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Questions and Answers
Which drug competitively inhibits the voltage-gated sodium channel, preventing burst firing?
Which drug competitively inhibits the voltage-gated sodium channel, preventing burst firing?
Which drug is highly effective in Absence epilepsy by blocking T-type calcium channels in the thalamus?
Which drug is highly effective in Absence epilepsy by blocking T-type calcium channels in the thalamus?
Which type of epilepsy is characterized by intermittent high amplitude discharges at the site of epileptic focus during inter-ictal periods?
Which type of epilepsy is characterized by intermittent high amplitude discharges at the site of epileptic focus during inter-ictal periods?
Which anticonvulsant drug facilitates GABAergic transmission and tends to cause drowsiness/sedation?
Which anticonvulsant drug facilitates GABAergic transmission and tends to cause drowsiness/sedation?
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What is the impact of sodium valproate on cognitive development in infants?
What is the impact of sodium valproate on cognitive development in infants?
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Which enzyme does valproate inhibit?
Which enzyme does valproate inhibit?
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What is the percentage of refractory epilepsy patients who remain unresponsive to pharmacological treatment?
What is the percentage of refractory epilepsy patients who remain unresponsive to pharmacological treatment?
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Which group of patients face particular issues when starting epilepsy treatment?
Which group of patients face particular issues when starting epilepsy treatment?
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What is the most common side effect associated with long-term use of phenytoin?
What is the most common side effect associated with long-term use of phenytoin?
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What percentage of patients with Juvenile Myoclonic Epilepsy are refractory to treatment?
What percentage of patients with Juvenile Myoclonic Epilepsy are refractory to treatment?
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Which enzyme induction is associated with carbamazepine?
Which enzyme induction is associated with carbamazepine?
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What is the main issue concerning teratogenicity of anticonvulsants?
What is the main issue concerning teratogenicity of anticonvulsants?
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What issue might pharmacogenomics investigate in relation to variability in pharmacological success of AEDs?
What issue might pharmacogenomics investigate in relation to variability in pharmacological success of AEDs?
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What is the primary function of anti-epileptic drugs (AEDs) available today?
What is the primary function of anti-epileptic drugs (AEDs) available today?
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How do most anti-epileptic drugs (AEDs) work to prevent the spread of epileptic discharges?
How do most anti-epileptic drugs (AEDs) work to prevent the spread of epileptic discharges?
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What is the aim of treatments for preventing increased activity in the brain attributable to increased membrane excitability?
What is the aim of treatments for preventing increased activity in the brain attributable to increased membrane excitability?
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Which type of drugs were the first generation antiepileptic drugs that act on reducing membrane excitability?
Which type of drugs were the first generation antiepileptic drugs that act on reducing membrane excitability?
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What is the primary action of sodium channel blockers in controlling seizures?
What is the primary action of sodium channel blockers in controlling seizures?
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What is the effect of drugs with selective actions at sodium channels on normal neuronal firing?
What is the effect of drugs with selective actions at sodium channels on normal neuronal firing?
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What is the impact of increased neuronal activity (as in a seizure) on neurons when inhibited by sodium channel blocker drugs?
What is the impact of increased neuronal activity (as in a seizure) on neurons when inhibited by sodium channel blocker drugs?
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What is the primary function of GABA enhancers in reducing membrane excitability?
What is the primary function of GABA enhancers in reducing membrane excitability?
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What is the commonest form of primary generalized epilepsy?
What is the commonest form of primary generalized epilepsy?
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What is the characteristic feature of Absence seizures?
What is the characteristic feature of Absence seizures?
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Which type of seizures are characterized by electrical discharges starting in one cortical region and then may spread over the whole brain?
Which type of seizures are characterized by electrical discharges starting in one cortical region and then may spread over the whole brain?
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What is the duration of a typical Generalized Tonic Clonic Seizure (Grand Mal)?
What is the duration of a typical Generalized Tonic Clonic Seizure (Grand Mal)?
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What is the main risk factor for Juvenile Myoclonic Epilepsy (JME)?
What is the main risk factor for Juvenile Myoclonic Epilepsy (JME)?
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What is the characteristic feature of Absences that distinguishes them from other seizure types?
What is the characteristic feature of Absences that distinguishes them from other seizure types?
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What is the most common type of seizure in patients with Juvenile Myoclonic Epilepsy (JME)?
What is the most common type of seizure in patients with Juvenile Myoclonic Epilepsy (JME)?
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What is the characteristic feature of Complex Partial Seizures?
What is the characteristic feature of Complex Partial Seizures?
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Which type of epilepsy is strongly associated with a space-occupying lesion?
Which type of epilepsy is strongly associated with a space-occupying lesion?
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What type of seizures are often misdiagnosed as non-epileptic and have an often normal ictal EEG?
What type of seizures are often misdiagnosed as non-epileptic and have an often normal ictal EEG?
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Which symptom is typically associated with parietal lobe epilepsy?
Which symptom is typically associated with parietal lobe epilepsy?
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Which type of seizure is strongly associated with Todd's paresis?
Which type of seizure is strongly associated with Todd's paresis?
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Which type of seizures are frequently predominantly nocturnal and have rapid recovery?
Which type of seizures are frequently predominantly nocturnal and have rapid recovery?
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Which type of seizure is characterized by a fencing posture, overlapping with temporal lobe epilepsy?
Which type of seizure is characterized by a fencing posture, overlapping with temporal lobe epilepsy?
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Which type of seizure is characterized by oral automatisms like lip smacking and chewing movements?
Which type of seizure is characterized by oral automatisms like lip smacking and chewing movements?
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Which type of epilepsy symptom includes hallucinations of taste, speech, and/or smell, and visual distortion?
Which type of epilepsy symptom includes hallucinations of taste, speech, and/or smell, and visual distortion?
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Which type of seizure has a last duration of typically 1-3 minutes?
Which type of seizure has a last duration of typically 1-3 minutes?
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Which type of sensory symptom is typically associated with occipital lobe epilepsy?
Which type of sensory symptom is typically associated with occipital lobe epilepsy?
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What is the primary function of anti-epileptic drugs (AEDs) available today?
What is the primary function of anti-epileptic drugs (AEDs) available today?
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What is the characteristic feature of Absence seizures?
What is the characteristic feature of Absence seizures?
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What is the impact of sodium valproate on cognitive development in infants?
What is the impact of sodium valproate on cognitive development in infants?
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Which type of epilepsy is characterized by intermittent high amplitude discharges at the site of epileptic focus during inter-ictal periods?
Which type of epilepsy is characterized by intermittent high amplitude discharges at the site of epileptic focus during inter-ictal periods?
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What is the most common type of seizure in patients with Juvenile Myoclonic Epilepsy (JME)?
What is the most common type of seizure in patients with Juvenile Myoclonic Epilepsy (JME)?
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Which enzyme does valproate inhibit?
Which enzyme does valproate inhibit?
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What is the characteristic feature of Complex Partial Seizures?
What is the characteristic feature of Complex Partial Seizures?
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What is the primary function of GABA enhancers in reducing membrane excitability?
What is the primary function of GABA enhancers in reducing membrane excitability?
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Which enzyme induction is associated with carbamazepine?
Which enzyme induction is associated with carbamazepine?
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What is the impact of drugs with selective actions at sodium channels on normal neuronal firing?
What is the impact of drugs with selective actions at sodium channels on normal neuronal firing?
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What is the aim of treatments for preventing increased activity in the brain attributable to increased membrane excitability?
What is the aim of treatments for preventing increased activity in the brain attributable to increased membrane excitability?
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Which process is defined as the conversion of parts of a normal brain to a hyperexcitable brain?
Which process is defined as the conversion of parts of a normal brain to a hyperexcitable brain?
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What is the physiological definition of an epileptic seizure?
What is the physiological definition of an epileptic seizure?
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What tends to cause the 'electrical brain-storm' during an epileptic seizure?
What tends to cause the 'electrical brain-storm' during an epileptic seizure?
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Why is the brain prone to seizure activity?
Why is the brain prone to seizure activity?
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What is the primary focus of ion channels in relation to epilepsy?
What is the primary focus of ion channels in relation to epilepsy?
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What does EEG stand for in the context of epilepsy?
What does EEG stand for in the context of epilepsy?
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What is the characteristic feature of an epileptic seizure?
What is the characteristic feature of an epileptic seizure?
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What is the impact of epileptogenesis on parts of a normal brain?
What is the impact of epileptogenesis on parts of a normal brain?
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What causes an 'electrical brain-storm' during an epileptic seizure?
What causes an 'electrical brain-storm' during an epileptic seizure?
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What does 'EEG' measure in relation to epilepsy?
What does 'EEG' measure in relation to epilepsy?
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Study Notes
Antiepileptic Drugs and Their Mechanisms of Action
- Sodium channel blockers oldest to newest: Phenytoin, Carbamazepine (oxcarbazepine/ eslicarbazepine), Lamotrigine, Zonisamide, Lacosamide
- Sodium channel blockers prevent epileptiform discharges without affecting ordinary action potential firing
- Carbamazepine, oxcarbazepine, and eslicarbazepine competitively inhibit the voltage-gated sodium channel, preventing burst firing
- Several experimental agents active in animal models of epilepsy are blockers of NMDA, AMPA, or kainate subtypes of glutamate receptor
- Calcium channels are voltage-activated and regulate calcium entry and neurotransmitter release from pre-synaptic nerve terminals
- Ethosuximide, highly effective in Absence epilepsy, blocks T-type calcium channels in the thalamus
- Focal epilepsy is characterized by intermittent high amplitude discharges at the site of epileptic focus during inter-ictal periods
- Anticonvulsant drugs that facilitate GABAergic transmission tend to cause drowsiness/sedation
- Levetiracetam is a high-affinity synaptic vesicle protein-2A ligand that modulates neurotransmitter release and is effective in refractory epilepsy
- Relative rates of partial (focal) onset seizures reduction vs placebo: Levetiracetam – 3.81, Topiramate – 3.32, Lamotrigine – 2.71
- Choosing the right drug for the patient: ideal antiepileptic agent should have good efficacy, easy and rapid titration, no drug-drug interactions, and low side-effects
- Classification of seizures/epilepsy syndromes: Sodium valproate and lamotrigine are first-line for primary generalized epilepsy, while carbamazepine and lamotrigine are first-line for partial (focal onset) epilepsy. Some drugs exacerbate generalized seizure types.
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Description
Test your knowledge on the pharmacological treatments of epilepsy with a focus on anti-epileptic drugs (AEDs) and how they work. Explore the effectiveness of AEDs in preventing the spread of epileptic discharges and controlling seizures.
