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epilepsy Flashcards

1
Q

def. epileptic seizure

A
  • transient occurance of signs and Sx

- due to abnormal excessive syncronous neuronal brain activity

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2
Q

def.epilepsy

A
  • disorder of the brain with an enduring predisposition to seizures
  • patient has had at least one seizure
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3
Q

def. focal seizure

A

originating within networks limited to one hemisphere

- can be discretely localized or more widely distributed

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4
Q

def. generalized seizures

A

originating at some point in the brain and rapidly engaging bilaterally distributed networks

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5
Q

*** 3 types of focal seizures

A
  1. no impairment of consciousness
    - simple partial
    - subjective Sx only, or observable motor features only
  2. with impairment of consciousness or awarness
    - complex partial
  3. eveolving to bilateral convulsive seizure
    - secondary generalized
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6
Q

6 types of generalized

A
  1. tonic-clonic
  2. abscence
  3. clonic - full body
  4. tonic - seize up
  5. atonic
  6. myoclonic - very short
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7
Q

what does 3Hz spike and slow wave indicate

A

absence epilepsy

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8
Q

DDx for a “spell” (7)

A
  1. seizure
  2. cardiac
  3. migraine
  4. stroke/TIA
  5. decerebration
  6. movement disorder
  7. psychogenic non-epileptic event
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9
Q

3 patient Hx questions

A
  1. warning with siezure
  2. preciptating factors
  3. health at seizure onset
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10
Q

what to ask for to see if there is a previous seizure

A

many PTs unaware

  • positive phenomenology
  • flashin lights
  • aura
  • post-ictal confusion
  • tonguq biting
  • bed wetting
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11
Q

5 possible predisposing factors

A
  1. birth insult
  2. febrile seizures
  3. meningitis
  4. traumatic brain injury
  5. fam Hx of epi
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12
Q

why is close questioning important

A

50% of “1st” seizures will have had one before

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13
Q

what are acute precipitants

A
  1. drugs
  2. withdrawal
  3. metabolic
  4. meninggitis
  5. brain abscess
  6. vascular
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14
Q

5 investigations

A
  1. general and neuro exam
  2. labs
  3. EKG - long QT, brugada
  4. EEG
  5. neuroimaging
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15
Q

why EEG? 2

A
  1. helps diagnose - tells if consistent with Sx

2. help prognosticate - if +ve, 50% chance risk of seizure in next 5 years

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16
Q

what is sens of interictal epiletiform changes

A

intial EEG - seen in 20-55%
repeat - seen in 80-90%
negative EEg doesn’t rule out

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17
Q

use of imaging

A
  • significant problem in 10%

- should always do unless known primary epilepsy

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18
Q

5 predictors of recurrent sizure

A
  1. epiletiform on EEg
  2. know etiology is symptomatic
  3. post-ictal todd’s paralysis
  4. prior seizure
  5. multiple seizure in first 24 hours NOT predictove
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19
Q

what to be cautious about with meds

A

triggering a seizure

20
Q

what are cautions for GTC, partial, myclonic, absence, atonic/clonic

A

GTC - ETX
partial - ETX
myclonic - ETX, PHT, CBZ, OXC, LTG
absence - PHT, CBZ, OXC

21
Q

what are good drug for fast dosing

A
  • pheytoin
  • valproate
  • gabapentin
  • levetircetem
22
Q

what is phenytoin use for

A

emerg. and maintance

23
Q

AE of phenytoin

A

CNS - mystagmus, cognition, encephalopathy, movement disorders
GI - give with meals
chronic - cerebellar, peripheral neuopathy, cosmetic

24
Q

when to use and not use carbemazepine

A

good - partial onset, generalized tonic/clonic

bad - JME

25
Q

carbemazepine SE

A

nausea, GI

neuro - dizzy, sedation, HA, ataxia

26
Q

how to give valproic acid

A

emergency loads, then gradually titrate loads up

27
Q

main caution in valpoate

A

teratogenticity

28
Q

SE of levetiracetam

A
  • somnolence, dizzyness
  • behav. mood distubances
  • hypersensitivity
29
Q

what is best drug for seizure control

A

vaproic acid

30
Q

what is Juv. myoclon epi

A

triad of absence, generalized convulsions, and myoclinc seizures

  • high rate of remission with AED
  • life long therapy
  • traditionally valproate
31
Q

what is caution with valproate

A

teratogenicity

- can give folic acid

32
Q

6 meds that are high risk for contraceptive failure

A
  1. phenobarbital
  2. primidone
  3. phenytoin
  4. carbamazpine
  5. oxcarbazepine
  6. topriamate
33
Q

def. status epilepticus

A
  • 5 mins or longer of continuous seizure

- or 2 or more discrete seizures without complete recovery of consciousness

34
Q

4 types of status

A
  1. generalized tonic-clonic
  2. nonconvulsive - absence, partial
  3. focal motor status
  4. myoclonic
35
Q

what is mort. of SE

A

17-23%

36
Q

what does mort depend on (4)

A
  1. etiology - alc. better
  2. duration (best predictor)
  3. age - worse older
  4. treatment adequacy
37
Q

morbidity of SE

A
  • neuro delay in kids
  • speech deficits
  • 10-23% of pts with SE are left disabled
38
Q

what is important with timing in SE

A

need to treat ASAP

39
Q

mgmt step in SE (4)

A
  1. ABCs
  2. check glucose, thiamine if giving glucose
  3. anticonvulsants
  4. diagnose and treat underlying cause
40
Q

what are anticonvulsants for sE

A

1st line - benzos
2nd line - if fail - phenytoin
3rd line - ICU for general anasthetic

41
Q

etiology of SE in order

A
  1. stroke
  2. med change/non-compliance
  3. EtOH/ drugs
42
Q

def. refractory epilepsy

A
  • not well controlled after 2 trials of drugs
  • 20-40%
  • after 2, send for speciality care
43
Q

def. psychogenic non-epiletic seizures

A
  • form of conversion disorder

- most commonly masquerade as medically refactory epi

44
Q

features of psedo seizures

A
  • multiple ill defined and illdescribed
  • tongue bite on tip, not sides
  • paradoxical response to drugs
  • other Psych
  • tearing/crying during seizure
45
Q

what is concept of surgery

A
  • remove the zones that begin the seizure

- epileptogenic zone

46
Q

what is rate of cure for surg

A

70-80%

- mortality ration of 2-5%

47
Q

when to refer

A

when there has not been appropriate seizure control by neurologist in 9 months
- takes average of 20 years

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