42a - Adult Seizures Flashcards
Are all seizures epileptic?
no. A seizure is just an episode of abnormal high frequency firing neurons. They could be provoked.
Epsilepsy is a chronic brain disorder characterized by recurrent, unprovoked seizures.
Why is there an increase in seizures after age 60?
increase rate of strokes.
In what age groups is epilepsy most commom?
peaks in children and elderly
What are common causes of adult-onset epileptic seizures?
cerebrovascular disease, trauma, infections, cerebral degeneration
What is a primarily generalized seizure accoriding to ILAE?
no focal onset, with spread to both hemispheres at same time. Thought to come from brainstem
What is difference between an simple and complex seizure?
simple = consciousness preserved complex = consciousness impaired
what is a secondarily generalized seizure?
consciousness lost + bilateral cerebral involvement
What is a simple partial seizure?
consciousness intact. Focal motor, sensory, autonomic or psychic signs.
EEG may appear normal.
May show jacksonian march
What is jacksonian march?
focal seizure that starts in hand and marches up arm to face.
What is a complex partial seizure?
impaired consciousness. Lasts 1 min about
blank stare.
focal abnormality on EEEG.
Emanate from temporal or frontal lobes
oral automatisms like chewing / lip smacking.
What is a Petit mal seizure?
primary genralized seizure with absence.
Absence = brief loss of consciousness, staring spell, NO post-ictal confusion.
Baseline EG = 3Hz spikes
What is a tonic clonic seizure?
cry, loss of consciouss muscular rigidity (tonic) falling rhythmic jerking (clonic) tongue biting bladder incontinennce post-ictal confusion
What is a myoclonic seizure?
breif, shock-like muscle contractions
usually bilateral
consciousness preserved
can progress to tonic-clonic
What are atonic seizures?
impaired consciousness loss of muscle tone head drop fall (injury common) brief duration (seconds)
What is thought to be pathophys of seizures?
ligand-gated ion channels can be excitatory or inhibitory.
Loss of GABA:
GABA activates GabaA receptors that mediate fast synaptic inhibition (IPSP) by permitting rapid influx of Cl ions, hyperpolarizing cells.
Overactivity of Glutamate:
Glutamate activates AMPA, Kainate, NMDA that mediate fast synaptic excitation by allowing rapid influx of Na and Ca
What is drug of choice for JME? (juvenile)
Depakote
What is MOA of phenobarbitol?
enhance GABA receptor activity, depress glutamate activity, reduce Na and K conductance.
What is MOA of phenytoin?
block Na channels and inhbitory action on Ca and Cl conductance
MOA f carbamazepine?
block of neurona Na channels
MOA of valproate?
GABA glutamatergic activity and reduce thresholds of Ca and K conductance
MOA of thosuximide?
block Ca T channels
MOA of lamotrigine?
block voltage depend Na channels
MOA of oxcarbazepine?
Na block
MOA of topiramate?
block Na channel
Enhance GABA mediated Cl influx
MOA of zonisamide?
block of Na, K and Ca channel
Inhibit glutamate
MOA of gabapentin?
modulate N-type Ca channels
What drugs are effective for absence seizures (petit mal)?
ethosuximide and valproate
What drugs are effective for partial seizures?
gabapentin and oxcarbazepine
What drugs are for partial AND generalized seizures?
lamotrigine, topiramate, levetiracetam and zonisamide
ADE of carbamazepine?
aplastic anemia, SJS, hepatotoxic, lupus-like syndrome
ADE of ethosuximide?
bone marrow depression, hepatotox
ADE of lamotrigine?
SJS or toxic epidermal necrolysis
ADE of phenytoin?
aplastic anemia, hepatic failure, SJS, lupus
ADE of oxcarbazepine?
hyponatremia, rash
ADE of topiramate?
renal calculi, hypohidrosis
ADE of zonisamide?
renal calculi, hypohidrosis
ADE of phenobarbitol?
hepatotoxicity, connective tissue disorders, SJS
ADE of valproate?
hepatotoxicity, hyperammonemia, leukkopenia, thrombocytopenia, pancreatitis
** dont give in 1st trimester pregnancy
Which anti-epileptics are CypP450 inducers?
CPPOT
carbamazepine, phenobarbital, phenytoin, oxcarbazepine, topiramate
What can P450 induces cause?
failure of OCPs, osteopenia, osteoporesis, fractures, increase androgen and estrogens.
What is incidence of medical remission in newly diagnosed patients with 2 AEDs used?
4%.
96% are seizure free for 2 or more years
What is gneralized convulsive status epilepticus?
continous, generalized, convulsive seizure lasting more than 5 minutes or two or more sequential seizures occuring without full recovery of consciousness.
Non-convulsive status epilepticus is EEG diagnosis
