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NS Exam4 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

spell

A

non-specific term for a sudden paroxysmal event

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2
Q

seizure

A

manifestation of abnormal excitation and synchronization of a group of cortical neurons

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3
Q

epilepsy

A

a diagnosis of two or more unprovoked seizures separated by greater than 24 hours or one seizure with studies (EEG/MRI) suggesting further risk of seizures.

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4
Q

syndrome

A

a constellation of common clinical pathological and electrographic features (lennox-gastaut syndrome)

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5
Q

provoked seizure

A

a seizure triggered by a brain injury or insult that would have reasonably resulted in a seizure in any person and if removed or avoided would likely lead to cessation of seizures (alcohol, TBI, hypoglycemia, febrile seizures)

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6
Q

types of seizures

A

focal onset
generalized onset
unknown onset

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7
Q

most common area of seizures

A

temporal or frontal lobes

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8
Q

types of epilepsy

A

generalized
focal
combines
unknown

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9
Q

pathology of seizures

A

1) too much excitation - ionic (inward Na and Ca currents) and neurotransmitters (glutamate and aspartate)
2) too little inhibition - ionic (inward Cl and outward K currents) and neurotransmitters (GABA)

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10
Q

B6

A

cofactor that converts glutamate to GABA (from excitation to inhibition)

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11
Q

complications of generalized convulsive status epilepticus

A 
rhabdomyolysis
hyperthermia
orthopaedic
aspiration pneumonia
neuronal injury (cerebral edema) 
cardiac/Resp. arrest
hepatic failure
renal failure
hypotension
death
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12
Q

evolution of seizures

A

!) precipitating injury or initial epileptogenic trigger

2) latent period for months to years
3) emergence of chronic epilepsy/spontaneous recurrent seizures

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13
Q

non-epileptic spells

A

also called psychogenic seizures/pseudoseizures
a form of conversion disorder
1/3 have identifiable risk factors (depression, anxiety, PTSD, abuse history, combat)
can coexist with epilepsy (mixed disorder)
treat with CBT

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14
Q

seizure recurrence rates

A

about 50% with new onset seizures will have recurrence

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15
Q

factors for treating seizures

A 
focal neuro exam
lesion on imaging
unprovoked
abnormal EEG
focal seizure
long seizure
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16
Q

factors against treating seizures

A 
normal neuro exam
normal imaging
provoked
normal EEG
generalized seizure
short seizure
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17
Q

AEDs for generalized/partial seizures

A 
ethosuximide (absence only) 
valproate
lamotrigine
topiramate
levetiracetam
felbamate
rufinamide (gen. only) 
clobazam (gen. only)
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18
Q

AEDs for partial-only seizures

A 
phenobarbital
phenytoin
carbamazepine
oxcarbazepine
gabapentin 
tiagabine
zonisamide
pregabalin
lacosamide
ezogabine
19
Q

special populations with AEDs

A

elderly: reduce doses, avoid certain meds
pregnancy: close monitoring, dose changes, concern about birth defects
children: liquid formulations, reduced doses, certain meds approved

20
Q

AEDs without interactions

A

gabapentin, pregabalin, levetiracetam

21
Q

risks with surgical treatment of seizures

A

memory loss, language problems, weakness, incoordination, vision problems, common surgical risks

22
Q

vagal nerve stimulation for seizures

A

palliative, seizure freedom is rare, 50% have 30-70% reduction of symptoms
most common side effect is hoarseness

23
Q

responsive neurostimulation for seizures

A

neurostimulator implanted in the skull at sites of seizure onset, records and responds to seizures by delivering electrical impulses

24
Q

DBS for seizures

A

DBS for bilateral ant. nuclei of the thalamus, median seizure reduction 69% at 5 years, improved QOL

25
Q

factors that promote seizures

A

missing meds, sleep deprivation, alcohol use, recreational drug use, infections, menstration

26
Q

seizures and driving restriction

A

varies by state from no restriction to a while year restriction in NY and VT, mandatory reporting in western coast states

27
Q

treating drug resistant epilepsy

A

50% are seizure free with 1st drug
12% are seizure free with 2nd drug
4% are seizure free with 3rd drug
34% are drug resistant (pharmaco-resistant epilepsy)
*only do surgery if they fail at least 2 different treatments that are appropriately selected

28
Q

absence seizures

A

characteristic 3Hz spike and wave discharge on EEG

29
Q

febrile seizures

A

seizure in infancy or childhood associated with fever but without evidence of intracranial infection or defined cause. Most common childhood seizure, usually presents 6months - 3 years.
*seizure with fever in kids who have had previous non-febrile seizures are excluded

30
Q

simple febrile seizures

A

generalized (both sides)
less than 10-15 minutes
don’t reoccur within 24 hours

31
Q

complex febrile seizures

A

focal at onset or during
longer than 10-15 minutes
recur in less than 24 hours
*20-30%

32
Q

timing of febrile seizures

A

usually within first 24 hours of illness
not due to rapid rise in fever, preventing fever with tylenol wont stop them
can begin to tolerate a higher fever over the course of the illness

33
Q

recurrence with febrile fever

A

25-40% recur

50% with one recurrence will have a third

34
Q

risk factors for recurrence of febrile fevers

A 
less than 1 y/o
positive family history 
low grade fever
brief fever
complex febrile fever
baseline neurodevelopmental abnormality 
day care attendance (more frequent illnesses)
35
Q

development of epilepsy after febrile fevers

A

increased risk with complex febrile seizures, neurologically abnormal prior to seizures, family history of afebrile fevers
treating with AEDs doesn’t prevent later epilepsy

36
Q

lennox-gastaut syndrome

A

multiple seizure types (tonic - often nocturnal - atonic, myoclonic, atypical absence - slower 2Hz spike and wave - focal
cognitive dysfunction can evolve later but not always
onset usually 1-7y/o with first seizure 3-5y/o but can happen into adulthood
*have to diagnose over time not at the first seizure

37
Q

causes of lennox-gastaut syndrome

A

cerebral malformations, hypoxic-ischemic injury, encephalitis, meningitis, tuberous sclerosis, preceeded by infantile spasm (9-40%)

38
Q

how long must you be on AEDs before considering weaning off

A

2 years seizure free

consider EEG prior to weaning

39
Q

medications that can worsen some seizures

A

lamotrigine: can worsen myoclonic seizures

phenytoin, carbamazepine, oxcarbazepine, and gabapentin can worsen generalized seizures

40
Q

important side effects of AEDs

A

avoid valproic acid in teenagers b/c polycystic kidney disease and fetal issues
no valproic acid for children under 2y/o b/c fatal liver toxicity
avoid topiramate or zonisamide with acidosis in kids

41
Q

ketogenic diet for drug resistant epilepsy

A

high fat, low carbs, protein control
useful for kids more than adults
useful for all seizure types, but less so for partial seizures
7% seizure free
20% have at least 90% seizure reduction
50% have at least 50% seizure reduction
*b/c limited efficacy only use after meds fail

42
Q

adverse effects of ketogenic diets

A

hunger, hypoglycemia, drowsy, lethargy, irritability, nausea, vomiting (because of low blood sugar and ketone buildup), dehydration, refusal to eat, excessive ketosis (acidosis)

43
Q

chronic effects of ketogenic diets

A

refusal to eat, hyperlipidemia, low free and total carnitine, constipation or diarrhea, Zn deficiency (hair thinning and loss), acidosis, hyperuricemia, hypocalcemia, suboptimal growth, kidney stones, prolonged QT interval, increased bruising and bleeding, pancreatitis, immunosuppression

NS Exam4 (22 decks)

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