100 Questions
Which type of epilepsy is sodium valproate considered a first-line treatment for?
Primary generalized epilepsy
Which type of epilepsy is carbamazepine considered a first-line treatment for?
Partial (focal onset) epilepsy
What percentage of patients with refractory epilepsy have idiopathic (primary) epilepsy?
27%
What is the main side effect of phenytoin?
Ataxia
What is the long-term side effect of sodium valproate?
Menstrual irregularities
Which factor can contribute to the variability of response to antiepileptic drugs?
Genetic differences among patients
What is the main enzyme inhibitor among the listed antiepileptic drugs?
Valproate
Which of the following is true about antiepileptic drugs (AEDs)?
AEDs control epilepsy's major symptom: seizures
What is the main goal of pharmacological treatments for epilepsy?
To control the major symptom of epilepsy: seizures
Which of the following is NOT a factor contributing to increased activity in the brain during epilepsy?
Increased efficiency of inhibitory synaptic transmission - GABA
What is the function of sodium channel blockers in the treatment of epilepsy?
To reduce membrane excitability and prevent seizure spread
Which of the following is the oldest sodium channel blocker?
Phenytoin
Which of the following sodium channel blockers enhances slow inactivation of sodium channels?
Lacosamide
What is the advantage of drugs with more selective actions at sodium channels?
They have less side-effects
Which type of calcium channels are heavily represented in thalamic neurons and are involved in bursting and intrinsic oscillations?
T-type calcium channels
Which neurotransmitter is responsible for reducing the efficiency of excitatory synaptic transmission?
Glutamate
Which antiepileptic drug is a non-competitive blocker of AMPA glutamate receptors and reduces the spread or generalization of seizures?
Perampanel
Which antiepileptic drug acts by competitively inhibiting the voltage-gated sodium channel in its inactive state, prolonging the period between successive firings?
Carbamazepine
Which type of neurotransmitter release can be controlled by voltage-activated calcium channels?
Excitatory neurotransmitter release
Which antiepileptic drug acts as a facilitator of GABAergic transmission by inhibiting GABA-T (GABA transaminase)?
Vigabatrin
Which antiepileptic drug is a high-affinity synaptic vesicle protein-2A ligand and modulates neurotransmitter release?
Levetiracetam
Which one of these is NOT an outstanding problem with all antiepileptic agents?
Lack of side effects
What are the ideal properties of an antiepileptic drug?
Low side effects
Why do antiepileptic agents have so many side effects?
High toxicity
What issues particularly face women starting epilepsy treatment?
Reproductive concerns
Which antiepileptic drug is mentioned in a retrospective study in epilepsy clinics in the UK?
Lacosamide
Which antiepileptic drug showed a good response of over 90% reduction in seizure frequency in a study involving pediatric patients with Lennox-Gastaut syndrome?
Lacosamide
Which antiepileptic drug is mentioned in a perspective article about the use of perampanel and intravenous carbamazepine for generalized seizures?
Carbamazepine
Which antiepileptic drug is mentioned in a pooled analysis of three phase III studies for the treatment of refractory partial seizures?
Carbamazepine
Which antiepileptic drug acts as a facilitator of GABAergic transmission by inhibiting GABA-T (GABA transaminase)?
Valproate
Which of the following is a common symptom of temporal lobe epilepsy?
Forced head/eye deviation to the contralateral side
Which type of seizure is often misdiagnosed as non-epileptic?
Frontal lobe seizures
Which type of seizure is strongly associated with a space-occupying lesion?
Frontal lobe seizures
Which type of seizure is characterized by positive sensory symptoms like tingling and pain?
Parietal lobe seizures
Which type of seizure is characterized by simple visual hallucinations like balls of colored or flashing lights?
Occipital lobe seizures
Which of the following antiepileptic drugs can make myoclonic jerks and absences worse?
Phenytoin
Which type of seizure is suggestive of juvenile myoclonic epilepsy?
Occipital lobe seizures
Which type of seizure should prompt a brain scan recommendation?
Jacksonian motor or sensory seizures
Which type of seizure is characterized by a temporary unilateral weakness known as Todds paresis?
Frontal lobe seizures
Which type of seizure is associated with alcohol withdrawal?
Frontal lobe seizures
Which type of seizures are provoked by acute insults such as stroke, infection, alcohol withdrawal, or a metabolic disturbance?
Acute symptomatic seizures
Which type of seizures are characterized by electrical discharges appearing to start over the whole brain at the same time on EEG?
Primary generalized onset seizures
Which type of seizures are characterized by electrical discharges appearing to start in one cortical region and then may remain localized or may spread over the whole brain?
Partial/focal onset seizures
Which type of seizures have a limited repertoire of seizures including tonic-clonic seizures, absences, tonic seizures, atonic seizures, and myoclonic seizures?
Idiopathic (Primary) generalized seizures
Which type of seizures are the commonest form of primary generalized epilepsy and have an onset in childhood or adolescence?
Juvenile myoclonic epilepsy
Which type of seizures are characterized by early morning myoclonic jerks and can be triggered by photosensitivity and sleep deprivation?
Juvenile myoclonic epilepsy
Which type of seizures occur with sudden onset, without warning, and have an increased risk of injury for the patient?
Primary generalized onset seizures
Which type of seizures are abrupt, short, and can occur multiple times a day, leading to learning difficulties?
Partial/focal onset seizures
Which type of seizures are characterized by the seizure activity localized at onset and recruiting activity in other leads as the seizure spreads?
Partial/focal onset seizures
Which lobe of the brain is most commonly associated with temporal lobe seizures?
Temporal lobe
Which of the following is a physiological definition of an epileptic seizure?
An explosion of synchronous activity by lots of neurons at once
Why is the brain prone to seizure activity?
A network of excitatory neurons connected together is potentially explosive
What is the process by which parts of a normal brain are converted to a hyperexcitable brain called?
Epileptogenesis
Which type of epilepsy represents a hyperexcitation or a failure of inhibitory regulation?
Generalized epilepsy
What is the main requirement to avoid the 'explosion' of activity in the brain?
More inhibition than excitation
Which type of seizures have a tendency to spread throughout the cerebral cortex?
Generalized seizures
Which type of seizures are characterized by a brief change in behavior caused by the synchronous and rhythmic firing of action potentials?
Focal seizures
What is the main factor contributing to increased activity in the brain during epilepsy?
Positive feedback
Which type of epilepsy is characterized by seizure activity localized at onset and recruiting activity in other leads as the seizure spreads?
Focal epilepsy
Which type of seizures are characterized by early morning myoclonic jerks and can be triggered by photosensitivity and sleep deprivation?
Generalized seizures
Which type of ion channels are implicated in genetic epilepsy when mutated?
Both voltage-gated and ligand-gated ion channels
What does the electroencephalogram (EEG) record?
The electrical activity of very large numbers of neurons in the cerebral cortex
What is the origin of focal (partial) seizures?
Cerebral cortex
What contributes to the synchronized 'paroxysmal depolarizing shift' (PDS) during focal seizures?
Both increased extracellular K+ and glutamate release
How do focal seizures spread to other brain regions?
Along the normal neuronal pathways
What is the primary origin of generalized seizures?
Thalamus
What brain region is more prone to seizures than the neocortex?
Hippocampus
What can secondary generalization of seizures involve?
Spread of activity to the thalamus
What does the electroencephalogram (EEG) help with?
Determining the localization of a seizure
What is the function of ion channels implicated in genetic epilepsy?
Both action potential generation and repolarization impaired
What is the main role of inhibitory pathways in the brain?
To act as a brake and balance hyperexcitability
What can induce convulsions and lift depression in some patients?
AZT
What can cause a single neuron to fire bursts of action potentials?
Intrinsic ability
What is the role of sodium channels and calcium channels in epilepsy?
They play an important part in epilepsy
Which type of seizures are particularly common at night?
Nocturnal seizures
What is the goal of antiepileptic drug therapy?
To treat the seizures
Which type of drugs were the first generation of antiepileptic drugs?
Sodium channel blockers
What is the main goal of antiepileptic drug therapy in terms of sodium channels?
To have a selective effect on sodium channels
Which of the following is a common symptom of epilepsy?
Muscle weakness
What is the main factor contributing to increased activity in the brain during epilepsy?
Low potassium levels
Which type of epilepsy is characterized by seizure activity localized at onset and recruiting activity in other brain regions as the seizure spreads?
Focal epilepsy
What is the main requirement to avoid the 'explosion' of activity in the brain during epilepsy?
Increased inhibitory regulation
Which of the following is NOT true about epilepsy Genesis?
It is an explosion of activity by lots of neurons at once
What is the main factor contributing to increased activity in the brain during epilepsy?
Electrical brainstorms in the cerebral cortex
What happens to the patient during an epileptic seizure?
It depends on where the seizure is passing through
What is the function of ion channels implicated in genetic epilepsy?
They reduce the efficiency of excitatory synaptic transmission
What percentage of patients with epilepsy will respond well to medications and be seizure free?
70%
What is the main reason why valproate is not favored in young women?
It is teratogenic
What is the main concern regarding the use of antiepileptic drugs in women with a learning disability?
It can increase the risk of congenital malformations
Why is it important to be aware of drug interactions with antiepileptic drugs?
To avoid interactions with other medications
What is one of the key messages the speaker wants to drive home about antiepileptic drugs?
Not all antiepileptic drugs are equal for an individual patient
What is one of the disadvantages of using older antiepileptic drugs?
They can have nasty toxic effects, especially when used for a long time
What is the primary goal of matching antiepileptic drugs to patients?
To minimize side effects and optimize efficacy
What is one advantage of more modern antiepileptic drugs?
They tend to have fewer side effects
Which type of epilepsy is more likely to be mentioned in the text?
Juvenile myoclonic epilepsy
What is the percentage of all epilepsy cases that are juvenile myoclonic epilepsy?
More than 10%
Which age group is typically affected by juvenile myoclonic epilepsy?
Adolescents
What is a characteristic feature of juvenile myoclonic epilepsy?
It is a lifelong condition
What can provoke seizures in patients with juvenile myoclonic epilepsy?
Sleep deprivation
What is the main reason for the warnings about flashing lights?
To prevent seizures in patients with juvenile myoclonic epilepsy
Test your knowledge on different types of medications and their effects with this quiz. From established drugs with single modes of action to modern medications with broad spectrum effects, explore the differences in selectivity, side effects, drug interactions, and more. Challenge yourself to understand the kinetics and therapeutic ranges of these medications, while also considering factors like cost and long-term toxicity. Discover the various psychiatric and behavioral effects that some medications may have.
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