - blocks glutamate release Pregabalin - enhances glutamic acid decarboxylase activity - Reduces release of excitatyr neurotransmitter (glutamate, noradrenaline, substance P) |
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Levetiracetam
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binds at the synaptic vesicle protein SV2A,
-site found in the brain - acts by enhancing SV2A function, inhibits abnormal bursting of epileptic circuits *lack of SV2A function would cause seizures. |
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Pregnancy and AED
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Metabolic clearance increases during last trimester
- monotherapy is best and - monitor serum levels **by end of pregnancy may be using levels double to triple doses as when first started |
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poor cognitive outcomes from what drugs during pregnancy
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Valproate use druing pregnancy and potentially with phenobarbital and phenytoin.
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