5: Seizure Disorders Flashcards
Recurrent, uncontrolled cerebral excitation
seizure
How are seizures initated?
neurons
Where are seizure activities?
adjecent areas of brain; can stay local or spread
cause of seizure disorders
often unknown in younger people; in adults it’s often secondary to a specific even (CVA, tumor, trauma, etc)
classify seizures according to…
1) extent of cerebral involvement
2) EEG activity
3) symptoms
4) etc.
subdivisions of seizures
1) focal (partial) seizures
2) generalized seizures
focal seizures
simple, complex
generalized seizures
absence; tonic-clonic; others
can focal become generalized?
yes
which primary subdivision affects both cerebral hemispheres?
generalized
most common seiures
1) complex partial
2) generalized tonic clonic
goal of antiseizure medications
SELECTIVE effect on hyperexcitable neurons
primary antiseizure agents- “front line”
1) phynytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Ethosuximide (Zarontin)
4) Valproates (Depakene, Divalproex, others)
other primary antisizure agents
benzos, barbiturates
most common antizeizure agent worldwide
barbitol
“second generation” antiseizure drugs
1) Gabapentin (Neurontin)
2) Lamotrigine (Lamictal)
3) Levetiracetam (Keppra)
4) pregabalin (lyrica)
5) Tiagabine(Gabitril)
6) Topiramate (Topamax)
“second generation” antiseizure drugs: are they more effective than traditional agents?
not necessarily but they tend to have milder side effects; more predictable profile
“second generation” antiseizure drug benefits: all more ( ) to tx seizures
drug combos
“second generation” antiseizure drug benefits: used to tx what?
neuropathic pain (esp. Neurontin)
primary antiseizure mechanisms: Dilantin, Tegretol, and Depakene decrease what entry into rapidly firing neurons?
Na+
primary antiseizure mechanisms: Zarontin decreases what entry into thalamic neurons?
Ca++
primary antiseizure mechanisms: barbs, BZDS, several newer drugs increase what inhibition?
GABA
primary antiseizure mechanisms: several newer drugs decrease the release or effects of what?
excitatory amino acids
antiseizure med side effects: relatively minor
1) sedation
2) headache
3) dizziness
4) incoordination
5) GI problems
antiseizure med side effects: more serious
1) liver toxicity
2) blood dyscrasias (aplastic anemia, agranulocytosis)
3) increased risk of birth defects
( ) % can remain seizure-free after meds are withdrawn
60-70%
success in no meds are associated with: bein free of seizure for at least ( ) while on meds
2 years
success in no meds are associated with: having good seizure control withing ( ) after seizures being
1 year
success in no meds are associated with: having a normal ( ) prior to withdrawal
neurologic exam
success in no meds are associated with: having intial seizure onset in ( )
childhood
PTs should document ( ). what does this help? what population is this especially true in?
seizure activity; helps assess efficacy of meds; children
