Epilepsy Flashcards
There’s a _____% US prevalence of epilepsy
1.2%
When does genetic epilepsy usually present?
In young children
True or false: Infectious epilepsy does not include when a patient experiences seizures in the setting of acute infection such as meningitis or encephalitis
True; only occurs when a patient develops epilepsy as the sequelae of an infection
What is neurocysticercosis?
Parasitic infection of the brain that results from ingestion of eggs from a pork tapeworm
A protein responsible for the fusion of vesicles to the membrane has been found to be upregulated in certain models of epilepsy.
1) What is it called?
2) What does it cause?
1) Synaptic vesicle protein 2A (SV2A)
2) Dysfunction of SVA2 impairs synaptic GABA release
γ-aminobutyric acid (GABA) is an inhibitory neurotransmitter, and _______________ is an irreversible inhibitor of γ-aminobutyric acid transaminase (GABA-T)
vigabatrin
True or false: Seizures can manifest physically in a variety of ways
True
Seizures are classified into an initial three categories depending on how they begin in the brain; what are they? How does each begin?
1) Focal seizures: Start in a network of cells on only one side of the brain
2) Generalized seizures: Start in a bilaterally distributed network
3) Unknown onset: Can later be recategorized when it becomes clear how seizures begin in a particular patient’s brain
What are the two types of focal seizures? Differentiate them
1) Focal aware seizure: Cognizant during seizure (doesn’t mean they can respond to questions)
2) Focal impaired seizure: Loss of awareness may occur at any point
1) What are 3 different motor signs of focal seizures?
2) What are nonmotor signs?
1) Myoclonus (e.g., twitching and jerking)
Tonic contraction (e.g., stiffening)
Automatisms (e.g., smacking lips or rubbing hands)
2) Changes in sensation, emotions, thinking or experience
What are focal to bilateral tonic–clonic seizures?
Focal seizures that propagate beyond the brain’s one hemisphere to the contralateral hemisphere
Feelings of fear, depression, joy, anger, or memory phenomena such as feelings of familiarity (déjà vu) or unfamiliarity (jamais vu) may indicate what type of focal seizure?
Temporal lobe seizure activity
Describe the presentation of a tonic-clonic seizure
1) Sudden sharp tonic contraction
2) Subsequent period of rigidity and clonic movements
3) Pt may cry or moan or may lose sphincter control with bladder and/or bowel incontinence or bite their tongue
4) Postictal Sx: confusion, drowsiness, lack of coordination, soreness throughout the body, and amnesia
Atonic seizures:
1) How may they present?
2) What are they a hallmark feature of?
1) Head drop, the dropping of a limb, or slumping to the ground.
2) Lennox–Gastaut syndrome
How do typical absence seizures present?
Blank stare
What are some examples of generalized nonmotor seizures that aren’t typical absence?
Atypical absence
Absence seizures with myoclonia
Absence seizures with eyelid myoclonia
What are the 2 types of seizures of unknown onset?
Motor and nonmotor
After establishing the epilepsy type, what should be determined if possible?
An epilepsy syndrome
1) What is the gold standard for diagnosing epilepsy?
2) What is commonly performed in a patient who presents after their first seizure, as a way to evaluate for a brain tumor, cerebral bleeding, or gross anatomical injury?
1) Video EEG
2) CT
True or false: Some clinicians choose to start an antiseizure drug (ASD) treatment after one seizure with a definite abnormal MRI or epileptiform EEG while others do not initiate treatment until a second seizure has occurred
True
What is the general recommendation as far as treating first seizures goes?
Don’t Tx unless recurrent seizures likely
For childhood absence epilepsy (CAE):
1) What works?
2) What is detrimental?
1) Efficacious = ethosuximide
2) Detrimental = phenytoin or carbamazepine
Comorbidity Tx:
1) Epilepsy + migraine?
2) Epilepsy + bipolar disorder?
3) Epilepsy + neuropathy
1) Topiramate
2) Lamotrigine
3) Pregabalin
1) What is the general guideline for treating epilepsy?
2) How do you know if optimal dose has been achieved and no further increase is necessary?
3) When may further titration to a maximum dose may be needed for optimal seizure control be needed?
1) Start low and titrate
2) If the patient is seizure free with no adverse effects at a minimal therapeutic dose
3) If the patient continues to have seizures at a minimal or moderate-therapeutic dose