B7-053 CBCL Seizures Flashcards
1
Q
involuntary synchronous stiffening of the limbs
A
tonic convulsion
2
Q
involuntary synchronous semi-rhythmic movements of the limbs
A
clonic convulsion
3
Q
[…] is often associated with a brief convulsion
A
syncope
4
Q
syncope due to convulsion is usually caused by
A
transient hypotension
5
Q
[seizure or convulsive syncope]
prolonged standing
A
convulsive syncope
6
Q
[seizure or convulsive syncope]
valsalva
A
convulsive syncope
(straining for bowel movement/urination)
7
Q
[seizure or convulsive syncope]
in response to pain, blood
A
convulsive syncope
8
Q
[seizure or convulsive syncope]
tunnel vision, distant hearing
A
convulsive syncope
9
Q
[seizure or convulsive syncope]
focal onset
A
seizure
10
Q
[seizure or convulsive syncope]
tongue biting on side
A
seizure
11
Q
[seizure or convulsive syncope]
prolonged unconsciousness
A
seizure
12
Q
[seizure or convulsive syncope]
postictal confusion
A
seizure
13
Q
[seizure or convulsive syncope]
incontinence
A
seizure
14
Q
types of focal onset seizures [3]
A
focal onset with retained awareness
focal onset with impaired awareness
focal onset to bilateral tonic-clonic
15
Q
broad classifications of seizures based on manifestations [3]
A
simple motor seizure
complex movement or behavior seizure
auras
16
Q
types of generalized onset seizures [2]
A
motor: tonic-clonic (grand mal), myoclonic
nonmotor: absences (petite mal)
17
Q
[…] seizures do not have auras
A
generalized
(focal might, but generalized does not)
18
Q
types of unknown onset seizures [3]
A
motor
nonmotor
unclassified
19
Q
intrinsic tendency of the brain to have seizures
A
epilepsy
20
Q
[…] or more unprovoked seizures constitutes a diagnosis of epilepsy
A
two
21
Q
seizures typically onset […] after ischemic stroke
A
1 year
22
Q
about 20% of patients will develop […] following ischemic stroke
A
epilepsy
23
Q
focal onset seizures
localized EEG abnormalities
usually acquired
A
focal epilepsies
24
Q
if they find the scar causing focal epilepsy it is called
A
non-cryptogenic
(if they don’t find it, it is called cryptogenic)
25
the typical cause of focal epilepsies in middle age patients is
tumor
26
the typical cause of focal epilepsies in elderly patients is
old stroke
27
temporal lobe focal epilepsy that starts in the hippocampus is called
mesial temporal sclerosis
28
frontal lobe focal epilepsy that starts in the motor cortex is called
supplementary motor
29
types of focal epilepsies [4]
temporal lobe
frontal lobe
parietal lobe
occipital lobe
(temporal and frontal are more common)
30
common visible causes of focal epilepsies [3]
post traumatic scarring
tumor
old stroke
31
generalized onset seizures
bilateral symmetric EEG abnormalities
often genetic
generalized epilepsy
32
genetic generalized epilepsies [3]
childhood absence
juvenile absence
juvenile myoclonic epilepsy
33
causes of generalized epilepsy due to severe brain damage at a young age [2]
infantile spasms
Lennox-Gaustaut syndrome
34
treatments for patients refractive to epileptic drugs [2]
epilepsy surgery
electrical stimulation of nervous system
35
drugs that only prevent either focal onset or generalized onset seizures are called
narrow spectrum
36
drugs that only prevent both focal onset and generalized onset seizures are called
broad spectrum
37
only narrow spectrum drug for generalized epilepsy
ethosuximide
(other narrow spectrums are for focal)
38
modifies synaptic release of GABA by binding to SV2A
levtriracetam
39
inhibit T-type Ca+ channels [2]
ethosuximide
valproic acid
40
drugs that tend to be efficacious for absence seizures [2]
ethosuximide
valproic acid
(inhibit T-type Ca+ channels)
41
decrease excitatory neurotransmission by binding to voltage gate Ca++ channels [1]
gabapentin
42
what type of seizure is associated with abnormal T-type calcium channel activity?
absence
43
increases the affinity of GABA receptors for GABA, which increases the likelihood of channel opening
benzos
44
DOC for status epilepticus
benzos
45
effective for 2-3 weeks due to tolerance to anticonvulsant effects
limited to short term treatment
benzos
46
bind to binding site on GABA to increase channel open time
barbituates
47
DOC of tonic-clonic seizures [2]
barbiturates
valproic acid
48
abrupt withdrawal can precipitate status epilepticus
phenobarbital
49
prolongs inactivation of Na+ channels and decreases glutamate release
phenytoin
50
DOC for tonic-clonic and partial seizures
less sedating than barbiturates
phenytoin
51
why should you initially order phenytoin at low doses?
zero order kinetics
(small dose increases cause large changes in toxicity and concentration)
52
why is phenytoin debatable as a first line choice? [2]
extensive side effect profile
zero order kinetics
53
increases inactivation of Na+ channels and decreases release of glutamate
carbamazepine
54
DOC for partial seizures
relatively safe and non-toxic
carbamazepine
55
binds to synaptic vesicular protein SV2A
levetiracetam
56
effective in refractory partial seizures when used in combination with other drugs
gabapentin
57
DOC for absence seizures [2]
ethosuximide
valproic acid
58
which drug should be used in a epilepsy patient with bipolar disorder?
lamotrigine
59
which drug should be used in a epilepsy patient with recurrent migrains?
topiramate
60
common side effects of phenytoin [2]
gait ataxia
nystagmus
61
common side effects of carbamazepine/oxcarbazepine [2]
double vision
hyponatremia
62
common side effects of lamotrigine [2]
rash
SJS
63
common side effects of levetiracetam [1]
irritability
64
common side effects of valproic acid [2]
teratogen
tremor
65
breakthrough seizures are commonly caused by [3]
non-adherence
intercurrent infection
drug interaction
66
liver enzyme inducers [3]
phenytoin
phenobarbital
carbamazepine
(increase oral contraceptive metabolism)
67
liver enzyme inhibitor
valproic acid
68
medications that lower the seizure threshold
tramadol
buproprion
penicillin, cephalosporins, metronidazole
cyclosporin/tacrilimus
stimulants
69
when should surgical treatment of epilepsy be considered?
patients who have failed greater than three seizure medications
70
what type of seizures are an indication for surgical treatment of epilepsy?
focal
(resection of epileptogenic zone)
71
most common causes of seizure due to electrolyte imbalance [2]
hyponatremia
hypokalemia
72
when can a patient drive following seizure in Kansas?
must be seizure free for at least 6 months
73
aura represents the [...] of seizure
onset
74
valproic acid is a [...] spectrum antiepileptic drug
broad
75
ethosuximide is a [...] spectrum antiepileptic drug
narrow
76
one of the first side effects of phenytoin toxicity
nystagmus
77
a small change in [...] dosage can have large effects on serum drug levels
phenytoin
(zero order kinetics)
78
cerebral edema is associated with what electrolyte imbalance?
hyponatremia
79
common cause of seizure in diabetic patients
hypoglycemia
80
first line treatment of acute seizures
benzos
81
benzodiazepines target [...] receptors
GABA
82
next best step for a patient with intractable epilepsy who has failed several medications
epilepsy surgery evaluation
83
appropriate dose of benzodiazepines for status epilepticus
4 mg
84
[...] and [...] form the core workup of patients with suspected epilepsy
EEG
MRI brain
85
seizures with a predominant laughing semiology
gelastic seizures
(caused by hypothalamic hamartoma in kids)
86
considered the most efficacious medication for generalized epilepsy
valproic acid
87
which medication should be used with caution in women of child bearing age due to the risk of teratogenicity?
valproic acid
88
SJS is a side effect of
lamotrigine
89
carbamazepine is a [...] spectrum antiseizure medication
narrow
90
childhood [...] epilepsy can be mistaken for ADHD
absence
91
a clinical test of [...] can support a diagnosis of childhood absence epilepsy
hyperventilation
92
new onset seizures later in adulthood should raise suspicion for
brain tumor
93
test that can be used to confirm a diagnosis of epilepsy, but doesn't tell you etiology
EEG
94
imaging modality more sensitive for brain tumors
MRI brain
95
subacute onset of confusion with clinically observable seizures in the temporal lobe
herpes encephalitis
(order LP to confirm, treat empirically with antibiotics)
96
lamotrigine is a [...] spectrum antiseizure medication
broad
97
decreases glutamate release via SV2A
levetiracetam
98
most common cause of breakthrough seizures
medication non-adherence
99
has dual use in migraine control
topiramate
100
has dual use in the treatment of bipolar disorder
lamotrigine
101
common side effect of levetiracetam
agitiation
102
hyponatremia can be a side effect of what antiseizure medication?
carbamazepin/oxcarbazepine
103
focal seizures most commonly originate in the [...] lobe
medial temporal
104
continuous (>5 min) or recurring seizures without interictal return to baseline consciousness that may result in brain injury
status epilepticus
105
most common causes of seizures in children <18
genetic
infection (febrile)
trauma
congenital
metabolic
106
most common causes of seizures 18-65
tumor
trauma
stroke
infection
107
most common causes of seizures >65
stroke
tumor
trauma
metabolic
infection
108
disorder of recurrent, unprovoked seizures
epilepsy
109
3 Hz spike and wave discharges
absence seizures
110
short and frequent episodes of blank stare, no postictal confusion
absence seizures
111
can be triggered by hyperventilation
absence seizures
112
quick, repetitive jerks
no loss of consciousness
myoclonic
113
alternating stiffening and movement
postictal confusion
urinary incontinence
tongue biting
tonic-clonic
114
carbamazepine is a [...] spectrum seizure medication for [...] seizures
narrow
focal
115
gabapentin is a [...] spectrum seizure medication for [...] seizures
narrow
focal
116
penytoin is a [...] spectrum seizure medication for [...] seizures
narrow
focal
117
ethosuximide is a [...] spectrum seizure medication for [...] seizures
narrow
absence
(only narrow spectrum for generalized seizures)
118
valproate is a [...] spectrum seizure medication
broad
119
lamotrigine is a [...] spectrum seizure medication
broad
120
levetiracetam is a [...] spectrum seizure medication
broad
121
topiramate is a [...] spectrum seizure medication
broad
