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Pathophysiology Final > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

epidemiology

A

0.6% of canadian population; 15500 new cases each year in Canada

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2
Q

seizure

A
  • temporary neurological reaction to sudden excessive electrical excitation of cortical neurons
  • loss of awareness or consciousness, movement or sensation disturbances, changed mood or mental function
  • results from either known or idiopathic (unknown) origins
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3
Q

is the stratum corneum involved in seizures?

A

NO - this is in psoriasis (outer layer of epidermis)

said he made an exam q with this

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4
Q

epilepsy

A
  • CHRONIC neurological disorder affecting the brain (although some can “get out of it”)
  • symptoms are RECURRENT seizures
  • IDIOPATHIC: no known cause
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5
Q

What must occur for a person to be diagnosed with epilepsy?

A
  • an individual must have had 2 or more seizures of unknown aetiology to be diagnosed
  • therefore if they are diagnosed with epilepsy, we don’t know the root of the origin of the disease!
  • first they will go through all the differential diagnosis procedures (tumour, meningitis, head trauma, metabolic, etc)
    (i. e. if they have 2 seizures all from separate, KNOWN causes this is NOT epilepsy)
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6
Q

describe the flow chart of “questions” that one must go through to diagnose epilepsy

A

1) More than one seizure?
- no-> can’t diagnose epilepsy at this time
- yes-> …
2) provoked?
- yes-> therefore secondary seizure-> investigate underlying cause
- no-> therefore primary seizure-> examine patient history-> diagnostic tests-> determine epilepsy syndrome-> examine treatment options (AKA THEY HAVE EPILEPSY)

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7
Q

Diagnostic tests

A

Brain imaging:

  • electroencephalograph
  • computerized tomography scanning
  • magnetic resonance imaging
  • positron emission tomography

Blood tests

Lumbar puncture

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8
Q

electnoenecphalograph

A
  • EEG
  • looks at the wave pattern-> is it normal or not
  • non-invasive
  • record electrical activity on brain surface
  • locate area of irregularly firing cortical neurons
  • determine severity and type of seizure disorder
  • does not diagnose or exclude epilepsy
  • person with epilepsy may have normal EEG
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9
Q

computerized tomography scanning

A
  • CT scan
  • this is a generalized snapshot of the area
  • look for gross structural abnormalities
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10
Q

magnetic resonance tomography

A
  • MRI
  • get the detail-> repeated slice of the body to get a full image
  • gets the exact size, depth, etc for the abnormality
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11
Q

positron emission tomography

A
  • PET scan
  • ask person to pick up a pen and the scan will highlight the specific part of the brain that made you pick it up (i.e. any specific function/movement)
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12
Q

what do blood tests check for when diagnosing epilepsy

A

-check for infections, anemia (low iron is a trigger), minerals, poisons that may have caused a seizure (secondary causes)

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13
Q

what does a lumbar puncture check for when diagnosing epilepsy

A

-seizure caused by infection of bleeding in the brain

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14
Q

4 mains stages to an action potential

A

1) resting
2) depolarization
3) repolarization
4) hyperpolarization

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15
Q

resting membrane potential

A

= -70mV

  • more Na, Ca, Cl outside
  • more K inside
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16
Q

depolarization

A
  • Ca influx creates partial depolarization
  • Na channels open and Na rushes into cortical neuron
  • becomes more positive
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17
Q

repolarization

A
  • K rushes out of cortical neuron, leaving behind a negative charge
  • Cl rushes into cortical neuron, bringing in a negative charge
  • going back toward resting state
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18
Q

hyperpolarization

A
  • some K channels remain open
  • slows K to leak through
  • membrane becomes more negative than resting membrane potential
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19
Q

pathophysiology

generic

A

-cluster of cortical neutrons in a localized area simultaneously fire abnormally and this may spread to other regions of the brain

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20
Q

pathophysiology

initiation

A
  • bursts of APs from a cluster of cortical neurons
  • synchronization of these neurons
  • prolonged neuronal depolarization-> reptitive APs
  • hyperexcitability due to imbalance of neuronal membrane
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21
Q

balanced neuron

A

excite= inhibit

  • Na and Ca in= Cl in and K out
  • aspartate and glutamate= GABA
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22
Q

imbalanced neuron

A

EXCITE>inhibit (blocked)

  • defective voltage gaed ion channels-> hyperexcitability
  • Na: excessive influx
  • Ca: excessive influx
  • K: insufficient efflux
  • Cl: insufficient influx
  • excessive excitatory NTs-> glutamate and aspartate
  • insufficient inhibitory NT-> GABA
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23
Q

Pathophysiology

Termination

A
  • seizure ends after a few seconds/minutes depending on type of seizure
  • YOU WANT THEM TO BE AS SHORT AS POSSIBLE*
  • spontaneous
  • unknown mechanism
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24
Q

what it is called if there is not termination of the seizure

A

status epilepticus-> a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them.

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25
Q

2 main seizure categories

A

1) partial

2) generalized

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26
Q

partial seizure

A
  • originates in a localized part of the brain in one hemisphere or a specific lobe
  • only small part of the brain!
    a) simple partial
    b) complex partial
    c) secondarily generalized
  • 80% of people at least start off with partial seizures
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27
Q

generalized seizure

A
  • occurs in both hemispheres of the brain-> throughout ENTIRE brain
    a) absence
    b) atonic
    c) myoclonic
    d) tonic- clonic
28
Q

simple partial

A

-most benign seizure
Before:
-aura- physiological warning sign before experiencing a seizure (i.e. various scents, anxiousness, deja vu)
During:
-symptoms depend on which area of the brain in affected; they are most likely just an abnormality:
Motor- ie jerking movements, tonic movements (stiffening)
Sensory- ie tingling/ numbness
Autonomic- ie abdominal discomfort
psychic- ie hallucinations, fear, sadness
-no loss of consciousness, awake, aware
After:
-memory intact, can recall what happened

29
Q

what is important when it comes to simple partial seizures?

A

-early detection so that it doesn’t progress into a more severe type of seizure

30
Q

Complex partial

A

-more invasive- bigger area, more severe and complex than simple
Complex b/c lose consciousness
before:
-may be preceded by an aura (simple partial)
During:
-impaired consciousness (unaware of environment)- makes it even more dangerous
-involves automatisms, ie mumbling, picking at clothes, random walking
-may progress into a generalized seizure
After:
-doesnt recall event
-may be confused or tired immediately after

31
Q

Secondarily generalized

A
  • partial seizure that evolves into a generalized seizure (keep expanding into different parts of the brain)
  • can start as simple partial seizure (aura)-> complex partial-> secondarily generalized (tonic-clonic)
  • tonic-clonic convulsions
  • aka starts off small, but finishes like generalized (hyper excitability of entire brain)
32
Q

Absence

A

-petit mal
-more common in children (2-18)
-keep this in mind for children (i.e. having trouble concentrating- may not just be ADHD
Before: no aura
During:
-brief lapse of consciousness, blank stare, unaware, then continue on with activity
-begins and ends suddenly, lasting a couple of seconds
-may involve automatisms
-may occur many times throughout the day, thus interfere with learning
After:
-continue on with activity
-prompt recovery
*this can happen 200-300 times a day-> aka blips that you miss through the day

33
Q

Atonic

A 
ATONIC= absence of tone
Before:
-no warning-> completely out of blue (could even be walking and then fall over)
During:
-abruptly lose muscle tone
-brief loss of consciousness
-collapse and fall (drop attack)
After:
-recover after a few seconds
-regain consciousness
34
Q

Myoclonic

A

*opposite to atonic-> walking and then stiffen up
Before: no warning
During:
-muscle jerks- foot kicking, hand flings out suddenly, whole body jerks
-may have 1 seizure or many in a row
-consciousness intact
After: memory intact

35
Q

Tonic Clonic

A

-grand mal
Before: no warning
During:
-epileptic cry, lose consciousness, collapse
-Tonic phase: body stiffens
-Clonic phase: body jerks (muscles contract and relax)
-convulsive
-change in breathing, bite tongue, incontinsence
After:
-no recollection
-fatigued, confused, tired
* this is what a “normal” seizure is seen as”

36
Q

Status epilepticus

A

(-recall: usually, seizures last only a couple seconds, no more than 5 minutes)

  • seizure lasts for long
  • may repeat without recovery
  • can lead to neurological disability
  • can be convulsive or non-convulsive
37
Q

secondary seizures

A 
can be triggered by:
-head trauma
-head injury
-stress
-lack of sleep
-drug use
-alcohol withdrawal
-poor nutrition
-disease of infection
(if one of these is what causes a person's seizure, it rules out epilepsy
38
Q

alcohol and its effect on seizures

A
  • its a CNS depressant and an inducer of the liver
  • induces production of hepatic enzymes that triggers the breakdown of the drugs that treat seizures, therefore:
  • heavy consumption decreases seizure threshold (could happen to anyone)
  • chronic consumers likely to experience seizures upon withdrawal from alcohol
  • patients with epilepsy advised not to consume large amounts
  • can react negatively with AEDs- less effective, have side effects-> vulnerable to have seizure
39
Q

febrile seizure

A
  • convulsions (tonic-clonic) due to fever
  • common in infants and children, usually harmless
  • most last for a few minutes
  • therefore not considered to have epilepsy
40
Q

is there a cure for epilepsy?

A

no- BUT there IS a cure for seizure disorder-> i.e. you find whatever the cause is for you and treat towards that

41
Q

treatment goals

A
  • decrease frequency and severity of seizures
  • pharmacological treatment-> anti-epileptic drugs (AEDs)
  • nonpharm treatment:
  • surgery
  • vagal nerve stimulation
  • ketogenic diet
42
Q

vagal nerve stimulation

A
  • brief jolts of electrical energy sent to brain via left vagus nerve
  • prevent or interrupt electrical disturbances in brain
  • decrease frequency and duration of seizures
  • pulse generator implanted under skin on upper left side of chest to left side of neck
  • unknown mechanism
43
Q

ketogenic diet

A
  • high in fat, low in CHO
  • by tricking body into thinking its starving it make brains burn fats to metabolize instead of glucose
  • for children
  • unknown mechanism
44
Q

pharmacological treatment

A
  • AEDs
  • 3 basic mechanisms of action:
    1) modification of voltage-gated ion channel
    2) increasing gamma-aminobutyric (GABA)- mediated inhibitory neurotransmission
    3) decreasing glutamate-mediated excitatory neurotransmission
45
Q

What is the most commonly used path for AEDs

A

-voltage gated Na channel blockers (mainly during the hyper polarized stage of an AP)
-prevents influx of Na and decreases the frequency of recurrent APs
(voltage gated Ca channel blockers work similarly- limits depolarization of the cortical neuron by restricting entrance of Ca)

46
Q

Other than Na and Ca channel blockers, what is another possible site of action of AEDs?

A
  • glutamate receptors

- drugs that act at these receptors reduce receptor activity- inhibits glutamate-mediated excitatory neurotransmission

47
Q

What are some common side effects of AEDs?

A

-drowsiness
-irritability
-nausea
-skin rash
-lack of coordination
(but side effects of each drug may vary)

48
Q

Why are doses of AEDs titrated up?

A
  • these drugs hyperactive the metabolic activity of the liver, therefore:
  • takes a long time to saturate the liver of a full dose needed to control seizures (titrate up until this happens)
49
Q

When do we turn to surgery to treat seizures

A

-considered when seizures are not responsive to pharmaceutical treatment

50
Q

what are the 2 goals of surgery

A

1) maximize seizure control

2) minimize disruption of normal brain functioning

51
Q

what are the 2 main types of surgery

A

1) resection/resective surgery

2) disconnection surgery

52
Q

resection/ resective surgery

A
  • removal of the area of brain involved in seizure activity

goal: cure seizure disorder

53
Q

disconnection surgery

A
  • interrupts nerve pathways that allow seizures to spread
  • useful when seizure activity occurs in critical areas of the brain that cannot be removed
    goal: provide relief
54
Q

If a woman who experiences seizures is pregnant will her children be healthy?

A
  • most likely (>90%)

- depends on severity of epilepsy

55
Q

what is the biggest danger to the fetus from their mom being epileptic?

A
  • AEDs can affect fetus
  • risk of malformation in child
  • risk still present even with disuse of AED
  • seizures can still endanger the mom and fetus so taking AEDs at lowest dose is safest option for both
56
Q

can pregnancy effect seizure patterns?

A

yes

  • there are increased seizures even with AED use
  • concentration of AED in blood can change
57
Q

what is the GENERAL thing to do if you see someone having a seizure

A

1) look at a clock and know how long they have had a seizure, as after 5 mins their brain nerves start to die and could have major permanent damage
3) can put something soft under head (prevent more trauma-> could trigger another episode), cover up mid-section (lose control of bowel movement), but other than this don’t hold them or put anything in mouth
* ONLY turn them SLIGHTLY on SIDE-> don’t want to choke on tongue or saliva
3) call 911 if over 5 mins (or other certain circumstances)

58
Q

first aid for complex partial

A
  • guide person away from danger

- do not restrain person

59
Q

atonic

A

-call 911 if any injuries from fall

60
Q

tonic-clonic

A
  • protect from head injury
  • turn person on side to clear airway
  • dont restrain
  • dont put anything in mouth
  • cover in case of incontinence
61
Q

Why do we call 911 if their seizure lasts longer than 5 minutes?

A

-this is now status epileptics

62
Q

in what other cases do we call 911

A
  • continuous seizures
  • consciousness does not return
  • occurred in water
  • difficulty breathing
  • chest pain
  • injured
  • individual is not known to have epilepsy
63
Q

A patient has 3 seizures this year. First one had UNKNOWN cause. 2nd one was caused by FEVER. The 3rd had IDIOPATHIC origin. Can this person be diagnosed with epilepsy?

A

yes

64
Q

You are a pharmacist and someone approaches you with a new Rx. This patient has been diagnosed with epilepsy and his physician wants to treat him with Drug X, a Cl- channel antagonist. Using your understanding of the pathophysiology of seizures, would this be an appropriate treatment? If not, what would you recommend?

A

No- b/c we want chloride to go into the cell b/c it is negative! (this will therefore dampen the excitation)

Recommend a Na or K channel antagonist/ or glutamate, NMDA receptor blocker, a K channel efflux agonist -> ALL work!

65
Q

A patient with epilepsy had five seizures last year and was put on Drug X, which is Na+ channel blocker. This year, she had five seizures while still taking Drug X. What would be the best treatment strategy for this patient?

A) Immediately discontinue use of Drug X and start patient on Drug Y, which is a Ca2+ channel blocker.
B) Slowly decrease dose of Drug X, while simultaneously introducing and slowly increasing dose of Drug Y.
C) Introduce Drug Y while continuing Drug X at same dose.
D) No change in treatment is necessary.

A

technically C and D is correct-> C is more correct:
-it is definitely not A or B, b/c this drug has clearly been working (disease has not gotten worse- a plateau of seizure #s= treatment success)
-however, not adding a new drug is also not a terrible thing
-it is good to try tho as this might even REDUCE # of seizures
(if this had been on exam, the answer would have been E- 2 of the above, or C&D)

66
Q

Are patients with epilepsy treated with mono-pharmacy?

A

NO
-poly-pharmacy b/c there is no cure therefore we just have to manage it the best that we can
(this also applies for pain

Pathophysiology Final (10 decks)

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