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Neuro IV > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Seizure

A

occasional, sudden, excessive and rapid discharge of gray matter –> positive sx

Post-seizure –> negative sx (post-ictal period)

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2
Q

Posictal period mechanisms

A

neuronal exhaustion, inhibitory inputs to seizure area

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3
Q

Signs of epileptic seizures

A

paroxysmal change in behavior or movement, or altered consciousness

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4
Q

Partial seizure

A

begins in one area of cortex

remains localized or spreads (may spread to whole cortex –> grand mal seizure)

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5
Q

Generalized epilepsy

A

due to whole cortex hyper-irritability (genetic). Overreaction to deep gray matter inputs –> seizure

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6
Q

Difference between partial complex seizures and absence seizures

A

partial complex seizures –> postictal state

no postictal state in absence seizures

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7
Q

DDx of episodic epilepsy sx

A

Syncope/near syncope (circulatory, altered blood state like hypoxia), movement disorders (myoclonus, paroxysmal dyskinesia), fasciculation, stroke/TIA, Migraine, sleep disorder, psychogenic/behavioral

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8
Q

Focal seizures, consciousness preserved

A

motor signs (Jacksonian, aversive), somatosensory sx, autonomic s/sx, psychic sx

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9
Q

Focal seizures, loss/impaired conciousness

A

Partial onset –> impaired consciousness; OR impairment of consciousness on onset

Can evolve into convulsive seizure

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10
Q

Generalized seizures

A

tonic-clonic, tonic, atonic, myclonic, absence

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11
Q

Epilepsy

A

chronic disease of recurrent, unprovoked sizures. 2+ unprovoked seizures, more than 24h apart OR 1 seizure with studies suggesting further risk for seizures

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12
Q

Drug resistant epilepsy

A

36% of cases

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13
Q

symptomatic seizures

A

30% with structural abnormality (tumor, arteriovenous malformation). Half remit

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14
Q

Idiopathic seizures

A

genetic. Usually children

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15
Q

Benign epilepsy

A

easily treated, normal intelligence, normal tests.

Genetic, remission by teen years

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16
Q

Catastrophic epilepsy

A

Med resistant. Affects development –> mental retardation, shortened lifespan of child

Abnormal EEG, MRI. Symptomatic seizures

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17
Q

Febrile seizures

A

age 6mo-3y. seizure c fever without evidence of intracranial infection or defined cause

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18
Q

Simple seizure

A

generalized, less than 10-15min, do not recur in less than 24h

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19
Q

Complex seizure

A

focal, > 10-15 min, recur in less than 24h. 30% of febrile seizures

20
Q

Timing of febrile seizures

A

within first 24h of illness

21
Q

Risk factors for recurrence of febrile seizure

A

less than 1 yo, family hx, low grade fever, brief fever

22
Q

Seizure’s effect on cognition

A

nearly all children have normal cognition. prolonged or complex seizures –> increased risk of cognitive problems (most do well)

Tendency for sleep problems

23
Q

Risk factors for developing epilepsy

A

Complex febrile seizure, neurologically abnormal prior to seizure, family hx of afebrile seizures

24
Q

Treatment of seizure now

A

DOES NOT prevent later epilepsy

25
Q

Lennox Gastaut syndrome

A

Generalized seizures, cognitive dysfunction (may evolve later), usually children 1-7y

26
Q

Causes of Lennox Gastaut syndrome

A

malformations, hypoxic-ischemic injury, encephalitis, meningitis, TUBEROUS SCLEROSIS

30% of pts with infantile spasms –> LGS

27
Q

When do you treat seizures?

A

after someone has 2 seizures or if there is an acute reason for seizure (tumor, stroke, etc) –> anticonvulsants

28
Q

How long should a patient be seizure free before we consider weaning off meds?

A

2 years

29
Q

Myoclonic seizure tx

A

lamotrigine

30
Q

Generalized seizure tx

A

phenytoin, carbamazepine, oxcarbazepine, gabapentin

31
Q

valproic acid contraindications

A

teen girls (polycystic ovarian disease), pregnant women, children

32
Q

Topiramate and zonisamide contraindications

A

acidosis

33
Q

Old, partial seizure meds

A

phenytoin, carbamazepine

34
Q

Old, broad spectrum seizure meds

A

phenobarbital, valproic acid, ethosuxamide, benzodiazepines

35
Q

New partial antiseizure meds

A

Tiagabine, Oxcarbazepine, gabapentin, pregabalin, lacosamide, exogabine, eslicarbazepine

36
Q

New broad seizure meds

A

lamotrigine, zonisamide, topiramate, levoteracetam, felbamate, clobazam, rufinamide, perampanel

37
Q

“Special” seizure meds

A

Vigabatrin, ACTH

38
Q

Ketogenic diet

A

starvation –> ketone bodies –> antiepileptic effect
Diet (creams and MCT oils) continues ketosis (enough calories and protein to grow)

Children > adults

Used with generalized > partial seizures

39
Q

Ketogenic diet adverse effects

A

hunger, hypoglycemia, drosiness, lethargy, irritability, acidosis (excessive ketosis)

Serious: kidney stones, prolonged QT, increased bruising with bleeding, pancreatitis, immunosuppression

40
Q

Vagal nerve stimulation

A

pacemaker implanted in left chest wall –> stops seizures

For chronic intractable seizures, stopping clustered/prolonged seizures

41
Q

vagal nerve stimulation side effects

A

temporary hoarseness, ticking in throat, dyspnea

42
Q

Epilepsy surgery

A

for partial epilepsies

43
Q

Epilepsy surgery in adults

A

temporal lobe

44
Q

Epilepsy surgery in children

A

extratemporal, hemispherectomy

45
Q

Focal epilepsy surgery

A

lesionectomy, lobectomy, corticectomy, multiple subpial transection

46
Q

Generalized epilepsy surgery

A

corpus callosotomy for drop

47
Q

Indications for epilepsy surgery

A

Drug-resistant with poor prognosis and natural hx (Rassmussen’s, Sturge Weber, hemimegalencephaly, focal cortical dysplasia, hippocampal sclerosis), rapid regression of development status, lesion/focus in area not critical for function, predominant seizure type and frequency

Neuro IV (21 decks)

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