Epilepsy Flashcards
Enduring predisposition to generate epileptic seizures:
Epilepsy
Prolactin elevated 3-4x:
Generalized tonic-clonic seizures
Imaging studies:
CT, MRI and EEG —> Video-EEG monitoring
The standard test for classifying the type of seizure or to diag pseudoseizures:
Video-EEG monitoring
Hyperventilation, Photic stimulation, Sleep deprivation, Alcohol,:
Seizure precipitants
Valproic acid, Topiramate, Gabapentin and Lamotrigine:
Multiple mechanisms of action
Carbamazepine, Phenytoin and Ethosuximide:
Only one mechanism of action
Nonpharmocologic therapy:
Ketogenic diet and Vagal nerve stimulation
Palliative surgical therapy:
Vagal nerve stimulator
Possible curative surgeries:
Lobectomy and Lesionectomy
Stroke, Infection, Trauma, Hypoglycemia, Metabolic insult, Neoplasia, Drug use, Genetic predisposition and Congenital malformation:
Causes
Diagnostic criteria:
At least 2 unprovoked seizures
Prevalence of active epilepsy:
0,8%
Mechanisms that may cause focal seizures:
Increased activation, Decreased inhibition and Defective activation of GABA neurons
Leading causes in children:
Infection, Trauma, Inherited synd. and Congenital malformation
Most common cause in young adults:
Head trauma
Most common cause in the eldery:
Stroke, Trauma and Tumor
Hypoglycemia, Acidosis,
Metabolic causes
Dermatologic abnormalities suggests:
Sturge-Weber synd or Tuberous sclerosis
Classification:
Generalized and Focal
Subtypes of Generalized Seizures:
Absence, Atonic, Tonic, Clonic, Tonic-clonic and Myoclonic
Subtypes of Focal Seizure:
Simple, Complex and Secondary generalized
Brief episodes of impaired consciusness with no aura or postictal confusion:
Absence seizures
Absence seizure duration:
Typically less than 20s
Petit mal:
Absence seizure
Grand mal:
Tonic-clonic seizure
Generalized seizure originated from a Focal seizure:
Sencondary Generalized seizure
Exam required for all new-onset seizure in patients +30y:
cranial CT
Lab studies:
Electrolytes,
Low Na, Ca and Mg:
Electrolytes imbalance causes
Syncope, Migraine, Stroke, Febrile seizure and Psychogenic non-epileptic seizure:
DDx
Drug of choice for absence seizures:
Ethosuximide
Drug of choice for generalized seizure:
Valproate
Drugs that have the broadest spectrum of action:
Topiramate and Lamotrigine
Continuous video-EEG:
5-7d of monitoring
3Hz spike and wave pattern:
Absence seizure
Anticonvulsivant for pregnant:
Carbamazepine or Levetiracetam