eizures and Epilepsy: Pathophysiological and Pharmacological Perspectives
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What is the primary mechanism of action for Lamotrigine in treating seizures? A) Blocking AMPA receptors to inhibit glutamate release. B) Binding to the fast inactivated state of Nav channels to slow recovery and reduce sodium influx. C) Enhancing GABAA receptor activity to increase inhibitory neurotransmission. D) Binding to T-type Cav channels to block calcium influx.

  • Blocking AMPA receptors to inhibit glutamate release.
  • Binding to the fast inactivated state of Na<sub>v</sub> channels to slow recovery and reduce sodium influx. (correct)
  • Enhancing GABA<sub>A</sub> receptor activity to increase inhibitory neurotransmission.
  • Binding to T-type Ca<sub>v</sub> channels to block calcium influx.

    • Which of the following drugs inhibits T-type Cav channels?

  • Carbamazepine
  • Ethosuximide (correct)
  • Gabapentin
  • Phenytoin

    • What additional action does Lamotrigine perform aside from inhibiting Nav channels?

  • Enhances GABA release.
  • Blocks AMPA receptors.
  • Reduces calcium currents and glutamate release. (correct)
  • Modulates NMDA receptors.

    • Which of the following drugs primarily binds to the α2δ accessory protein of voltage-gated calcium channels?

    <p>Pregabalin</p> Signup and view all the answers

    Which receptors are targeted in glutamate receptor antagonism?

    <p>AMPA, NMDA, Kainate</p> Signup and view all the answers

    How do Gabapentinoids like Pregabalin and Gabapentin modulate calcium channels?

    <p>By binding to the α<sub>2</sub><sup>δ</sup> accessory protein.</p> Signup and view all the answers

    Which of the following is NOT a known inhibitor of voltage-dependent sodium channels?

    <p>Ethosuximide</p> Signup and view all the answers

    Which receptor is directly modulated by benzodiazepines?

    <p>GABA<sub>A</sub> receptor</p> Signup and view all the answers

    What is the mechanism of action of benzodiazepines on GABAA receptors?

    <p>Increases the frequency of channel opening by binding at the α-γ interface.</p> Signup and view all the answers

    Which of the following drugs enhances the duration of GABAA receptor channel opening?

    <p>Phenobarbital</p> Signup and view all the answers

    Which drug inhibits GABA transaminase to increase GABA concentration?

    <p>Vigabatrin</p> Signup and view all the answers

    What is the primary action of Perampanel in glutamate receptor antagonism?

    <p>Blocks AMPA receptors.</p> Signup and view all the answers

    Tiagabine increases GABA availability by: A) Blocking GABA uptake. B) Enhancing the frequency of GABAA receptor opening. C) Inhibiting glutamate release. D) Blocking NMDA receptors.

    <p>Blocking GABA uptake.</p> Signup and view all the answers

    Which of the following is a glutamate receptor antagonist that blocks AMPA receptors?

    <p>Perampanel</p> Signup and view all the answers

    Which drugs interact with NMDA, AMPA, or Kainate receptors?

    <p>Felbamate, Topiramate, and Levetiracetam</p> Signup and view all the answers

    Where does Phenobarbital bind on the GABAA receptor?

    <p>α-β and γ-β interfaces</p> Signup and view all the answers

    Which of the following drugs does NOT directly interact with GABAA receptors but still influences inhibitory neurotransmission?

    <p>Vigabatrin</p> Signup and view all the answers

    Which drugs bind to synaptic vesicle protein 2A (SV2A) to decrease glutamate release?

    <p>Levetiracetam and Brivaracetam</p> Signup and view all the answers

    What is the proposed mechanism of action of Levetiracetam in reducing seizures?

    <p>Binding to SV2A, enhancing synaptic vesicle function to decrease glutamate release.</p> Signup and view all the answers

    Which of the following antiepileptic medications (ASMs) is associated with weight gain as a side effect?

    <p>Perampanel, Pregabalin, Valproate</p> Signup and view all the answers

    Which ASM is most likely to cause weight loss?

    <p>Topiramate</p> Signup and view all the answers

    Which antiepileptic medication (ASM) is most likely to cause weight loss?

    <p>Topiramate</p> Signup and view all the answers

    Common side effects of anti-seizure medications (ASMs) include all of the following EXCEPT:

    <p>Excessive weight gain with Topiramate</p> Signup and view all the answers

    Which of the following adverse effects is shared by most anti-seizure medications?

    <p>Fatigue</p> Signup and view all the answers

    Levetiracetam and Brivaracetam are believed to reduce seizures by:

    <p>Modulating SV2A to enhance synaptic vesicle function.</p> Signup and view all the answers

    Weight loss as a side effect is characteristic of which set of ASMs? A) Pregabalin, Levetiracetam, Perampanel B) Topiramate, Stiripentol, Zonisamide C) Valproate, Ethosuximide, Gabapentin D) Phenobarbital, Carbamazepine, Rufinamide

    <p>Topiramate, Stiripentol, Zonisamide</p> Signup and view all the answers

    What is the primary goal of polypharmacy in the treatment of epilepsy?

    <p>To use multiple drugs at synergistic, lower doses targeting different mechanisms.</p> Signup and view all the answers

    Which of the following best defines polypharmacology? A) The use of drugs with multiple therapeutic effects for non-epileptic conditions. B) The use of multiple drugs for synergistic control of seizures. C) Drugs that target multiple mechanisms of action within a single agent. D) Combining drugs to avoid adverse effects.

    <p>Drugs that target multiple mechanisms of action within a single agent.</p> Signup and view all the answers

    Which ASM is commonly used for managing neuropathic pain?

    <p>Gabapentinoids</p> Signup and view all the answers

    Carbamazepine is frequently used to treat which condition beyond epilepsy? A) Migraine management B) Bipolar disorder C) Trigeminal neuralgia D) Generalized anxiety disorder

    <p>Trigeminal neuralgia</p> Signup and view all the answers

    Which antiepileptic medications (ASMs) are commonly used for the management of bipolar disorder?

    <p>Valproate and Lamotrigine</p> Signup and view all the answers

    Benzodiazepines are frequently prescribed for which condition beyond epilepsy?

    <p>Generalized anxiety disorder</p> Signup and view all the answers

    Which of the following is an example of polypharmacy in epilepsy management?

    <p>Using Levetiracetam and Lamotrigine together to target different mechanisms.</p> Signup and view all the answers

    What is the primary focus of developmental toxicology?

    <p>Study of pharmacokinetics, mechanisms, pathogenesis, and outcomes of agents causing abnormal development.</p> Signup and view all the answers

    Teratology is primarily concerned with:

    <p>Congenital defects caused by teratogens.</p> Signup and view all the answers

    Which of the following factors does NOT influence the effects of a teratogen?

    <p>Parent's socioeconomic status.</p> Signup and view all the answers

    Which of the following is NOT an example of a human teratogen?

    <p>Obesity</p> Signup and view all the answers

    What is the purpose of genotoxicity studies?

    <p>To determine genetic damage potential before first human exposure.</p> Signup and view all the answers

    Which of the following is included in the standard 3-test battery for genotoxicity? A) In vitro test for chromosomal damage in bacterial cells. B) In vivo test for chromosomal damage in rat hematopoietic cells. C) Test for gene mutations in mammalian cells. D) In vivo test for chromosomal damage in humans.

    <p>In vivo test for chromosomal damage in rat hematopoietic cells.</p> Signup and view all the answers

    Which species is typically used as the non-rodent model in Embryo-Foetal Development (EFD) studies?

    <p>Rabbits</p> Signup and view all the answers

    Which of the following is assessed in Fertility and Early Embryonic Development (FEED) studies?

    <p>Sperm count and oestrus cycle measurements.</p> Signup and view all the answers

    In Pre- and Post-natal Development (PPND) studies, animals are exposed to the drug during which period?

    <p>From gestational day 6 to postnatal day 20.</p> Signup and view all the answers

    Which parameter is NOT measured in Embryo-Foetal Development (EFD) studies?

    <p>Maternal health post-weaning</p> Signup and view all the answers

    Which of the following parameters is assessed in Pre- and Post-natal Development (PPND) studies? (Select one)

    <p>Learning and memory in offspring.</p> Signup and view all the answers

    What causes hyper-excitability in the brain?

    <p>Both A and B</p> Signup and view all the answers

    Which of the following is true regarding GABA's role in seizures?

    <p>GABA antagonists can trigger seizures.</p> Signup and view all the answers

    What is a common pathological finding in temporal lobe epilepsy (TLE)?

    <p>Hippocampal sclerosis</p> Signup and view all the answers

    What is the result of chronic glial dysfunction in the brain?

    <p>Ionic imbalance and excessive release of pro-inflammatory molecules</p> Signup and view all the answers

    Which of the following seizure types originates from networks limited to one hemisphere?

    <p>Partial seizures</p> Signup and view all the answers

    Which of the following seizure types originates from networks limited to one hemisphere?

    <p>Focal seizures</p> Signup and view all the answers

    Which seizure type is characterized by sudden, brief, shock-like muscle jerks?

    <p>Myoclonic seizure</p> Signup and view all the answers

    Which type of seizure involves a loss of consciousness with tonic-clonic convulsions?

    <p>Loss of consciousness with tonic-clonic convulsions</p> Signup and view all the answers

    Which seizure type involves a brief loss of awareness without loss of postural tone?

    <p>Absence seizure</p> Signup and view all the answers

    Which type of seizure involves sudden, brief, shock-like muscle jerks?

    <p>Myoclonic</p> Signup and view all the answers

    What is the primary characteristic of a tonic seizure?

    <p>Sustained muscle contraction without a clonic phase</p> Signup and view all the answers

    Which of the following is characterized by a loss of postural tone, also known as 'drop' attacks?

    <p>Atonic</p> Signup and view all the answers

    Which of the following clinical features is commonly associated with seizures?

    <p>Disordered thought (e.g., deja vu)</p> Signup and view all the answers

    What is a possible consequence of a seizure affecting the motor cortex?

    <p>Tonic-clonic convulsions</p> Signup and view all the answers

    Which of the following can occur as a seizure spreads within the brain? A) Sudden loss of vision B) Sequential behaviours (e.g., fingers → wrist → elbow) C) Immediate loss of consciousness D) Lack of muscle coordination

    <p>Sequential behaviours (e.g., fingers → wrist → elbow)</p> Signup and view all the answers

    Which of the following is commonly seen after a seizure?

    <p>Post-ictal confusion, disorientation, agitation</p> Signup and view all the answers

    Urinary incontinence can be a clinical feature of which condition? A) Headaches B) Seizures C) Stroke D) Migraine

    <p>Seizures</p> Signup and view all the answers

    What characterizes status epilepticus?

    <p>Seizure lasting for more than 5 minutes without recovery</p> Signup and view all the answers

    Which of the following is a potential consequence of status epilepticus?

    <p>Neuronal death due to excitotoxicity</p> Signup and view all the answers

    What is a significant long-term effect of prolonged or severe epilepsy on the brain?

    <p>Gliosis and cell death</p> Signup and view all the answers

    What medical approach is necessary for treating status epilepticus?

    <p>Immediate treatment with anticonvulsants</p> Signup and view all the answers

    What does the term 'SUDEP' stand for?

    <p>Sudden unexpected death in epilepsy</p> Signup and view all the answers

    What does an electroencephalogram (EEG) record?

    <p>Weak electrical activity generated by the brain</p> Signup and view all the answers

    How is the electrical activity recorded in an EEG?

    <p>By detecting electrical currents in the brain's extracellular space</p> Signup and view all the answers

    Where are EEG signals typically recorded from?

    <p>The scalp</p> Signup and view all the answers

    What is the primary advantage of EEG?

    <p>Good temporal resolution</p> Signup and view all the answers

    What is a limitation of EEG?

    <p>Poor spatial resolution</p> Signup and view all the answers

    What generates the extracellular dipole that is detected by EEG?

    <p>EPSPs in pyramidal cells of the cortex</p> Signup and view all the answers

    What type of seizure is characterized by repetitive generalized or focal spikes and sharp waves lasting longer than 10 seconds at a frequency of 3 Hz or more?

    <p>Generalized onset seizure</p> Signup and view all the answers

    In a generalized onset seizure, where does the seizure activity begin?

    <p>Simultaneously in both hemispheres</p> Signup and view all the answers

    What characterizes a focal onset seizure? (Select all that apply)

    <p>Seizure activity begins in one or more brain regions</p> Signup and view all the answers

    Which EEG abnormalities are commonly seen in epilepsy? (Select all that apply)

    <p>Spikes and sharp waves</p> Signup and view all the answers

    What is typically assessed during interictal activity (between seizures) in epilepsy diagnosis?

    <p>Transient abnormalities or discharges</p> Signup and view all the answers

    Which imaging technique is commonly used to identify structural abnormalities such as scar tissue, tumors, or bleeds in the brain?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    Which imaging technique is used to identify functional abnormalities by measuring blood flow to active brain regions?

    <p>Functional MRI (fMRI)</p> Signup and view all the answers

    Which brain imaging technique is specifically useful for detecting hippocampal sclerosis?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    What does an odd numbered lead indicate in paired electrode recordings?

    <p>Left side activity</p> Signup and view all the answers

    What is primarily assessed in the diagnostic value of wave recordings?

    <p>Frequency and amplitude of the waves</p> Signup and view all the answers

    In the context of paired electrodes, how is potential recorded?

    <p>Between each pair of electrodes</p> Signup and view all the answers

    What does an even numbered lead signify in paired electrode recordings?

    <p>Right side activity</p> Signup and view all the answers

    Which of the following options does NOT contribute to interpreting wave recordings?

    <p>Color of the waves</p> Signup and view all the answers

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