Welcome to our new feature: NEUROLOGY FLASHCARDS! Understanding is paramount, but unfortunately, one aspect of academic success does rely on simple memorization and repetition. In our new Neurology flashcards feature, we have taken the most commonly seen rote memory topics and “buzzwords” from neurology board and RITE* exams and made easy to use flashcards. These work on desktop, tablet, and mobile devices. This is a new feature, so please contact us if you see any issues! FLASHCARDS will be available for all chapters soon!

Side Effect: Kidney Stones
Topiramate
Also can cause: weight loss, cognitive slowing, paresthesia, and dizziness. Can cause cleft palate in newborn of parent taking this. Zonisamide can also cause nephrolithiasis.
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P450 Inducer AEDs
(anti-epileptic drugs)
Phenobarbital (CYP2A6 & CYP2B6), phenytoin (CYP1A1 & CYP2B6), carbamazepine (CYP2B6), topiramate (CYP3), oxcarbazepine (CYP3).
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3 Hz Spike and Wave
Absence Seizure
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4- to 6-Hz Polyspike/Spike and Wave
Juvenile Myoclonic Epilepsy (JME)
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Side Effect: Stevens-Johnson Syndrome
Lamotrigine
Must titrate up this medication very slowly to try to avoid this.

Also, the HLA-B*1502 allele (Asian patients) increases SJS risk with carbamazepine.
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Hypsarrhythmia on EEG
Infantile Spasms/ West Syndrome
High amplitude, irregular waves and spikes in a background of chaotic disorganized activity.
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Frequency of alpha, beta, delta, theta

Beta: >13 Hz
Alpha: 8-13 Hz
Theta: 4-7 Hz
Delta: <4 Hz

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Epilepsy with Vomiting and Autonomic Features
Panayiotopoulos syndrome
Child (2-8 years) with vomiting, migraine features, autonomic symptoms, and acute loss of tone (ictal syncope) due to focal occipital lobe seizures. Most cases resolve. Some evolve to BECTS.
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Localization: Déjà vu or Automatisms
Temporal Lobe
The most common focal epilepsy. Can present with an aura of unusual smell, taste, automatisms (lip smacking, hand rubbing), or déjà vu.
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Tonic Spasms, Burst Suppression EEG
In child < 3 months of age
Ohtahara syndrome
A.K.A. Early infantile epileptic encephalopathy (EIEE)
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TRIAD: Agenesis of the Corpus Callosum, Chorioretinal Lacunae, Infantile Spasms
Aicardi Syndrome
X-linked dominant. Usually presents in first 3 months of life.
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Infantile Spasms (axial flexion), developmental delay, hypsarrhythmia
What is the diagnosis and treatment?
West Syndrome
Can be secondary to other diseases, like Tuberous sclerosis (TSC).

TREATMENT: ACTH, glucocorticoids. Add vigabatrin if seen with TSC.
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Generalized Slow (1.5 Hz to 2.5 Hz) Spike-and-wave
Lennox-Gastaut Syndrome
Generalized paroxysmal fast activity (GPFA) can also be seen.
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Hemifacial Twitching, Excessive Salivation, Inability to Speak
Age 7-13 years.
Rolandic Seizures
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Bilateral Independent Centrotemporal Spikes during Light Sleep
Benign rolandic epilepsy (BRE)/ Benign epilepsy with centrotemporal spikes (BECTS)
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Brief Bursts of 2-5 Hz Spike and Wave Discharges
With astatic/atonic seizures.
Doose syndrome / Myoclonic-atonic epilepsy
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Mutation commonly associated with BFNE
(Benign Familial Neonatal Epilepsy)
KCNQ2 and KCNQ3
Autosomal dominant, potassium channel defects.
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SLC2A1
GLUT-1 Deficiency
Refractory seizures in an infant with developmental delay, microcephaly, hypotonia, spasticity, ataxia, and dystonia
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Chromosome 15q14 (alpha-7 subunit of Ach receptor)
Benign Rolandic Epilepsy (BRE)
Also called Benign epilepsy with centrotemporal spikes (BECTS) or childhood epilepsy with centrotemporal spikes (CECTS). Autosomal dominant.
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SCN1A
(with convulsions)
Dravet Syndrome
A.K.A. "severe myoclonic epilepsy of infancy" (SMEI). Also seen with GEFS+, and LGS.

→ Keep going for a BONUS!

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BONUS:
Medications to Avoid?
Lamotrigine, Phenytoin, Carbamazepine
Sodium channel blockers can make symptoms worse in patients with SCN1A-mutation-related epilepsy.
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Language Regression, Auditory Agnosia
EEG with continuous spike and waves during slow sleep (CSWS).
Landau-Kleffner Syndrome
Also called acquired epileptic aphasia.
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Cystatin B Gene (CSTB)
Unverricht-Lundborg Syndrome
A.K.A. EPM1. This is the most common "progressive myoclonus epilepsy" (PME).
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Absence Seizure: Trigger and Treatment
Trigger: Hyperventilation
Also worsened by sodium channel medications (phenytoin and carbamazepine).

→ Keep Scrolling

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Contraindicated AED in POLG-related Epilepsy
Valproic Acid
Valproic acid is an absolute contraindication due to its effect on mitochondrial metabolism.
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GluRε2 (anti-NR2A) or GluR3 (AMPA receptor)
Rasmussen Encephalitis
Also called "chronic focal epilepsy" (CFE)

→ Scroll for MRI Findings
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Juvenile Myoclonic Epilepsy
Treatment of choice:
Valproic Acid
Valproic acid is the treatment of choice. Lamotrigine is a second option, or for women of childbearing age. Levetiracetam, topiramate, and zonisamide are additional options. Carbamazepine, phenytoin, gabapentin, pregabalin, tiagabine, and vigabatrin can worsen myoclonic seizures.
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Cause of Gelastic Epilepsy
("Laughing seizures")
Hypothalamic Hamartoma
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Progressive Myoclonic Epilepsy with Retinal Cherry-red Spots
Sialidosis Type 1
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AEDs: Sodium Channel Blockers
Carbamazepine
Lacosamide
Lamotrigine
Oxcarbazepine
Phenytoin
Topiramate
Valproate
Zonisamide (and calcium)
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AEDs: Calcium Channel Blockers
Ethosuximide (T-type)
Zonisamide (T-type, and Na+)
Pregabalin
Gabapentin
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Perampanel
Mechanism of action:
Black box warning:
Mechanism of action: AMPA receptor antagonist.

Black box warning: Homicidal ideation and aggression.
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Ezogabine
Mechanism of action:
Black box warning:
Mechanism of action: Enhances KCNQ potassium channels

Black box warning: Retinal abnormalities and vision loss. Requires periodic ophthalmologic examinations.
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Vigabatrin
Mechanism of action:
Black box warning:
Mechanism of action: Inhibition of GABA transaminase.

Black box warning: Permanent visual field loss. Requires periodic ophthalmologic exams.
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Levetiracetam
Mechanism of action:
Notable side effect:
Mechanism of action: SV2A synaptic vesicle modulation.
Notable side effect: Irritability and behavior issues (in patients with pre-existing psychiatric disorder).
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AED: Zero Order Kinetics
Phenytoin
Zero order at higher doses.
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AED with Autoinduction of Metabolism
Carbamazepine
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AEDs that can Cause Oral Contraceptive Failure
Phenytoin, phenobarbital, carbamazepine, and topiramate
Via strong induction of cytochrome P450.
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AEDs whose Serum Levels Decrease during Pregnancy
Lamotrigine and Oxcarbazepine
Decreased due to increased glucuronidation. Monitoring of serum levels during pregnancy is recommended.
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EPM2A
Lafora Body Disease
A.K.A. Myoclonic epilepsy of Lafora. This is the gene for Laforin protein.
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Seizures at 4-6 days of life that resolve in a couple of days
In an otherwise healthy neonate.
Benign Neonatal Seizures (Non-familial)
A.K.A. "Fifth-day fits" or “benign idiopathic neonatal convulsions, BINC.”
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Seizures at 2-3 days of life that resolve in a few months
In an otherwise healthy neonate.
Benign familial neonatal epilepsy (BFNE)
A.K.A. Benign familial neonatal seizures (BFNS) or convulsions (BFNC).
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