CS: Seizures Flashcards
What is the neuro 6 finger rule?
- localisation
- signalment
- onset
- progression
- symetry
- pain
What is the neuro 6 finger rule?
- localisation
- signalment
- onset
- progression
- symetry
- pain
How can ^ WBC (neutrophils and monocytes) with leucopenia and eosinopenia be explained in an apparently not - infected animal?
Stress leucogram
How can ammonium biurate crystals be visualised? When would these be seen?
ultrasound bladder - see calculi in empty bladder
What effect would ^ ammonia have on the kidneys?
Enlarged
What effect does extrahepatic PSS have on the liver?
Small d/t lack of blood suppply
1st line tx of idiopathic epilepsy in dogs?
- phenobarb (lic epilepsy)
- imepitoin (lic single generalised tonic clonic seizure - modern, more specific license) §
1st line tx of idiopathic epilepsy in dogs?
- phenobarb
- imepitoin (single generalised tonic clonic seizure - modern, more specific license)
How can ^ WBC (neutrophils and monocytes) with leucopenia and eosinopenia be explained in an apparently not - infected animal?
Stress leucogram
How can ammonium biurate crystals be visualised? When would these be seen?
ultrasound bladder - see calculi in empty bladder
What effect would ^ ammonia have on the kidneys?
Enlarged
What effect does extrahepatic PSS have on the liver?
Small d/t lack of blood suppply
When is tx starting indicated in dogs?
1st line tx of idiopathic epilepsy in dogs?
- phenobarb
- imepitoin (single generalised tonic clonic seizure - modern, more specific license)
When should serum plasma levles of phenobarb be checked in dogs?
@ 14d post tx
- ^ liver enzymes ALT etc. >7d so no point checking before this pont as metabolism will change
- if checking plasma levels as unresponsive to AED then measure trough levels (jsut before due next tx)
- if >10mg/kg/day need to measure peak and trough
Side effects of phenobarbitone?
- sedation
- PUPD
- polyphagia
- liver tox if >35ug/ml
- ataxia
- anaemia (IMHA blood dyscrasia ~= sulphonamides)
What antiepileptics are lic for cats? 1st line tx?
NONE!
- phenobarb- chronic use ok
- diazepam for status epilepticus only (Not chronic use)
> metabolism diazepam slower in cats cf. dogs, can -> fulminant hepatic necrosis
What AEDs are liv in horses? Most common tx?
NONE!
- phenobarb (cheap)
How do phenobarb doses differ int he cat cf. dog?
- only need SID as no induction of liver enzymes like in dogs
When should serum levels of KBr be checked?
> 60-90d (takes long time to reach steady state)
Side effects of KBr
~= phenobarb
- no blood dyscrasia
- GI irritant -> D+
- with ^ salt intake, will compete with KBr -> loss of function
- ataxia worse than phenobarb
- PANCREATITIS possible
- Br toxicity if loaded (loading does = 3-4x daily dose in one hit to rapidly reach therapeutic levels)
If focal seizure is seen on the LEFT where is the lesion?
Right forebrain
On MRI what are T1W, T2W and flare images?
T1: fat is white
T2: water and fat are white
flair= Fluid Attenuated Inversion Recovery : nulls fluid so can clearly see other structures without CSF interfering
Side effects of imepitoin?
- sedation
- polyphagia
- ataxia
- hyperactivity (transient)
- less cf. other AEDs
Side effects of diazepam, KBr and levacitracin and gabapentin in the cat?
- diazepam: severe liver necorisis
- KBr: feline asthma
- levacitram and gabapentin -> sedation and ataxia
How do phenobarb doses differ int he cat cf. dog?
- only need SID as no induction of liver enzymes like in dogs
Dog having recurrent seziures despite tx with phenobarb.. next course of action?
- check serum levels
- add another drug
> KBr lic 2nd line drug for phenobarb 1st line
> if on imepitoin initially more likely to add in Leviteracitam (no evidence for interaction)
Can idiopathic epilepsy cause asymetrical focal seizures?
NO!!!
If focal seizure is seen on the LEFT where is the lesion?
Right forebrain
On MRI what are T1W, T2W and flare images?
T1: fat is white
T2: water and fat are white
flair= Fluid Attenuated Inversion Recovery : nulls fluid so can clearly see other structures without CSF interfering
Further diagnostics in equine epilepsy
- EEG for partial seizures (refer)
- skull rads are NOT USEFUL!!!
- endoscopy/CT/MRI RARELY USEFUL!!!
> though owners still may want tehse to r/o other things
What is amaurosis? When may this be seen?
central blindness (normal PLR, no menace)
- may be seen for several hours post ictally
- depression, sedation, blindness of eye CONTRALATERAL to side of seizure
What does PE in between status epilepticus show you?
- typically normal (if stimulated may -> seizure)
- if neuro deficits present inbetween seziures indicates STRUCTURAL brain dz more liekly
When can horses said to be safe to ride if epileptic?
- seizure free for 6 months may ok? Still a risk (based on human driving legislation)
How may blood results be altered by a seizure?
^ CK 2d post
How should you approach a status epilepticus horse?
DONT! Leave it to finish - dont last long. very dangerous
> diazepam
> phenobarb dilute IV saline
> Pentobarbitone (careful! Usually used for PTS)
Tx status epilepticus horses?
Talk to owner $$$ tx not definitive so may be a waste of money
Further diagnostics in equine epilepsy
- EEG for partial seizures (refer)
- skull rads are NOT USEFUL!!!
- endoscopy/CT/MRI RARELY USEFUL!!!
> though owners still may want tehse to r/o other things
What advantages does KBr have over phenobarbitone?
Less sedation - use if level of sedation on PB unnacceptable
What biochemical changes occour to cells with chronic brain activity?
^ calcium -> 1* damage
What is 2* damage associated with seziures?
> everything othrer than ^ ca
- hypoxia
- hypertension
- hypercarbaemia
- lactic acidosis
- myoglobinuria
- hyperkalaemia
Tx course of action for stauts epilepticus
- stop the seizures
- protect the brain (cool, fluids, oxygen)
- think about seizures
Always 1st line tx of status
Diazepam up the bum
When may diazepam not be effective at controlling status? What should be given in this case?
- if seziuring >1hr GABA may be depleted so use PHENOBARB aswell
- but still give diazepam!!
- phenobarb takes min 20 mins to act
- if >120mins give propofol to induce anaesthesia
What may be seen with propofol used to tx seizures?
Twitches - hard to differentiate from seizures!
> if you move the animal twitches will stop, seizures wont
