E2 Seizures Flashcards
Seizure
-Brief episode of abnormal electrical activity in nerve cells of the brain
-Can involve motor, sensory, or cognitive manifestations
Convulsions
More severe seizure characterized by involuntary spasmodic contractions of muscles
Seizure Disease- Epilepsy
-Chronic, recurrent pattern of seizures
-Paroxysmal seizure activity
Myoclonic
Brief, shock-like jerks of a muscle or group of muscles
-Jerk of hand and legs
-Several in a row
-Overlooked often as tick, tremor, clumsiness
Seizure: Pathogenesis
“Seizure focus”
-Group of abnormal neurons that spontaneously fire
-Often this area is found to have scar tissue (gliosis)
Are global or local seizures more dangerous?
global
Primary seizures
-Idiopathic
-Epilepsy
-50% of cases
-Some genetic predisposition
Secondary seizures
-Chemical imbalances: low blood sugar, drugs (demoral)
-Febrile (most common in kids)
Brain issues associated with seizures
-Traumatic brain injury
-Stroke
-Meningitis
-Tumors
What does idiopathic mean?
unknown cause
What is the criteria for epilepsy diagnosis?
-Must have no evidence of a reversible metabolic cause (no tumor, no blood sugar issues, no meningitis)
-An electrical storm (takes multiple seizures, doesn’t matter what kind)
What is used to measure a seizure?
EEG
Seizure threshold
-the likelihood of a seizure
-the higher the threshold the less likely it is that a seizure will happen
What will increase or decrease likelihood of seizure?
Increase: drinking, menzies, missed meds, stress, illness
Decrease: meds, getting enough sleep
3 key features of seizure identification
- Area seizure originates (focal or generalized)
- Level of awareness of the patient
- Other feathers (ex. motor, nonmotor involvement)
Generalized onset seizures
-Formerly ‘grand-mal’
-Neuronal activity originates simultaneously in both hemispheres of the brain (grey matter)
-Subtypes: Tonic-clonic & Absence seizure
Absence seizures
brief loss of awareness that commonly occurs with repetitive spasmodic eye blinking for up to 30 seconds
-usually occurs in childhood, usually stop at age 14
Tonic phase of tonic-clonic seizures
-Prolonged skeletal muscle contraction
-“Cry”
Clonic phase of tonic-clonic seizures
-Alternating skeletal muscle contraction and relaxation
-Arm and legs jerk
Focal onset seizures
Originate in a localized or focal region (one lobe) of the brain
-further subdivided based on level of awareness by the patient
Phases of a seizure
- Prodromal: signs or activity that precede a seizure
- Aural phase: sensory warning
- Ictal phase: Actual seizure
- Post-ictal phase: recovery
What is the Aura/ prodrome phase?
-Subjective sense of impending seizure
-Clue to seizure
What is status epilepticus?
-Continuing series of multiple seizures without recovery period
-Last 30 mins or more
Status epilepticus is a life-threatening disorder and the biggest concern of tonic-clonic what can it cause?
-Respiratory distress
-Hypoxia
-brain damage
-Death
What is the goal of anti-epileptic drugs?
-to control or prevent seizures while maintaining a reasonable quality of life
-most cases can’t eliminate, so goal is to maximally reduce seizures incidence and minimize drug toxicity
What is the big issue with anti-epileptic drugs?
They have lots of side effects
Do not ______ anti-epileptic drugs?
abruptly stop
MOA of anti-epileptic drugs
- Increase the threshold of activity in the motor cortex- more difficult to excite nerve
- limit the spread of seizure
- Decrease the speed of nerve impulse conduction
What is the black box warning of all anti-epileptic drugs?
Increase the risk of suicidal ideation, increasing/worsening depression, and unusual changes in mood
When we mess with neurons we mess with NTs leading to mental health disorders
Adverse effects of anti-epileptic drugs
-Teratogenic: higher rates of brith defects
-Dizziness/drowsiness
-GI upset
What class is phenytoin
Hydantoins
Indication of phenytoin
tonic-clonic seizures and partial [focal] seizures, first line
How is phenytoin given?
PO (long half-life, 1x day)
IV (Push slow)
Adverse effects of phenytion
-Gingival hyperplasia (dental)
-Hirsutism
-Osteoporosis
-hypertrophy of Sub-Q facial tissue
-Lethargy
-Abnormal movements
-Mental confusion
-Cognitive changes
Why does phenytoin frequently interact with other meds?
It is highly protein bound
Who is most at risk for phenytoin toxicity?
-Malnourished
-Chronic kidney disease
-Decreased protein (albumin)
Indication for valproic acid?
-Treatment of generalized seizures (absence, myoclonic, tonic-clonic)
-Shown to work for partial seizures
-Bipolar Disorder
How is valproic acid given?
PO
IV
Delayed release
Sprinkles (kids)
Who is valproic acid contradicted for?
liver disease
urea cycle disorders
Adverse effects of valproic acid?
Hepatoxicity
Pancreatitis
Topiramate indication
-Adjunct therapy for partial and secondary generalized seizures, tonic-clonic
MOA of topiramate
not well understood
Adverse effects of topiramate
-General CNS depression
-GI upset
-Close-angle glaucoma
-Can interact with contraceptive drugs
Indication of levetiracetam
-Adjunct therapy for partial seizures with and without generalization
-Usually only used in hospital when uncontrolled
MOA of levetiracetam
Unknown
Side effects of levetiracetam
generally well tolerated
IV push ______ are gold standards for seizures
benzodiazepines
(Diazepam, lorazepam)
Most seizures stop spontaneously with no intervention in ______
2 minutes
