Epilepsy Flashcards by Steve Jeong

What is the ILAE 2014 definition of epilepsy?

≥2 unprovoked seizures ≥24 h apart OR 1 unprovoked + ≥60 % recurrence risk OR a defined epilepsy syndrome.

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When is epilepsy considered resolved?

Seizure-free ≥ 10 years and off ASMs ≥ 5 years.

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List the three major seizure onset types in ILAE 2025.

Focal / Generalised / Unknown onset.

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What is the mnemonic for epilepsy aetiologies?

S-GIMIU → Structural Genetic Infectious Metabolic Immune Unknown.

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Name two EEG activators that increase diagnostic yield.

Sleep deprivation and hyperventilation (plus photic stimulation).

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What MRI protocol is preferred for epilepsy?

3 T epilepsy protocol – hippocampal sclerosis and focal cortical dysplasia.

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Which gene mutation defines Dravet syndrome?

SCN1A loss-of-function.

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Which dietary therapy treats GLUT1 deficiency?

Ketogenic or modified Atkins diet.

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Which mTOR inhibitor helps seizures in TSC?

Everolimus.

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Mnemonic for ASM mechanisms?

SNaP GAMe → Sodium block / SV2A bind / GABA enhance / AMPA block / Mixed.

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First-line drug for focal seizures?

Levetiracetam (or Lamotrigine / Lacosamide).

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First-line drug for generalised tonic–clonic seizures?

Valproate (if no pregnancy risk) → Levetiracetam alternative.

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First-line drug for absence seizures?

Ethosuximide (or Valproate / Lamotrigine).

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First-line drug for myoclonic epilepsy?

Levetiracetam or Valproate ± Topiramate.

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What defines drug-resistant epilepsy?

Failure of two appropriate ASMs at tolerated doses.

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Best next step after confirming DRE?

Refer to epilepsy centre for surgery / VNS / diet therapy.

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Mechanism of Carbamazepine?

Sodium-channel blocker (prolongs inactivation).

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Key adverse effects of Carbamazepine?

Hyponatraemia / Rash / Enzyme induction / Worsens JME.

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Mechanism of Lamotrigine?

Na-channel block + glutamate modulation.

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Unique safety of Lamotrigine in pregnancy?

Low teratogenicity but clearance ↑ in pregnancy → monitor dose.

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Mechanism of Valproate?

↑ GABA + Na block + T-Ca block (multi-pathway).

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Main toxicities of Valproate?

Weight gain / tremor / hepatotoxicity / teratogenicity.

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Mechanism of Levetiracetam?

SV2A binding → ↓ vesicle release.

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Common side-effect of Levetiracetam?

Irritability or mood change.

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Mechanism of Topiramate?

Na block + GABA enhance + AMPA antagonism.

Notable Topiramate side-effects?

Cognitive slowing / weight loss / kidney stones.

Mechanism of Ethosuximide?

T-type Ca²⁺ channel block in thalamus (absence-specific).

Which ASM causes hyponatraemia?

Carbamazepine and Oxcarbazepine.

Which ASM causes cognitive slowing?

Topiramate.

Which ASMs cause weight gain?

Valproate (and clobazam slightly).

Which ASMs cause weight loss?

Topiramate and Zonisamide.

Which ASMs are enzyme inducers?

Carbamazepine / Phenytoin / Phenobarbital / Topiramate > 200 mg.

Effect of enzyme inducers on OCPs?

Reduced efficacy → use IUD or Depot MPA.

Interaction of Valproate with Lamotrigine?

Inhibits LTG metabolism → halve LTG dose.

Which ASM is safest in pregnancy?

Levetiracetam or Lamotrigine.

What folate dose for PWCEP?

5 mg daily ≥ 3 months before conception.

Which ASMs must be avoided in pregnancy?

Valproate / Phenytoin / Phenobarbital.

Define SUDEP.

Sudden unexpected non-traumatic non-status death in epilepsy.

Main risk factor for SUDEP?

Uncontrolled generalised tonic–clonic seizures (esp nocturnal).

Two SUDEP prevention strategies?

Optimise seizure control and avoid sleeping prone position.

Mnemonic for SUDEP risk?

Night + Non-adherence = No pulse.

Describe the EEG pattern in absence epilepsy.

3 Hz spike-and-wave discharges.

EEG pattern in JME?

Polyspike or polyspike-wave.

EEG pattern in infantile spasms?

Hypsarrhythmia (high-amplitude chaotic trace).

EEG pattern in encephalitis or tumour?

Periodic lateralised epileptiform discharges (PLEDs).

Mnemonic for EEG patterns?

3-P-H-P → 3 Hz, Polyspike, Hyps, Periodic.

First step in status epilepticus management?

Give benzodiazepine (IM midazolam 10 mg or IV lorazepam 0.1 mg/kg).

Second step in status epilepticus?

Load Levetiracetam 60 mg/kg or Valproate 40 mg/kg or Phenytoin 20 mg/kg.

Third step if status persists >30 min?

Induce anaesthesia with midazolam / propofol / thiopentone in ICU.

Australian private driving rule after a seizure?

Seizure-free ≥ 6 months before driving.

Commercial driving rule?

Seizure-free ≥ 2 years and off ASMs.

What does PWCEP stand for?

People with Epilepsy of Child-bearing Potential.

Which ASMs are mood-worsening?

Levetiracetam and Perampanel.

Which ASMs are bone-depleting?

Phenytoin and Phenobarbital.

What labs to monitor with VPA?

LFTs and platelets.

What labs to monitor with CBZ?

Sodium and LFTs.

Mnemonic for pregnancy ASM avoidance?

Very Poisonous Anti-Plasma = Valproate Phenytoin Phenobarbital.

Main difference between Dravet and JME management?

Dravet → avoid Na-blockers; JME → responds to Na-blockers (VPA/LEV).

Mechanism of Cenobamate?

Dual Na block + GABA-A enhancement.

Key adverse effect of Cenobamate?

QT shortening and CYP drug interactions.

Mechanism of Fenfluramine?

5-HT2C agonist modulating seizure threshold.

Mechanism of Cannabidiol?

Multi-target GABA and glutamate modulation.

Define hypsarrhythmia clinically.

High-voltage disorganised EEG seen in infantile spasms.

When to start antiepileptic therapy after first seizure?

If structural lesion or EEG abnormality → recurrence risk ≥ 60 %.

Three Tier 1 syndromes to know?

JME / Dravet / Lennox–Gastaut.

Drug of choice for TSC infantile spasms?

Vigabatrin.

Mnemonic for epilepsy emergency sequence?

B-L-I → Benzodiazepine → Load → Induce.

What is the private driving mnemonic?

6-0-S → 6 months 0 seizures Signed-off.

What gene and treatment combo for SCN1A loss?

SCN1A → Avoid Na-blockers → use CLB VPA CBD Fenfluramine.

Which ASM has no enzyme interactions?

Levetiracetam (and Lacosamide minimal).

Which ASM needs echo monitoring?

Fenfluramine (due to valvulopathy risk).

What is ASO therapy example in epilepsy?

STK-001 for SCN1A (antisense oligonucleotide).

Mnemonic for side-effect pairs?

Na↓ (CBZ/OXC) Wt↑ (VPA) Wt↓ (TPM/ZNS).

Main mechanism of SUDEP?

Post-ictal apnoea → bradyasystole from autonomic dysregulation.

What percentage achieves seizure freedom with 1–2 ASMs?

≈ 70 %.

When should surgery be considered?

After failure of 2 ASMs in focal lesion epilepsy.

What ASMs worsen JME?

Carbamazepine / Phenytoin / Tiagabine / Vigabatrin.

Which test confirms autoimmune epilepsy?

Antibody panel (VGKC, LGI1, NMDA-R).

What is the most common cause of DRE in adults?

Mesial temporal lobe epilepsy.

Key rule for exam answers?

Define → Classify → Treat → Prevent SUDEP → Protect pregnancy.

Epilepsy Flashcards

(80 cards)