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Block 8 Week 5 > Bloch: Clinical Epilepsy > Flashcards

Bloch: Clinical Epilepsy Flashcards

1
Q

the clinical manifestation of an abnormal, excessive excitation and synchronization of a population of cortical neurons

A

seizure

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2
Q

recurrent seizures (two or more) which are not provoked by systemic or acute neurologic insults

A

epilepsy

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3
Q

Two main types of seizures

A

partial

generalized

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4
Q

Three types of partial seizures

A

simple partial
complex partial
secondarily generalized (starts on both sides of the brain at the same time)

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5
Q

Different types of partial seizures?

A

somatosensory or special sensory symptoms
motor signs
autonomic signs
psychic symptoms

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6
Q

Hallmark of complex partial seizures

A

impaired consciousness

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7
Q

How long do complex partial seizures last?

A

<2 minutes

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8
Q

What can happen to partial seizures?

A

they can secondarily generalized

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9
Q

How long do secondarily generalized seizures last? How is the patient following the seizure?

A

1-3 minutes; usu confused, somnolent, with or w/o transient focal deficit

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10
Q

List the types of generalized seizures

A 
absence
myoclonic
atonic
tonic
tonic-clonic
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11
Q

Brief staring spells (“petit mal”) with impairment of awareness
3-20 seconds
Sudden onset and sudden resolution
Often provoked by hyperventilation
Onset typically between 4 and 14 years of age
Often resolve by 18 years of age
Normal development and intelligence
EEG: Generalized 3 Hz spike-wave discharges

A

typical absence seizures

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12
Q

Brief staring spells with variably reduced responsiveness
5-30 seconds
Gradual (seconds) onset and resolution
Generally NOT provoked by hyperventilation
Onset typically after 6 years of age
**Often in children with global cognitive impairment
EEG: Generalized slow spike-wave complexes (

A

Atypical absence seizures

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13
Q

Brief, shock-like jerk of a muscle or group of muscles
Differentiate from benign, nonepileptic myoclonus (e.g., while falling asleep)
EEG: Generalized 4-6 Hz polyspike-wave discharges

A

myoclonic seizures

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14
Q

Symmetric, tonic muscle contraction of extremities with tonic flexion of waist and neck

Duration - 2-20 seconds.

A

tonic seizures

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15
Q

Sudden loss of postural tone
When severe often results in falls
When milder produces head nods or jaw drops.

Consciousness usually impaired

Duration - usually seconds, rarely more than 1 minute

A

atonic seizures

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16
Q 
Associated with loss of consciousness and post-ictal confusion/lethargy
Duration 30-120 seconds 
Tonic phase
Stiffening and fall
Often associated with ictal cry
Clonic Phase
Rhythmic extremity jerking
A

generalized tonic-clonic seizure

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17
Q

Why do babies and children have seizures?

A

Prenatal or birth injury
Inborn error of metabolism
Congenital malformation

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18
Q

Why do kids and adolescents have seizures?

A

Idiopathic/genetic syndrome
CNS infection (fever can cause seizure)
Trauma

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19
Q

Why do adolescents and young adults have seizures?

A

head trauma

drug intoxication and withdrawal*

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20
Q

Why do older adults have seizures?

A

stroke
brain tumors
acute metabolic disturbances*
neurodegenerative

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21
Q

6 labs/things you can do after the first seizure?

A

H&P
blood tests: look at CBC, electrolytes, glucose, Ca++, Mg++
Lumbar puncture (only if meningitis/encephalitis expected)
Blood/urine screen
EEG
CT or brain scan

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22
Q

What are some things that can precipitate a seizure?

A 
metabolic/electrolyte imbalance
stimulants or proconvulsant intoxications
sedative or EtOH withdrawal
sleep deprivation
hormones (estrogen)
stress
fever/infection
closed head injuries
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23
Q

Which metabolic disturbances can lead to seizures?

A

low blood glucose
low Na+
low Ca++
low Mg++

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24
Q

What drugs can cause seizures?

A 
IV drugs
cocaine
ephedrine
medication reductions
antidepressants
neuroleptics
etc etc
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25
Q

Relapse rate of seizure after first seizure depends on the following four factors:

A

abnormal imaging
abnormal neuro exam
abnormal EEG
family history

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26
Q

What percentage of unprovoked seizures will recurr w/i 5 years?

A

16-62%

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27
Q

What things should you consider when choosing an antiepileptic drug?

A 
seizure type
epilepsy syndrome
efficacy
cost
adverse effects
pt's medical conditions
28
Q

What does choice of anti-epileptic drug for partial epilepsy depend on?

A

the drug side-effects and the pt’s preference/concerns

29
Q

What does choice of anti-epileptic drug for generalized epilepsy depend on?

A

predominant seizure type
drug side-effects
patient’s preference/concerns

30
Q

T/F: Monotherapy is best for partial seizures

A

True

31
Q

Which AEDs have the best evidence and FDA indication for partial seizures?

A

carbamazepine
oxcarbazepine
phenytoin
topiramate

32
Q

Which AEDs have the best evidence and FDA indication for generalized tonic-clonic seizures?

A

valproate
topiramate

**topiramate makes you dopey, and also decreases your appetite

33
Q

What is the gold standard drug for generalized tonic clonic seizures? What’s one side effect to think about?

A

valproate; makes people eat more

34
Q

Which AEDs should be used for absence seizures?

A

ethosuximide *absence only

valproate

35
Q

Which AEDs work the best for myoclonic seizures?

A

valproate
levetiracetam
clonazepam

36
Q

Drugs for Lennox-Gastaut Syndrome?

A 
topiramate
felbamate
clonazepam
lamotrigine
rufinamide
37
Q

Why is monotherapy best?

A

simplifies treatment, increases compliance

reduces adverse effects

38
Q

These AEDs can induce metabolism of other drugs

A

carbamazepine
phenytoin
phenobarbital
primidone

39
Q

Which AEDs inhibit metabolism of other drugs?

A

valproate (if you’re on phenytoin and you add valproate, your phenytoin level in the blood may increase)
felbamate

40
Q

Which AEDs decrease the efficacy of oral contraceptive pills?

A 
phenytoin
carbamazepine
phenobarbital
topiramate
oxcarbazepine
felbamate

**ex: phenytoin can decrease BC concentration and can increase risk of pregnancy - recommend IUD or other form of BC

41
Q

This AED is used frequently in women

A

lamotrigine

**may need higher doses of lamotrigine if you are on BC though

42
Q

When do we check blood levels when pts are on AEDs?

A

levels can be used to see if a pt is compliant (taking the drug) or to monitor drug levels during pregnancy, etc

43
Q

What symptoms do all AEDs cause?

A

dizzy, fatigue, ataxia, diplopia

44
Q

Levetiracetam causes (blank)

A

irritability

45
Q

Can cause word-finding difficulty, weight loss, renal stones, anhydrosis or heat stroke, glaucoma

A

topiramate

46
Q

(blank) is the most common side effect of AEDs that causes people to be taken off their meds

A

rash

47
Q

These populations have a higher incidence of rash than other pts taking AEDs

A

Asian pts

48
Q

This is the worst case scenario in patients who experience rash on AEDs

A

Stevens Johnson syndrome

49
Q

Which two AEDs are most likely to increase risk of SJS?

A

lamotrigine titrated in combo with valproate

50
Q

Comorbidities to consider in pts with long term AED use

A

osteoporosis (esp phenytoin)
migraine
depression

51
Q

20-60% of pts on epileptic meds are (blank)

A

depressed

**these pts more likely to commit suicide, feel stigma, less likely to get married

52
Q

Antiepileptic drugs increase the risk of (blank)

A

suicide

53
Q

When to discontinue AEDs?

A 
seizure free for >2years and are younger
control with one drug at low dose
no previous unsuccessful attempts at withdrawal
normal neuro exam or EEG
benign syndrome

**always think about the risks of taking the pt off, like driving and pregnancy

54
Q

What things should you consider if a seizure recurrs?

A

some avoidable precipitant?
if not on AED, start therapy?
if on AED, are they compliant? do you need to increase dose or change meds?

55
Q

What lifestyle modifications can be made to decrease seizures?

A

adequate sleep!!
avoid alcohol and stimulants
reduce stress

56
Q

This type of diet can be therapeutic for patients, especially children, with multiple seizure types

A

ketogenic diet

**low carbs, high fat

57
Q

Other diets that can be somewhat helpful?

A

modified Atkins

low-glycemic index treatment (our brains run on glucose, so this decreases seizures of hyperactive neurons)

58
Q

When might you consider surgery for patients with epilepsy?

A

not responding to medical management

partial seizures

59
Q

This type of treatment can be used to stimulate the left vagus nerve and decrease seizures

A

Vagus nerve stimulator

60
Q

More than 10 minutes of continuous seizure activity
or
Two or more sequential seizures without full recovery between seizures

A

status epilepticus

61
Q

What are some potential consequences of status epilepticus?

A 
hypoxia
hypotension
acidosis
hyperthermia
neuronal injury

**this is a medical emergency, because neuronal death will destroy brain tissue

62
Q

Steps to treating status epilepticus?

A 
check ABCs
Give O2
get IV access
monitor EKG
check glucose (make sure they are not hypoglycemic)
do a tox screen
draw blood
63
Q

This is usu given IV as soon as possible for status epilepticus?

A

lorazepam
or diazepam if you can’t go IV
thiamine unless you know their blood glucose is OK

64
Q

If seizures persist for 10-20 minutes, what should you give?

A

fosphenytoin

65
Q

Different choices if the seizures last 10-60 minutes?

A

continuous IV midazolam
continuous IV propofol
IV valproate
IV phenobarbital

66
Q

This is a huge every day consideration for patients with epilepsy

A

driving

67
Q

How long must patients go w/o having a seizure to get their license back?

A

3 months

Block 8 Week 5 (13 decks)

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