epilepsy Flashcards
def. epileptic seizure
- transient occurance of signs and Sx
- due to abnormal excessive syncronous neuronal brain activity
def.epilepsy
- disorder of the brain with an enduring predisposition to seizures
- patient has had at least one seizure
def. focal seizure
originating within networks limited to one hemisphere
- can be discretely localized or more widely distributed
def. generalized seizures
originating at some point in the brain and rapidly engaging bilaterally distributed networks
*** 3 types of focal seizures
- no impairment of consciousness
- simple partial
- subjective Sx only, or observable motor features only - with impairment of consciousness or awarness
- complex partial - eveolving to bilateral convulsive seizure
- secondary generalized
6 types of generalized
- tonic-clonic
- abscence
- clonic - full body
- tonic - seize up
- atonic
- myoclonic - very short
what does 3Hz spike and slow wave indicate
absence epilepsy
DDx for a “spell” (7)
- seizure
- cardiac
- migraine
- stroke/TIA
- decerebration
- movement disorder
- psychogenic non-epileptic event
3 patient Hx questions
- warning with siezure
- preciptating factors
- health at seizure onset
what to ask for to see if there is a previous seizure
many PTs unaware
- positive phenomenology
- flashin lights
- aura
- post-ictal confusion
- tonguq biting
- bed wetting
5 possible predisposing factors
- birth insult
- febrile seizures
- meningitis
- traumatic brain injury
- fam Hx of epi
why is close questioning important
50% of “1st” seizures will have had one before
what are acute precipitants
- drugs
- withdrawal
- metabolic
- meninggitis
- brain abscess
- vascular
5 investigations
- general and neuro exam
- labs
- EKG - long QT, brugada
- EEG
- neuroimaging
why EEG? 2
- helps diagnose - tells if consistent with Sx
2. help prognosticate - if +ve, 50% chance risk of seizure in next 5 years
what is sens of interictal epiletiform changes
intial EEG - seen in 20-55%
repeat - seen in 80-90%
negative EEg doesn’t rule out
use of imaging
- significant problem in 10%
- should always do unless known primary epilepsy
5 predictors of recurrent sizure
- epiletiform on EEg
- know etiology is symptomatic
- post-ictal todd’s paralysis
- prior seizure
- multiple seizure in first 24 hours NOT predictove
what to be cautious about with meds
triggering a seizure
what are cautions for GTC, partial, myclonic, absence, atonic/clonic
GTC - ETX
partial - ETX
myclonic - ETX, PHT, CBZ, OXC, LTG
absence - PHT, CBZ, OXC
what are good drug for fast dosing
- pheytoin
- valproate
- gabapentin
- levetircetem
what is phenytoin use for
emerg. and maintance
AE of phenytoin
CNS - mystagmus, cognition, encephalopathy, movement disorders
GI - give with meals
chronic - cerebellar, peripheral neuopathy, cosmetic
when to use and not use carbemazepine
good - partial onset, generalized tonic/clonic
bad - JME
carbemazepine SE
nausea, GI
neuro - dizzy, sedation, HA, ataxia
how to give valproic acid
emergency loads, then gradually titrate loads up
main caution in valpoate
teratogenticity
SE of levetiracetam
- somnolence, dizzyness
- behav. mood distubances
- hypersensitivity
what is best drug for seizure control
vaproic acid
what is Juv. myoclon epi
triad of absence, generalized convulsions, and myoclinc seizures
- high rate of remission with AED
- life long therapy
- traditionally valproate
what is caution with valproate
teratogenicity
- can give folic acid
6 meds that are high risk for contraceptive failure
- phenobarbital
- primidone
- phenytoin
- carbamazpine
- oxcarbazepine
- topriamate
def. status epilepticus
- 5 mins or longer of continuous seizure
- or 2 or more discrete seizures without complete recovery of consciousness
4 types of status
- generalized tonic-clonic
- nonconvulsive - absence, partial
- focal motor status
- myoclonic
what is mort. of SE
17-23%
what does mort depend on (4)
- etiology - alc. better
- duration (best predictor)
- age - worse older
- treatment adequacy
morbidity of SE
- neuro delay in kids
- speech deficits
- 10-23% of pts with SE are left disabled
what is important with timing in SE
need to treat ASAP
mgmt step in SE (4)
- ABCs
- check glucose, thiamine if giving glucose
- anticonvulsants
- diagnose and treat underlying cause
what are anticonvulsants for sE
1st line - benzos
2nd line - if fail - phenytoin
3rd line - ICU for general anasthetic
etiology of SE in order
- stroke
- med change/non-compliance
- EtOH/ drugs
def. refractory epilepsy
- not well controlled after 2 trials of drugs
- 20-40%
- after 2, send for speciality care
def. psychogenic non-epiletic seizures
- form of conversion disorder
- most commonly masquerade as medically refactory epi
features of psedo seizures
- multiple ill defined and illdescribed
- tongue bite on tip, not sides
- paradoxical response to drugs
- other Psych
- tearing/crying during seizure
what is concept of surgery
- remove the zones that begin the seizure
- epileptogenic zone
what is rate of cure for surg
70-80%
- mortality ration of 2-5%
when to refer
when there has not been appropriate seizure control by neurologist in 9 months
- takes average of 20 years
