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Medicine II: Neurology > Convulsive disorders > Flashcards

Convulsive disorders Flashcards

1
Q

Epilepsy:

A

occasional sudden excessive rapid and local discharge of gray matter

any disorder characterized by recurrent unprovoked seizures

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2
Q

Where are rates of epilepsy higher?

A

third world countries

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3
Q

Is epilepsy controllable?

A

yes, 60-70% of epileptics have well controlled seizures on current meds

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4
Q

Who has a higher incidence of epilepsy, when does it occur?

A

men, higher incidence at the beginning and end of our lives

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5
Q

What are the types of epilepsy?

A

genetic
structural/metabolic
unknown

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6
Q

What are the causes of genetic epilepsies?

A

inherited in autosomal dominant fashion

channelopathies

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7
Q

What are the causes of structural/metabolic epilepsies?

A 
head trauma
tumors
vascular
infectious
degenerative
metabolic disorders
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8
Q

What are the classifications of seizures?

A

focal onset

generalizes onset

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9
Q

What are the subtypes of focal onset?

A

no alteration of consciousness (simple partial)- aura, motor, sensory, autonomic, “psychomotor”

altered consciousness (complex partial)

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10
Q

What are the subtypes of generalized onset?

A 
tonic
clonic
atonic
myoclonic
absence
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11
Q

Partial seizures: Onset

A

single focus giving rise to abnormal discharges
symptoms are very specific and can help localize the lesion/source
no loss of consciousness

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12
Q

Simple partial seizure:

A

Twitching
sensory- abnormal sensations, paresthesias, abnormal vision, sounds or smells, distortions of perception
autonomic- flushing, tingling nausea

“march” to different parts of the body

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13
Q

Complex partial seizure:

A

aura- about 50%, which is a warning for the seizure, typically a familiar feeling (deja vu), nausea, heat or tingling, or distortion of sensory perceptions

automatism- lip smaking, picking at clothes, walking around aimlessly or saying nonsense phrases over and over again
staring and black out for a few seconds to minutes

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14
Q

Generalized seizure: Onset

A

start all over the brain at once

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15
Q

Absence seizure:

A 
impairment of consciousness
usually in childhood, cease by the 20 yo
starts with staring spells
able to resume activities
onset and termination are abrupt

Typical EEG - 3hz spike and wave

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16
Q

Generalized Tonic-Clonic Seizures (Grand mal)

A

sudden loss of consciousness and tonic activity (stiffening)
followed by clonic activity (rhythmic jerking) of limbs
eyes may roll up
lasts 1-3 min
postictal phase- sluggish, sleepy and confused

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17
Q

Atonic seizures

A

drop attacks
children or adults with wide spread brain injuries
suddenly become limp and may fall to the ground

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18
Q

Myoclonic seizure:

A

brief unsustained jerk or series of jerks

19
Q

Tonic seizures

A

stiffening of muscles as the primary seizure manifestation

consciousness may or may not be lost

20
Q

What is the breakdown of adult seizure types?

A

complex partial- 40%
simple partial- 20%
primary gen tonic clonic- 20%

21
Q

What is the most common seizure in kids?

A

absence

22
Q

What is the rate of re occurrence after a first unprovoked seizure?

A

30-50%

23
Q

What are causes of epilepsy?

A

alteration of seizure threshold, acquired or inherited

specific epileptogenic disturbances- metabolic disturbances, anoxia, trauma, vascular malformation, tumor and infection

24
Q

What is the first aid for a tonic clonic seizure?

A

turn person on side with head inclined toward ground to keep airway open, protect from near hazards
DO NOT PUT RIGID OBJECT IN MOUTH OR RESTRAIN

25
Q

Staticus epilepticus:

A

a seizure or series of seizures lasting for 30 min w/out return to normal

neurological emergency!

26
Q

do anti epileptic drugs work?

A

yes, 50% seizure free with first drug, 30% though not seizure free even after the third drug

27
Q

What are considered the rescue drugs for seizures?

A

benzodiazepines

28
Q

What drugs will make primarily generalized seizures worse?

A

phenytoin, carbamazepine, oxcarbazepine

29
Q

What is a useful tool for diagnosisng and localizing seizures?

A

EEG monitoring

if its bilateral synchronus = generalized

30
Q

Epilepsy in which part of the brain is extremely refractory to meds?

A

temporal, need surgery, good success rate

31
Q

What is an alternative to epileptic surgery?

A

corpus callostomy

vagal nerve stimulation (pacemaker of the brain)- palliative only

32
Q

What are the most common congenital abnormalites from AED therapy?

A

orofacial clefts, heart defects

less common: microcephaly, NTD

33
Q

What is SUDEP? When is it most likely to occur?

A

sudden unexpected death in epilepsy, higher frequency in males, pts with refractory epilepsy

34
Q

Seizure precautions

A

no driving
no swimming or tub baths w/out someone around
avoid climbing heights

35
Q

What is the most common cause of seizures with the onset at age 60 years or older?

A

vascular disease

36
Q

When does an absence seizure most likely to occur?

A

in conversation

37
Q

What meds do you give for focal seizures?

A

carbamazapine, phenytoin or valproic acid

38
Q

What meds do you give for generalized seizures?

A

valproate

39
Q

Do you give a pregnant woman an antiepileptic?

A

According to book: even though antiepileptics are tetratogenic you still give it to a pregnant woman

40
Q

What is the most common cause of lower concentration of drug than expected for the prescribed dose?

A

poor patient compliance

41
Q

What type of seizure is a/w alcohol with drawl?

A

tonic clonic, give benzo

42
Q

most common cause of status epilepticus

A

poor compliance

43
Q

Tx of status epilepticus:

A

50% dextrose IV
IV bolus lorazepam, diazapam if it doesnt work
if the continue, phenobarbital

44
Q

Which seizures are gradual in onset and termination?

A

atypical absence, marked changes in tone occur

Medicine II: Neurology (12 decks)

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