L1 Pathophysiology and Drug Principles for Epilepsy

L1_What is a seizure?

A ____, discrete event that occurs intermittently, __, and unpredictably
Results from abnormal, excessive, and ____ discharge of cortical neurons

brief, irregular, synchronous

L1_What are the 2 main seizure onset types?

1. ____ onset = begins in a ____ area of the brain

2. ____ onset = ____ brain involved from onset

Focal, specific, Generalized, whole

L1_How are focal onset seizures classified?

Awareness: — vs —

May progress from focal to —

Aware, impaired awareness, bilateral tonic-clonic

L1_How are generalized onset seizures classified?

Onset: Motor vs Nonmotor (____)
Motor: ____
Nonmotor: ____

Absence, Tonic-clonic, clonic, tonic, myoclonic, atonic, typical, atypical

L1_What is epilepsy?

Neurological condition characterized by ____ (2 or more) seizures
→ ____ by any immediately identifiable cause
→ Seizures separated by ____

Recurrent, unprovoked, >24 hr

L1_ What is an AURA?

A __ phenomenon that may __ an observable seizure

→ If it occurs alone, it is a ____ seizure

Subjective, precede, sensory/focal aware

L1_ What is automatism?

A set of __ behavior observed during seizures

Examples: chewing, swallowing, lip smacking, fumbling, mumbling

unconscious

L1_ What does ICTAL mean?

The actual seizure __ itself

event

L1_What is the goal of ASM therapy?

Complete seizure control without __ side effects

OR

Best balance between seizure control and __

disabling, side effects

L1_ When is ASM therapy NOT indicated?

• Seizure due to __ cause

• __ unprovoked seizure

• Certain epilepsies (ex. __ seizures)

Reversible, first, febrile

L1_ What are the main principles of ASM therapy?

• Match drug to __

• Start __ , increase _

• Use __ whenever possible

• Monitor for: seizures, interactions, side effects, __

patient, low, slow, monotherapy, complicance

L1_ What factors are used to match an ASM to the patient?

• ____ type / epilepsy syndrome

• ____ + lifestyle

• Other ____ conditions

• ____ effects

• Administration issues

• ____

Seizure, age, medical, side, cost

L1_ What factors may precipitate seizures and should be avoided if possible?

• ____

• Lack of ____

• ____

• Poor diet

• ____

• Exposure to ____ lights

alcohol, sleep, stress, fever, flickeringfor s

L1_ What are the possible initial ASM options for focal onset seizures?

• ____

• ____

• ____

• ____

Carbamazepine, oxcarbazepine, levetiracetam, lamotrigine

L1_ What are the possible initial ASM options for generalized tonic-clonic seizures?

• ____

• ____

• ____

Levetiracetam, lamotrigine, topiramate

L1_ What are the possible initial ASM options for absence seizures?

• ____

Valproic acid

L1_ Which possible initial ASMs are used for myoclonic vs atonic seizures?

• Myoclonic: ____

• Atonic: ____ , ____ , ____

Valproic acid, valproic acid, lamotrigine, topiramate

L1_ Carbamazepine (CBZ): what are the key selection pearls?

• 
  

• Chronic AEs: osteoporosis, leukopenia, ____

• Interaction: CYP ____ inducer

• Other indications: ____, depression, bipolar

hyponatremia, 3A4, migraine

L1_ Lamotrigine (LTG): what are the key selection pearls?

• Chronic AEs: ____

• Titration: ____ weeks

• Interactions: may be induced/inhibited by other ASMs and ____

• Other indication: ____ disorder

none, 6-8, hormonal contraception, bipolar

L1_ Levetiracetam (LEV): what are the key selection pearls?

• Behavioral AEs: agitation, irritability, ____

• Idiosyncratic AEs: ____

• Drug interactions: ____

Anxiety, no, none

L1_ Valproic acid (VPA): what are the key selection pearls?

• Chronic AEs: alopecia, ____ gain, polycystic ovaries

• __risk

• Interaction: CYP____ + ____ inhibitor

• Other indication: ____ prevention

weight, teratogenic, 2C9, glucuronidation, migraine

L1_ If seizures are not controlled at the maximally tolerated dose of the first ASM, what should be reevaluated?

• ____ of epilepsy

• ____ of seizure type

• Adequate ____ / ____ of therapy

• Medication ____ (plasma concentration)

Diagnosis, classification, dose, duration, compiance

• L1_ Levetiracetam (Keppra)

  • ___ spectrum → focal + generalized

  • Eliminated mainly unchanged ___

  • Enzyme induction/inhibition: ___

    • therefore ___ drug-drug interactions

  • Range: – mcg/mL

  • AE: behavioral changes, ___

  • Avoid in patients with ___ / psychiatric disorders

  • ___ kinetics

broad, renally, none, no, 12–46, irritability, behavioral, linear

L1_ Oxcarbazepine (Trileptal)

• — seizures

• Active metabolite: —

• CYP3A4 — → ↓ hormonal contraception

• AE: —

• — PK

• Range: — mcg/mL

Focal, 10-monohydroxy metabolite (MHD), inducer, hyponatremia, linear, 3-35

L1_ Valproic Acid (Depakote)

• ___ spectrum → focal + generalized

• Inhibitor

  • CYP ___ → ↑ phenytoin

  • ___ → ↑ lamotrigine

  • epoxide hydrolase → ↑ CBZ epoxide

• AE: weight gain, ___, thrombocytopenia

• Avoid initial use in women of ___ age

• Range: – mcg/mL

• ___ kinetics

broad, 2C9, glucuronidation, alopecia, childbearing, 50–100, linear