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Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

ILAE definitions of epilepsy

A 
1) Two unprovoked seizures 24 hrs apart 
OR
2) unprovoked seizure + probability further seizures
OR 
3) two seizures in reflex epilepsy
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2
Q

Define generalized seizure/ focal:

A
  • generalized: onset is bilateral involving both hemispheres
  • focal: one sided, onset consistent
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3
Q

EEG important for monitoring what non-epileptic neuro disease?

A
  • herpes encephalitis

- hypoxic anoxic brain injury

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4
Q

When should EEG be done in ICU?

A

-unexplained AMS

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5
Q

What seizures may not be recorded at scalp?

A

frontal

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6
Q

When is EEG highest yield?

A
  • sleep deprivation

- w/in 24-48 hours of seizure

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7
Q

When should treatment be started after first seizure?

A

-If eptileptiform activity is seen on EEG

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8
Q

Occipital protuberance is aka:

A

-inion

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9
Q 
How many leads are on standard EEG?
Which side (left vs right) of head is assigned odd numbered leads?
A

-21, left leads are odd

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10
Q

List the frequencies for standard EEG wave types (a,b,y, d, theta)

A
  • D: 0-4
  • T: 4-8
  • A: 8-12
  • B: 12-40
  • Y: 40-100
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11
Q

List the wave forms seen in each stage?

A 
-BATS Drink Blood
B-awake
A-eyes shut 
T-N1
Sleep spindles, K: N2
D: N3
B: REM
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12
Q

What are the types of (focal) seizures?

A
  • simple- conscious
  • complex: dyscognitive
  • partial w/ secondary generalization (bilateral convulsions)
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13
Q

Most classic seizure types (tonic, absence, myoclonic) are what type?

A

generalized

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14
Q

Four seizure etiologies

A

genetic
structural/metabolic
immune
unknown

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15
Q

List two infantile epilepsies

A
  • west

- dravet

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16
Q

List two childhood epilepsies

A
  • benign w/ centrotemporal spikes

- absence

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17
Q

Infantile spasm triad

A
  • hipsarrythmia
  • spasms
  • developmental arrest
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18
Q

List two adolescent/ adult epilepsies

A
  • JME

- JAE

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19
Q

What might MRI localize in epileptic disease?

A

heterotopia, meseal temporal sclerosis

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20
Q

What age group requires repeat MRI 1 year later?

A

children under two, cortical lesions may not appear early

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21
Q

Chances of second seizure following first unprovoked seizure?

A

-30-50% in 2-5 years

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22
Q

What increases the risk of second seizure?

A
  • abnormal EEG
  • known etiology
  • abnormal exam
  • cortical lesion
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23
Q

2 MC ADRs of AEDs

A

Drowziness

Dizziness

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24
Q

What are the broad spectrum AEDs?

A
  • Volcanic Lands Love Torturing People
  • VPA
  • Lamotrigine
  • Levitiracetam
  • TMX
  • Phenobarb
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25
Q

Of the broad spectrum AEDs, which effect cyps?

A
  • valproate: inhibitor

- phenobarb: inducer

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26
Q

Topiramate special ADRs?

A
  • impaired fluency, cognition (“dopamax”)

- weight loss because makes stuff taste nasty

27
Q

levetiracetam special ADR?

A

-irritable mood

28
Q

3 non-pharm treatments for epilepsy

A
  • vagal nerve stim
  • ketogenic diet
  • surgery
29
Q

Define catamenial epilepsy:

A

-assc w/ menstrual cycle

30
Q

Estrogen effect on seizures

A

lowers seizure threshold

31
Q

Increased risks of what repro conditions are seen in WWE

A
  • PCOS
  • infertility
  • low libido
32
Q

Which AEDs are assc w/ low bone density?

A

-EI

33
Q

When may NTDs occur?

A

within 28 days post conception

34
Q

What increases risk of NTD assc with AEDs?

What decreases?

A
  • increases: polytherapy

- decreases: folic acid supplementation

35
Q

Which AEDs are assc with NTDs? Which is worst?

A
  • Volcanic Lands Love Torturing People (making) Children
  • valproate **
  • lamotrigine
  • levitiracetam
  • topiramate
  • phenytoin
  • carbamazepine
36
Q

How may seizures effect neonate?

A

-fetal hypoxia seen in GTCS

37
Q

Rx for SE:

A
  • 1: benzo
  • 2: fosphenytoin
  • 3: intubation +midazolam/thiopental induced coma
38
Q

When is epilepsy considered no longer present?

A

-10 year seizure free period off of AEDs

39
Q

Important safety discussions to have with epilepsy patients:

A
  • driving
  • pregnancy
  • SUDEP
  • mood/SI
  • daily activity
40
Q

Compared to other neuro conditions, how many years of life are lost from SUDEP?

A

-2nd only to stroke

41
Q

Describe progression of SUDEP

A
  • usually at night

- GTC/ EEG supression –> rapid breathing –> cardio dysfunction

42
Q

SUDEP is most commonly assc with what seizure types?

A

-GTCS but can happen in partial or without preceding seizure

43
Q

High risk patients for SUDEP:

A
  • developmental disability
  • age 31-40
  • ETOH
  • symptomatic
  • channelopathies
  • AEDs w/ cardiac ADRs
44
Q

-List 4 AEDs that cause cardiac abnormalities

A
  • carbamazepine
  • phenytoin IV
  • rufinamide
  • lacosamine

Come play rugby, love.

45
Q

When in WV can epilepsy patients return to driving?

A

-seizure free 6 months

46
Q

Gold standard for treating depression in epilepsy:

A

-CBT +SSRI

47
Q

Phenyotin effects metabolism of which HIV drugs?

A

-must increase dose of ritonavir and lopinavir

48
Q

Valproic acid effects metabolism of which HIV drugs?

A

-must decrease dose zidovudine

49
Q

Phenytoin is known to interact with what drugs (in addition to antivirals

A
  • phenobarb
  • carbam
  • warfarin
  • digitalis
50
Q

List four drugs that lower seizure threshold

A
  • Wellbutrin
  • tramadol
  • pseudophedrine
  • levaquine
51
Q

When do catamenial seizurs tend to decrease?

A

Day 4-9 of menstrual cycle

52
Q

Preferred method of contraception in epilepsy?

A

-dual, IUD #1 choice

53
Q

Levitiracetam requires what changes in HC?

A

-decrease levonorgestrel + avoid and multiphasic doses

54
Q

What AED decreases levonogestrel by 40%?**

A

perampanel**

Don’t give to women of childbearing age!

55
Q

Emergency contraception for epilepsy patients

A

double emergency pill dose or get copper IUD within 5 days

56
Q

CBZ, LTM, Barbs are all assc with?

A

-cardiac defects

57
Q

Which AEDs are dependent on glucuronidation for metabolism? What is the relevance?

A
  • LTM and CBZ

- estrogen increases metabolism

58
Q

Should moms on AEDs continue breast feeding?

A

yes

59
Q

Which two AEDs may be assc with lower IQ in babies?

A

-VPA and CBZ

60
Q

In general what increases the risk of AEDs lowering bone density?

A
  • EI

- polytherapy

61
Q

What three AEDs are shown to decrease bone density?

A
  • PB
  • PHT
  • TPX
62
Q

Three AEDs with high DEXA score?

A
  • lamotrigine
  • levetiracetam
  • gabapentin
63
Q

Mechanism of decreased bone density w/ AEDs?

A

-^vitamin D metabolism –> ^^PTH

64
Q

Three concomitant risks for low bone density to remember for WWE?

A
  • tobacco
  • alcohol
  • agitation

Neuro (15 decks)

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