EPILEPSY Flashcards
Broadly, what are the types of epileptic seizures?
- Partial
- Generalized
- Unclassified
What are the types of PARTIAL seizures?
- simple
2. complex (with IMPAIRED consciousness)
What are the diff. types of generalised seizures?
- Absence- pt stares in to mid air
- TONIC-CLONIC seizure: pt collpases and WRITHES on the ground
- ATONIC- pt becomes FLACCID and collapses
- MYOTONIC- rhythmic jerking
Pt comes in with complaint of seizure. What is done?
- blood work + glucose
- EKG
- EEG
- CT/ MRI brain imaging
- LP (meningitis/ encephalitis is suspected)
What is meant by having a partial seizure?
- involved only ONE part of the brain
What is meant by generalized seizure?
- involves the ENTIRE brain
Can a partial seizure become generalized?
- YES
- it may start off as a partial seizure and then it may become generalized
Name some psychic symptoms.
What are they usually a.w?
- dysphasia
- deja vu
- fear
- HALLUCINATIONS
- distortions of time
—–SEEN with partial seizures (involvment of HIGHER cortical areas)
What are autonomic symptoms that may occur with seizures?
- sweating
- piloerection
- pupillary changes
- epigastric rising sensation
Which autonomic symptom acts as an aura with medial TEMPORAL LOBE epilepsy?
- epigastric sensation
What actually is an AURA?
- a SIMPLE, PARTIAL SEIZURE
- no altered consciousness (affects only part of the brain > some symptoms)
What are some examples of auras?
- flashing lights (if OCCIPITAL lobe is involved)
- Muscle jerking (motor cortex is affected) —jacksonian seizure
- sudden Smell
How to differentiate cardiac syncope from seizures?
- NO post-ictal state of confusion is seen with cardiac syncope
-in seizures: confusion and lack of alertness
(mins> hrs)
What is the common site of partial seizures?
TEMPORAL LOBE
What condition of the brain leads to the involvement of the temporal lobe?
Dx is by _____
- MESIAL Temporal Sclerosis
- —aka hippocampal sclerosis (Neuronal loss in hippocampus)
– MRI
Juvenile myoclonic seizures are commonly seen in whom______?
And how may it progress>
children
- 5y.o: absence seizures first
- 15 y.o: MYOCLONIC seizures …GRAND MAL after
What is the HALLMARK of JME?
- MYOCLONIC jerks on awakening from sleep
- shock-like, irregular movements of both arms
What is the first line rx of JME?
- SODIUM VALPROATE
What drug is C.I for myoclonic, tonic and atonic seizures?
- Carbamazepine and Oxcarbamazepine
What is childhood absence epilepsy like?
- sudden impairment of consciousness
- NO change in body tone
- REMITS by puberty
What helps to identify the type of seizure?
-EEG
Will a pt have post-ictal confusion with absence epilepsy?
NO
How to treat childhood ABSENCE epilepsy>
-ETHOSUXIMIDE
Women having eclampsia is treated with what?
MgSO4
How to treat the COMPLEX partial seizures that arise from hippocampal sclerosis?
- LAMOTIGRINE
- CARBAMAZEPINE
How to treat IIary generalized seizures?
- LAMOTIGRINE
- CARBAMAZEPINE
What is the use of carbamazepine?
-FOCAL onset seizure
auras
Why is SODIUM VALPROATE not that great a choice for seizure?
many S.Es
wgt GAIN, HAIR LOSS, teratogenic/FATIGUE
When is phenytoin used?
ACUTE management only
Which is ideal anti-convulsants and why?
- LEVETIRACETAM
well-tolerated/ moodswings
Can lamotigrine be given for BOTH focal and generlaized seizures?
YES
Which anti-convulsant also acts as a sedative?
TOPIRAMATE
—-also causes WGT loss
How do anti-convulsants affect contraceptives?
- AEDs are enzyme inducing
- —-MORNING after pill should be INCREASED
- efficacy of COC pill is altered
- depot progesterone needs MORE freq. dose and implants suck
Name some anti-convulsants.
carbamazepine
phenytoin
phenobarbitol
topiramate
What is status epilepticus?
- recurrent epileptic seizures WITHOUT full recovery of consciousness
- LASTs MORE than 30 mins
What are the diff. types of STATUS epilepticus>
- generalized convulsive Status epilepticus
- NON-convulsive status (altered state)
- epilepsia partialis continua (continual focal seizures/ consciousness preserved)
What precipitates status epilepticus?
- infection/ trauma/ sub-arachnoid hemorrhage/ abrupt WITHDRAWAL of anti-convulsants
- metabolic disorders (PYRIDOXINE/ hyponatremia)
How to treat absence seizures?
CBZ
What is the danger of status epilepticus?
- excess cerebral energy demand and POOR substrate delivery
> DAMAGE !
—-respiratory insufficiency and hypoxia
—hypotension
– hyperthermia
—rhabdomyolysis
Steven-Johnson $ may occur following exposure to which AED?
- Phenytoin
- Lamotigrine
What are the long term effects of Phenytoin?
- hirsutism
- megaloblastic anemia
- gingival hyperplasia
