Structural abnormalities of the CNS which may present at birth
- Anencephaly is caused by a failure of formation of the forebrain
- Spina bifida is a form of meningo-myelocele
- Dandy Walker syndrome is associated with failure of development of the cerebellum.
- Microcephaly is caused by development of a small brain
- Meningo-myelocele is caused by failure of closure of the caudal end of neural tube
Relationship of hippocampal sclerosis to epilepsy
- Neuronal loss and reorganisation of hippocampul structures
- related to the later development of temporal love epilepsy
- Related to febrile convulsions (not sure if a cause of or caused by)
- Commonest associated lesion of focal epilepsy
GABA synthesis, storage and recycling
Synthesised from glutamate
catalysed by glutamic acid decarboxylase (GAD)
Loaded and stored in vesicles by vesicular GABA transporter using the proton gradient
Released at synapse
reuptake by transporters on glia and GABA neuron and others
No transport back to neuron from glia, requires more new synthesis of GABA
Long term complications of Parkinson
Dementia Ons and Offs Dyskinesias Falls Swallowing difficulties Speech difficulties
What molecular events may lead to physical dependence to opioids
Acute morphine- acutely inhibits firing of LC through Gi
Chronic treatment- LC neurons return to normal firing rates (Gs upregulated to match Gi)
Withdrawal- increase in LC firing (LC is hypersensitive)
Side effects of typical antipsychotics and the mechanism by which they are manifested
EPS
- Akathisia
- Parkinsonian like symptoms including bradykinesia , resting tremor
- Due to suppression of dopamine activity in Caudate, putamen
Tardive dyskinesoa
- due to dopamine receptor upregulation- supersensitivity
- Other effects include drowsiness, restlessness, dry mouth, or blurring of vision
Why does correctly diagnosing the epilepsy syndrome affect patient management
- influences antiepileptic drug choices
- influences who needs brain imaging
- influences who needs an EEG
- influences the safety of the patient (if they have seizures with no warning)
What factors influence antiepileptic drug choices in women
Teratogenicity
drug-drug interactions with COCP
and
Side effects of weight gain/menstrual irregularity
