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Neurology COPY COPY COPY COPY > Adult Seizure disorders > Flashcards

Adult Seizure disorders Flashcards

1
Q

Seizure?

A

Episode of abnormally synchronized and high frequency firing of neurons resulting in abnormal behavior or experience

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2
Q

Epilepsy?

A

Chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures

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3
Q

Causes of adult onset epileptic seizures?

A 
Cerebrovascular disease
Trauma
Tumors
Infections
Cerebral degeneration
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4
Q

Types of partial seizures?

A

Simple
Complex
Secondarily generalized

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5
Q

Is consciousness preserved in simple partial seizures?

A

Yes

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6
Q

Is consciousness preserved in complex partial seizures?

A

No

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7
Q

Characteristics of secondarily generalized?

A

Consciousness lost

Bilateral cerebral involvement

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8
Q

Characteristics of simple partial seizures?

A

Consciousness is intact
EEG may appear normal
Auras are brief

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9
Q

Signs/symptoms of simple partial seizures depend on?

A

Focus

  • Motor (Jacksonian)
  • Somatosensory
  • Autonomic
  • Psychic
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10
Q

What is a Jacksonian march?

A

A focal seizure that starts distally and marches proximally on the same side
Seen in simple partial seizures emanating from motor cortex

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11
Q

How do somatosensory partial seizures present?

A

Focus on the sensory cortex

Tingling and numbness of an extremity or side of face

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12
Q

Autonomic partial simple seizures present?

A

Rising epigastric sensations, nausea

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13
Q

Psychic partial simple seizures present?

A

Sensations of fear
Deja vu
Jamais vu

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14
Q

Characteristics of complex partial seizures?

A 
Impaied consciousness
Lasts about 1 minute
Blank stare
Oral/Ipsilateral hand automatisms 
Contralateral dystonic posturing
Amnesia for ictal event
Focal abnormality on routine EEG
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15
Q

Where do complex partial seizures typically emanate from?

A

Temporal or frontal lobes

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16
Q

What are typical hand automatisms?

A

Hand rubbing and picking movements

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17
Q

What are oral automatisms?

A

Chewing and lip smacking movements

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18
Q

What does contralateral dystonic posturing result from?

A

Spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia

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19
Q

Types of Primary generalized seizures?

A 
Absence (Petit Mal)
Tonic-clonic
Clonic
Tonic
Myoclonic
Atonic
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20
Q

Pathogenesis of primary generalized seizures?

A

Arise from deep structures within the brain and spread synchroniously toward cerebral hemispheres

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21
Q

Characteristics of Absence Seizure?

A

Brief (10-20 secs) loss of consciousness
Staring spell
NO post-ictal confusion
Subtle myoclonic movement, eyelid flutter
NO baseline neurologic defictis
Baseline EEG may show generalized 3 Hz spike - wave discharge

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22
Q

What is pathognomonic for absence seizures?

A

Baseline EEG may show generalized 3 Hz spike - wave discharges

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23
Q

Most recognized seizure?

A

Tonic-Clonic

24
Q

Presentation of Tonic-clonic seizure?

A 
Cry
Loss of consciousness
Muscular rigidity (tonic)
Patient may fall
Rhythmic jerking (clonic)
Tongue-biting/injury common
Bladder/bowel incontinence
Post-Ictal confusion/sleep
25
Presentation myoclonic seizures?
``` Brief, shock-like muscle contractions -Head -Upper extremities Usually bilaterally symmetrical Consciousness preserved Precipitated by awakening or falling asleep May progress into tonic-clonic seizures Have trouble shaving/drinking coffee in the morning ```
26
Presentation of Atonic Seizures?
``` Impaired consciousness Loss of muscle tone Head drop Fall (if standing and injury is common) Brief duration (few seconds) Injury common ```
27
Ligand-gated ion channels are either excitatory or inhibitory depending on?
Ion selectivity
28
What does GABA activate? That do?
GABAa Receptors that mediate fast synaptic inhibition (IPSP) by permitting rapid influx of Cl ions --> hyperpolarization
29
What does glutamate activate? That do?
3 classes of ion channels (AMPA, Kainate, NMDA) that mediate fast synaptic excitation by permitting a rapid influx of Na and Ca
30
When does a seizure occur?
When excitation significantly exceeds inhibition
31
MoA of phenobarbital?
Enhances activity of GABA receptor Depresses glutamate activity Reduces Na/K conductance
32
MoA of phenytoin?
Blockage of Na Channels and inhibitory action on Ca and Cl conductance
33
MoA of carbamazepine?
Blockage of neuronal Na channel conductance
34
MoA of Valproate?
affects GABA glutamatergic activity and reduce threshold of Ca and K conductance
35
MoA of Ethosuximide?
Inhibits Ca T-channel conductance
36
MoA of Lamotrigine?
Blockage of voltage-dependent Na conductance
37
MoA of oxcarbazepine?
Na Channel blockage
38
MoA of Topiramate?
Blockage of Na channels | Enhancement of GABA medicated chloride influx
39
MoA of Zonisamide?
Blockage of Na, K, and Ca channels | Inhibits glutamate excitation
40
MoA of Gabapentin?
Modulation of N-Type Ca channel
41
What are effective for partial and tonic-clonic seizures?
Valproate, phenytoin, carbamazepine, and phenobarbital
42
What are effective for absence seizures?
Ethosuximide | Valproate
43
What are effective only for partial seizures?
Gabapentin | Oxcarbazepine
44
What are effective for both partial and generalized seizures?
Lamotrigine Topiramate Levetiracetam Zonisamide
45
SEs of carbamazepine?
Aplastic anemia Hepatotoxicity Stevens Johnson syndrome Lupus-like syndrome
46
SEs of ethosuximade?
Bone marrow depression | Hepatotoxicity
47
SEs of Lamotrigine?
SJS | Toxic epidermal necrolysis
48
SEs of Phenytoin?
Aplastic anemia Hepatic failure SJS Lupus
49
SEs of Oxcarbazepine?
Hyponatremia | Rash
50
SEs of Topiratmate?
Renal Calculi | Hypohidrosis
51
SEs of Zonisamide?
Renal calculi | Hypohidrosis
52
SEs of Phenobarbital?
Hepatotoxicity Connective tissue disorder SJS
53
SEs of Valproate?
``` Hepatotoxicity Hyperammonemia Leukopenia Thromocytopenia Pancreatitis ```
54
Hepatic cytochrome P450 inducers?
``` Caramazepine Phenobarbital Phenytoin Oxcarbazepine Topiramate ```
55
Older AEDs are which category of drugs? Newer AEDS?
D | C
56
Disabling seizures?
Causing impaird quality of life, limited educational or occupational opportunities, physical injuries, or social compromise
57
Generalized convulsive status epilepticus?
Continuous, generalized convulsive seizure lasting more than 5 minutes or two or more sequential seizures occurring without full recovery of consciousness

Neurology COPY COPY COPY COPY (25 decks)

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