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PHRM 845 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Seizure

A

Clinical manifestation of an abnormal, excessive excitation/synchronization of a population of cortical neurons

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2
Q

Epilepsy

A

Disease of brain defined by any following conditions:

  • Two unprovoked seizures occurring >24 hours apart
  • One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures occurring over next 10 years
  • Diagnosis of an epilepsy syndrome
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3
Q

Seizure Epidemiology

A
  • Approximately 10% of Americans will have 1+ seizures in their lifetime
  • 6mo-6 years: febrile seizure (4%)
  • Other: acute symptomatic seizure (3.6%)
  • Most prevalent among women at childbearing age and among Navajo
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4
Q

Seizure Pathophysiology

A

Major Neurotransmitters/modulators:

  • Excitatory NT: Glutamate
  • Inhibitory NT: GABA
  • Neuromodulators: ACh, DA, 5HT, histamine
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5
Q

Excitatory and Inhibitory Synapses

A

Inhibition

  • Increase Cl- current inward
  • Neurotransmitter: GABA

Excitation

  • Increase Na+, Ca++ current inward
  • Neurotransmitter: Glutamate

Hyperexcitability causes seizure

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6
Q

Seizure Causes

A
  • Idiopathic/genetic
  • Cryptogenic - unknown cause
  • Neurodegenerative disorders: Alzheimer
  • Electrolytes abnormality
  • Traumatic brain injury
  • Brain tumor
  • Brain surgery
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7
Q

Seizure Triggers

A
  • Medications: stimulants, GABA inhibitors, antibiotics
  • Menstrual cycles
  • Anxiety
  • Sleep deprivation
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8
Q

Epilepsy Diagnosis

A
  • Patient history: onset, family history, etiology, precipitating factors
  • Signs/symptoms: frequency, duration, description, post-ictal symptom (HA, fatigue, etc.)
  • Genetic Tests: gene mutation
  • Medication history: medications tried, worked/didn’t work, AE
  • Utilization of EEG and radiology for structural abnormalities
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9
Q

Partial Seizure

A
  • Onset in one part of brain
  • Localization-related or focal seizures
  • May last few minutes
  • With or without impairment of consciousness/awareness
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10
Q

Secondary Generalized Seizures

A
  • Followed by a focal seizure
  • Involves both cerebral hemispheres
  • With or without motor symptoms
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11
Q

Generalized Seizures

A

Occurs in both cerebral hemispheres

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12
Q

Absence Seizures

A
  • Type of generalized seizure
  • Brief staring spells (3-20 sec)
  • Sudden onset and resolution
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13
Q

Myoclonic Seizure

A
  • Type of generalized seizure

- Brief, shock-like jerk of a muscle/muscle group

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14
Q

Atonic Seizure

A
  • Type of generalized seizure

- Sudden loss of postural tone

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15
Q

Tonic Seizures

A
  • Type of generalized seizure

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

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16
Q

Tonic-Clonic Seizures

A
  • Type of generalized seizure
  • Tonic and clonic phases
  • Tonic: stiffening and fall
  • Clonic: rhythmic extremity jerking
17
Q

Epilepsy Syndromes

A

Group patients that have similar:

  • Seizure type
  • Age of onset
  • Natural history/prognosis
  • EEG patterns
  • Genetics
  • Response to treatment
18
Q

Antiepileptic Drug Goal

A
  • Target organ: Brain
  • Wanted effects: Seizure control
  • Unwanted effects: Toxicity and adverse reactions
19
Q

Treatment Goals

A
  • Ultimate: Seizure-free (life-long)
  • Preferable: well-controlled seizure status with minimal AE
  • Medications: AEDs
  • Devices: VNS, DBS, etc.
20
Q

AEDs + Pregnancy

A
  • All pregnancy category C or D
  • Birth defects are possible if taking while pregnant
  • May possibly effect IQ
  • Need special care before, during, and after pregnancy
21
Q

Contraception + Epilepsy

A
  • Use low-estrogen OC (<50 mcg), seizure trigger

- Use back up contraception since CYP inducing AEDs may reduce OC effectiveness

22
Q

Pregnancy + Folate

A
  • Folic supplementation recommended before and during pregnancy
  • Try to avoid valproic acid
  • Can use if other medications are not effective or are unacceptable to treat (NOT CI)
23
Q

Catamenial Epilepsy

A
  • Cyclical increase in seizure around time of menses or certain phases of menstrual cycle
  • Estrogen: Pro-convulsant
  • Progesterone: Anti-convulsant
  • Treatment agents: Progesterone, topiramate, zonisamide, acetazoramide, clobazam
24
Q

Seizure Nonpharm

A
  • Surgery
  • Implant devices: VNS, DBS, RNS (monitor and treats seizures)
  • Diet: ketogenic diet (high fat) recommended when multiple drugs haven’t worked, Atkins Diet

PHRM 845 (5 decks)

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