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Neurology

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9 out of 18
 

A 15 year old boy with epilepsy on treatment with combination of valproate and phenytoin has good control of seizures. Levels of both drugs are in the therapeutic range. All of the following adverse effects can be attributed to valproate except: (AIPG 2010)



A Weight gain of 5 kg

B Serum alanine aminotransaminase 150 IU/L

C Rise in serum ammonia level by 20g/dL

D Lymphadenopathy

Ans. D

Lymphadenopathy

Table: Selection of Antiepileptic Drugs ( Ref. Hari-18th ed., Table 369.8 Pg- 3262)

Generalized-onset Tonic-Clonic

Focal

Typical Absence

Atypical Absence, Myoclonic, Atonic

First-Line

Valproic acid

Lamotrigine

Topiramate

Lamotrigine Carbamazepine

Oxcarbazepine Phenytoin

Levetiracetam

Valproic acid

(AIIMS May 08)

Ethosuximide

Valproic acid

Lamotrigine

Topiramate

Alternatives

Zonisamide

Phenytoin

Carbamazepine

Oxcarbazepine

Phenobarbital

Primidone

Felbamate

Topiramate, Zonisamide

Valproic acid, Tiagabine

Gabapentin, Lacosamide

Phenobarbital, Primidone

Felbamate

Lamotrigine

Clonazepam

Clonazepam

Felbamate

Extra Edge: Valproate is the drug which is effective in most types of epilepsy. (LQ 2012)

Recent Advances: Newer Drugs in neurology (Ref. Hari-18th ed., also !!!)

1). Stiripentol

a. Stiripentol is used in the treatment of epilepsy.

b. Mechanism of action It increases GABA transmission.

2). Retigabine

a. It is an anticonvulsant used as a treatment for partial epilepsies.

b. It is a potassium channel opener—that is, by activating a certain family of voltage-gated potassium channels in the brain.

c. This mechanism of action is unique among antiepileptic drugs.

3). Ramelteon

It is the first in a new class of sleep agents that selectively binds to the MT1 and MT2 receptorsin the suprachiasmatic nucleus (SCN), instead of binding to GABA A receptors, such as with drugs like zolpidem, eszopiclone, and zaleplon.

4). Agomelatine

a. It is used for the treatment of major depressive disorder and has a reduced level of sexual side effects.

b. It also has positive effects on sleep.

5). Perampanel is an antiepileptic drug that acts as a selective noncompetitive antagonist of AMPA receptors, the major subtype of ionotropic glutamate receptors. It is effective in the treatment of refractory partial-onset seizures

6). Retigabine, is an anticonvulsant used as an adjunctive treatment for partial epilepsies. It is a potassium channel opener.

7). Rufinamide is an anticonvulsant medication. It is used in combination with other medication and therapy to treat Lennox–Gastaut syndrome and various other seizure disorders.

8). Progabide is an analog and prodrug of GABA used in the treatment of epilepsy. Specifically, generalized tonic-clonic, myoclonic, partial, and Lennox-Gastaut syndrome seizures—in both children and adults. This is a new drug not given in Harrison 18th edition also !!!

Surgical Treatment of Epilepsy – Procedures done are –

1). Temporal lobectomy – In temporal lobe epilepsy

2). Lesionectomy –

3). Multiple subpial transection

4). Hemispherectomy – In pt. of hemi egalencephaly

5). Corpus callosotomy – In Lennox – Gastaut syndrome.


Anti-Epileptic Drugs

Drug

Side effects

1). Phenytoin

Dizziness, diplopia, cerebellar ataxia, Gum hyperplasia, Lymphadenopathy

Hirsutism, osteomalacia.

2). Carbamazepine

Ataxia, vertigo, Dizziness, Aplastic anemia

Leukopenia, Hepatotoxicity, Hyponatremia

3). Valproic acid

Ataxia, tremor, Sedation, Hepatotoxicity, weight gain

Thrombocytopenia, Transient alopecia

4). Lamotrigine

Skin rash, Stevens. Johnson syndrome, Dizziness, diplopia

Sedation, Ataxia, Headache

5). Ethosuximide

Ataxia, Lethargy, Bone marrow suppression, Skin rash

6). Topiramate

Psychomotor slowing, Language disorder, Renal stones.

7). Phenobarbital

Sedation, ataxia, Confusion, dizziness

Decreased libido, Depression , Skin rash

Extra Edge:

1). Carbamazepine reduces phenobarbitone level. Carbamazepine and Phenobarbitone are strong inducer of each other’s metabolism by inducing CYP3A4).

2). Lymphadenopathy 'Pseudolymphoma' is a complication associated with use of phenytoin

Neurology Flashcard List

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