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Neuro weeks4-6 - Keith > 42a - Adult Seizures > Flashcards

42a - Adult Seizures Flashcards

1
Q

Are all seizures epileptic?

A

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.

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2
Q

Why is there an increase in seizures after age 60?

A

increase rate of strokes.

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3
Q

In what age groups is epilepsy most commom?

A

peaks in children and elderly

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4
Q

What are common causes of adult-onset epileptic seizures?

A

cerebrovascular disease, trauma, infections, cerebral degeneration

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5
Q

What is a primarily generalized seizure accoriding to ILAE?

A

no focal onset, with spread to both hemispheres at same time. Thought to come from brainstem

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6
Q

What is difference between an simple and complex seizure?

A 
simple = consciousness preserved
complex = consciousness impaired
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7
Q

what is a secondarily generalized seizure?

A

consciousness lost + bilateral cerebral involvement

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8
Q

What is a simple partial seizure?

A

consciousness intact. Focal motor, sensory, autonomic or psychic signs.
EEG may appear normal.
May show jacksonian march

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9
Q

What is jacksonian march?

A

focal seizure that starts in hand and marches up arm to face.

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10
Q

What is a complex partial seizure?

A

impaired consciousness. Lasts 1 min about
blank stare.
focal abnormality on EEEG.
Emanate from temporal or frontal lobes
oral automatisms like chewing / lip smacking.

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11
Q

What is a Petit mal seizure?

A

primary genralized seizure with absence.
Absence = brief loss of consciousness, staring spell, NO post-ictal confusion.
Baseline EG = 3Hz spikes

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12
Q

What is a tonic clonic seizure?

A 
cry, loss of consciouss
muscular rigidity (tonic)
falling
rhythmic jerking (clonic)
tongue biting
bladder incontinennce
post-ictal confusion
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13
Q

What is a myoclonic seizure?

A

breif, shock-like muscle contractions
usually bilateral
consciousness preserved
can progress to tonic-clonic

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14
Q

What are atonic seizures?

A 
impaired consciousness
loss of muscle tone
head drop
fall (injury common)
brief duration (seconds)
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15
Q

What is thought to be pathophys of seizures?

A

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

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16
Q

What is drug of choice for JME? (juvenile)

A

Depakote

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17
Q

What is MOA of phenobarbitol?

A

enhance GABA receptor activity, depress glutamate activity, reduce Na and K conductance.

18
Q

What is MOA of phenytoin?

A

block Na channels and inhbitory action on Ca and Cl conductance

19
Q

MOA f carbamazepine?

A

block of neurona Na channels

20
Q

MOA of valproate?

A

GABA glutamatergic activity and reduce thresholds of Ca and K conductance

21
Q

MOA of thosuximide?

A

block Ca T channels

22
Q

MOA of lamotrigine?

A

block voltage depend Na channels

23
Q

MOA of oxcarbazepine?

A

Na block

24
Q

MOA of topiramate?

A

block Na channel

Enhance GABA mediated Cl influx

25
Q

MOA of zonisamide?

A

block of Na, K and Ca channel

Inhibit glutamate

26
Q

MOA of gabapentin?

A

modulate N-type Ca channels

27
Q

What drugs are effective for absence seizures (petit mal)?

A

ethosuximide and valproate

28
Q

What drugs are effective for partial seizures?

A

gabapentin and oxcarbazepine

29
Q

What drugs are for partial AND generalized seizures?

A

lamotrigine, topiramate, levetiracetam and zonisamide

30
Q

ADE of carbamazepine?

A

aplastic anemia, SJS, hepatotoxic, lupus-like syndrome

31
Q

ADE of ethosuximide?

A

bone marrow depression, hepatotox

32
Q

ADE of lamotrigine?

A

SJS or toxic epidermal necrolysis

33
Q

ADE of phenytoin?

A

aplastic anemia, hepatic failure, SJS, lupus

34
Q

ADE of oxcarbazepine?

A

hyponatremia, rash

35
Q

ADE of topiramate?

A

renal calculi, hypohidrosis

36
Q

ADE of zonisamide?

A

renal calculi, hypohidrosis

37
Q

ADE of phenobarbitol?

A

hepatotoxicity, connective tissue disorders, SJS

38
Q

ADE of valproate?

A

hepatotoxicity, hyperammonemia, leukkopenia, thrombocytopenia, pancreatitis
** dont give in 1st trimester pregnancy

39
Q

Which anti-epileptics are CypP450 inducers?

A

CPPOT

carbamazepine, phenobarbital, phenytoin, oxcarbazepine, topiramate

40
Q

What can P450 induces cause?

A

failure of OCPs, osteopenia, osteoporesis, fractures, increase androgen and estrogens.

41
Q

What is incidence of medical remission in newly diagnosed patients with 2 AEDs used?

A

4%.

96% are seizure free for 2 or more years

42
Q

What is gneralized convulsive status epilepticus?

A

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

Neuro weeks4-6 - Keith (37 decks)

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