Epilepsy Overview and Pathophysiology

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Questions and Answers

What is the primary aim of epilepsy treatment?

To increase the dosage of medication rapidly

To control seizures with minimal side effects (correct)

To ensure patient receives multiple medications at once

To eliminate all symptoms of epilepsy

Which of the following is considered a first-line AED introduced slowly?

Zonisamide

Phenobarbital

Lacosamide

Levetiracetam (correct)

How are newer AEDs generally classified in relation to established AEDs?

More effective second-line drugs

Generally used as second-line drugs (correct)

Used only for pediatric patients

Less effective and poorly tolerated

What is the importance of correctly diagnosing and classifying seizure types?

It determines the choice of AED (C) Signup and view all the answers

What should be done to avoid side effects when initiating AED therapy?

Start with a small dose and gradually increase (C) Signup and view all the answers

What is the primary action of Tolcapone and Entacapone in the treatment of Parkinson's disease?

Inhibition of COMT to increase levodopa absorption (D) Signup and view all the answers

What is a possible side effect of both Tolcapone and Entacapone?

Exacerbation of dyskinesia (B) Signup and view all the answers

Which medication is specifically noted for requiring strict liver function monitoring?

Tolcapone (B) Signup and view all the answers

What is the role of MAO-B inhibitors in treating Parkinson's disease?

Slow the breakdown of dopamine (A) Signup and view all the answers

What is a characteristic effect of Amantadine in the therapy of Parkinson's disease?

It acts as a weak NMDA receptor antagonist (C) Signup and view all the answers

What maximum daily dose is often prescribed for Entacapone when given with levodopa?

200 mg (C) Signup and view all the answers

Which of the following drugs is marketed as a compound tablet containing levodopa and carbidopa?

Stalevo (B) Signup and view all the answers

In what context is Amantadine primarily utilized during Parkinson's disease treatment?

As an antidyskinetic agent in advanced disease (C) Signup and view all the answers

What are common side effects associated with higher doses of certain medications?

Peripheral & corneal oedema (C) Signup and view all the answers

Which side effect is associated with antimuscarinic agents?

Cognitive impairment (A) Signup and view all the answers

What is a potential benefit of surgery for patients with Parkinson's disease?

Significant benefits for patients with motor fluctuations (C) Signup and view all the answers

Why is monitoring necessary for younger patients taking antimuscarinic drugs?

Due to potential troublesome side effects (C) Signup and view all the answers

What type of therapy may benefit patients experiencing nocturnal bradykinesia?

Judicious use of hypnotic therapy (B) Signup and view all the answers

What is the purpose of keeping diaries for patients experiencing bradykinesia or dyskinesia?

To relate symptoms to drug and food intake (A) Signup and view all the answers

What is livedo reticularis?

A side effect of certain medications (D) Signup and view all the answers

What is a common reason for the decline in the use of antimuscarinic agents?

Troublesome side effects (C) Signup and view all the answers

Which of the following conditions can be misdiagnosed as epilepsy?

Breath-holding attacks (B) Signup and view all the answers

What must be present for a diagnosis of epilepsy to be considered accurate?

At least one of the three defining ILAE conditions (C) Signup and view all the answers

What is the most valuable investigation for suspected structural abnormalities in a patient experiencing seizures?

Magnetic resonance imaging (MRI) (C) Signup and view all the answers

What should be avoided during a seizure to prevent injury?

Giving them water to drink (A) Signup and view all the answers

What is a recommended position for a person after a seizure has stopped?

In the recovery position (C) Signup and view all the answers

During a focal seizure involving automatisms, what is the recommended action?

Leave the person undisturbed (C) Signup and view all the answers

Which of the following statements is true regarding convulsive seizures?

Persons usually have no recollection of the event afterwards. (C) Signup and view all the answers

What should not be done following a seizure?

Administer extra antiepileptic drugs (C) Signup and view all the answers

What is the definition of epilepsy according to the ILAE?

A condition comprising of at least two unprovoked seizures occurring more than 24 hours apart. (B) Signup and view all the answers

Which of the following statements is true regarding epilepsy worldwide?

More than 80% of individuals with epilepsy are found in resource-poor settings. (A) Signup and view all the answers

What characterizes the hallmark of epilepsy?

Rhythmic and repetitive hyper-synchronous discharge of neurons. (B) Signup and view all the answers

What is the role of the epileptic focus in seizures?

It denotes the area from which the abnormal neuronal discharge originates. (D) Signup and view all the answers

What is the significance of a diagnosis of an epilepsy syndrome?

It indicates a high probability of seizures similar to the general population. (D) Signup and view all the answers

Which of the following best describes the clinical manifestation of a seizure?

Dependent on the location of the focus and pathways involved. (A) Signup and view all the answers

How does epilepsy differ from other neurological conditions?

It has no identifiable pathognomonic lesion. (B) Signup and view all the answers

What percentage of people with epilepsy respond to treatment?

70% (A) Signup and view all the answers

What is the primary characteristic of sodium valproate in relation to seizure types?

It is effective over the complete range of seizure types. (C) Signup and view all the answers

Which of the following is NOT listed as an adverse effect of sodium valproate?

Hypoglycemia (A) Signup and view all the answers

At what age range is Parkinson's disease typically diagnosed?

55 to 65 years (A) Signup and view all the answers

What is a hallmark motor feature of idiopathic Parkinson disease?

Bradykinesia (B) Signup and view all the answers

Which environmental factor is associated with an increased risk of developing Parkinson's disease?

Pesticide exposure (D) Signup and view all the answers

What cellular degeneration is primarily responsible for the symptoms of Parkinson's disease?

Degeneration of dopaminergic neurons (D) Signup and view all the answers

Which demographic is reported to have a higher prevalence of Parkinson's disease?

Males over 80 years old (C) Signup and view all the answers

What role does therapeutic drug monitoring (TDM) have in the context of sodium valproate?

It should be conducted in cases of suspected toxicity. (D) Signup and view all the answers

Study Notes

Epilepsy

An epileptic seizure is a temporary event caused by abnormal brain activity
Epilepsy is defined by at least two unprovoked seizures 24 hours apart, or one unprovoked seizure with a high probability of further seizures, or an epilepsy syndrome diagnosis.
Epilepsy is a chronic neurological disorder affecting people of all ages
Over 50 million people worldwide have epilepsy.
Approximately two-thirds of people affected in poor countries do not receive treatment.

Pathophysiology

Epilepsy is different from other neurological conditions, as it lacks a specific, defining lesion.
A seizure is characterized by a hyper-synchronous neuronal discharge, either localized or generalized throughout the cortex.
Neurons discharge abnormally, spreading to adjacent brain regions.
The area of abnormal discharge is called the epileptic focus.

Clinical Manifestations

Clinical manifestation depends on the seizure focus and propagation pathways
Seizures are classified into three main groups based on their onset: generalized, focal and unknown onset
Seizure types (e.g., aware/impaired awareness, motor onset, non-motor onset, etc.) influence clinical presentation.

Generalized Seizures

Involve simultaneous activation of both brain hemispheres.
Include motor types (tonic-clonic, clonic, tonic, myoclonic, myoclonic-tonic-clonic, myoclonic-atonic, atonic, epileptic spasms).
Include non-motor types (typical absence, atypical absence, absence with special features, myoclonic, eyelid myoclonia).

Focal Seizures

Discharges are localized in the brain.
Manifested through activation of the underlying cortical areas.
Divided into focal aware and focal with impaired awareness, further classified into motor and nonmotor onsets. Motor onsets include automatisms, atonic, clonic, etc. Non-motor onsets include autonomic, behavior arrest, cognitive, emotional, and sensory seizures.

Diagnosis

Diagnosing epilepsy involves demonstrating a pattern of recurrent seizures.
Clinical evaluation (including eyewitness accounts) is crucial.
Electroencephalography (EEG) is a common diagnostic tool.

Treatment

Convulsion treatment focuses on managing the event while protecting from self-harm.
Long term treatment goals include seizure suppression using effective medications.
Common antiepileptic drugs (AEDs) include carbamazepine, clobazam, clonazepam, ethosuximide etc

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Description

This quiz covers essential information about epilepsy, including its definition, causes, and clinical manifestations. Learn about how seizures occur and the impact of epilepsy as a neurological disorder worldwide. Test your knowledge on the fundamentals of epilepsy and its clinical implications.