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What is the global eletrical activity in seizure?
1. high frequency of action potential
2. neuronal hypersynchronisation
Causes of seizure
Excitation > Inhibition
What causes neuronal excitation
Na in, Ca in
glutamate, aspartate
What causes neuronal inhibition
Cl- in , K out
GABA
What is epilepsy?
Tendency towards recurrent seizures
What are the 2 strong predictors for recurrence after 1st unprovoked seizure?
1. remote symptomatic cause
2. epileptiform EEG discharge
Hong Kong Practice

First line drug for partial seizure
Carbamazepine
Phenytoin
Hong Kong Practice

First line drug for primary GTCS
Carbamazepine
Phenytoin
Valproate
Hong Kong Practice

First line drug for absence seizure
Valproate
Hong Kong Practice

First line drug for myoclonic seizure
Valproate
Give some AED drug which is hepatic metabolised
1. Phenobarbital
2. Carbamazepine
3. Phenytoin
4. Valproate
Which one AED is CYP inhibitor?
Valproate
Where do phenobarbital bind to?
GABA-A receptor
Good thing of phenobarbital
1. cheap
2. once daily dosing
What is phenobarbital recommend by WHO?
DOC for partial and GTCS in developing countries
Bad thing of phenobarbital
1. Dupuytren's contracture
2. teratogenicity
Action of phenytoin
Na blocker
Good thing about phenytoin
Once daily dosing
Bad thing about phenytoin
1. Neurotoxicity
2. cerebellar atrophy
3. teratogeneicity
Mechanism of carbamazepine
Na blocker
Good thing about carbamazepine
Gold standard against partial seizure
What is the gold standard drug for partial seizure?
Carbamazepine
Bad thing about carbamazepine
1. neurotoxicity
2. may exacerbate myoclonus and absence seizure
3. teratogenicity
4. wide intra-individual serum concentration
Mechanism of ethosuximide
T-type Calcium blocker
Good thing about ethosuximide
Well tolerated, rapid absorption
Bad thing about ethosuximide
Only effective for absence seizure
Which AED is only effective for absence seizure?
Ethosuximide
Mechanism of valproate
Unclear
Good thing about valproate
1. broad spectrum
2. well tolerated
3. rapid and complete oral obsorption
What is valproate for?
DOC for general seizure
Bad thing about valproate
1. thrombocytopenia
2. rare but serious hepatotoxicity
3. teratogenicity
What is the most common cost for elderly to have epilepsy? What follows?
Commonest: Stroke

Next are: tumour and dementia
Progestrone is anticonvulsant or convulsant?
Anticonvulsant
Estrogen is anticonvulsant or convulsant?
Convulsant
What is catemenial epilepsy?
Increased seizures at menstruation
Increased seizures at menstruation is called?
catemenial epilepsy
What is status epilepticus?
Continuous seizure > 5 min or
two or more seizure without complete recovery of consciousness
The 3 commonest cause of Tonic-clonic Status epilepticus
1st: AED non-compliance
2nd: remote symtomatic
3rd: cerebral infarct
Non-pharmacological for epilepsy
1. surgical resection
2. vagal nerve stimulation
3. ketogenic diet in children
What surgery will be done in hippocampal sclerosis related epilepsy?
Anterior temporal lobectomy
Mechanism of vagal nerve stimulation
Unknown
What is vagal nerve stimulation for?
Refractory partial seizure
Side effect of vagal nerve stimulation
1. alternation of voice
2. dyspnea
3. tingling feeling in neck