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Neuro Round 2 wk 1 > Epilepsy and Seizure Disorders > Flashcards

Epilepsy and Seizure Disorders Flashcards

1
Q

paroxysmal episodic event caused by abnormal cortical electrical activity is …

A

seizure

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2
Q

genetic or acquired factors change the physiology of synapses to favor …. during a focal seizure

A

excitation over inhibition, as well as neuronal hypersynchrony

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3
Q

in generalized seizures, decreased inhibition from … to … results in enhance synchronization allowing thalamocortical neurons to fire simultaneously.

A

thalamoreticular neurons to thalamocortical neurons

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4
Q

focal onset seizure with preserved awareness is called…

A

simple partial seizure

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5
Q

focal onset seizure with impaired awareness is called…

A

complex partial seizure

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6
Q

generalized onset seizures will affect…

A

both hemispheres

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7
Q

What are some major imitators of seizures?

A

vasovagal

psychogenic nonepileptic seizure

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8
Q

What are key differences you will see in vasovagal syncopy from generalized seizure?

A
  • vasovagal
    • triggers - pain, anxiety, dehydration, stress
    • lightheaded or dizzy
    • usually while standing
    • atonic
    • myoclonic jerks terminate when laying flat
    • brief confusion
  • generalized seizure
    • any position
    • abrupt LOC
    • fast, tonic fall
    • side of tongue injury
    • unusual posturing
    • prolonged confusion
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9
Q

What is characteristic of a Psychogenic Non-epileptic event?

A
  • relatively dramatic - weeping, moaning, crying, coughing
  • tonic/clonic element is unchanged
  • no self-injury
  • eyes closed and pt resists eye opening
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10
Q

Where can EEGs not record seizures on the brain?

A

orbitofrontal or frontal opercular cortex

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11
Q

What causes an increased risk for seizures?

A
  • remote symptomatic seizure
  • abnormal EEG
  • significant MRI abnormality
  • nocturnal seizure
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12
Q

A seizure within 7 days of a stroke, brain trauma, encephalitis/meningitis would be considered…

A

acute symptomatic seizure

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13
Q

a seizure from a prior/static brain injury would be considered…

A

remote symptomatic seizure

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14
Q

If someone presents with one or multiple seizures withing 24 hours, who is more likely to have a recurrence?

A

no difference in recurrence

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15
Q

Delay in drug initiation until after the second unprovoked seizure will do what?

A

will not influence chance of long term remission

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16
Q

what is the definition of epilepsy?

A

disease with either recurrent seizures (>=2 unprovoked seizures that are <24 hrs apart) OR a heightened tendency toward future seizures

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17
Q

What is the goal of epilepsy treatment?

What if our goal is not met despite two or more AEDs on board?

A

goal is seizure free

pt has drug-resistant epilepsy and sx should be considered

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18
Q

Epileptics have an increased risk of what?

A

sudden death

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19
Q

What four AEDs are inducers of Cyt P450?

A

phenytoin

carbazepine

phenobarbital

primidone

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20
Q

What two AEDs have nonlinear kinetics and levels increase disproportionately to dose?

A

phenytoin (saturable metabolism)

carbamazepine (autoinduction)

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21
Q

What kind of drugs may worsen generalized and myoclonic seizures and should be avoided in idiopathic generalized epilepsy?

A

traditional sodium channel blockers:

phenytoin, carbamazepine, oxcarbazepine

22
Q

What is one of the most serious AEs of AEDs, especially phenytoin?

A

steven johnsons syndrome

23
Q

Common side effects of AED topiramate include…

A

metabolic acidosis and nephrolithiasis

24
Q

What is the MC form of epilepsy in adulthood?

A

Adult Focal Epilepsy

Mesial temporal lobe epilepsy more often than lateral temporal lobe

25
Q

In a mesial temporal lobe epilepsy event, how do you know what side the seizure focus is on?

A

The hand that wipes the nose first after a seizure is typically ipsilateral to the seizure focus

26
Q

What are symptoms associated with Mesial Temporal Lobe epilepsy?

A
  • aura: psychic (dejavu), gastric rising, olfactory hallucination
  • loss of conscious awareness, oral/manual automatisms, CL limb dystonic posturing with ipsilateral hand automatisms
  • 60-90 second duration
  • rarely generalizes
27
Q

What is the second MC focal epilepsy?

Is it shorter or longer in duration than temproal lobe epilepsy?

When do they occur?

A

Frontal Lobe Epilepsy

shorter duration

occur more often in sleep

28
Q

In what kind of seizure are you likely to see ‘Jacksonian March’ or head turning/eye deviation CL to seizure focus or even ‘fencing’?

A

dorsolateral frontal lobe

29
Q

What kind of seizure will present as speech and motor arrest with later motor elements and possibly proximal motor (hypermotor) activity?

(abnormal pelvis movement)

A

Frontopolar/orbitofrontal seizure

30
Q

an opercular/cingulate seizure may present as…

A

fear or emotion

31
Q

With Frontal Lobe Epilepsy, usually there is only a brief post-ictal confusion but there may be…

A

frank paralysis/Todd’s paralysis that slowly resolves

32
Q

What is the difference between simple and complex febrile seizures?

A
  • simple
    • nonfocal convulsions <15 minutes
  • complex
    • convulsions >15 minutes or more than one event in 24 hours
33
Q

>30 minutes of seizure associated with HHV-B6 virema or associated with hippocampal sclerosis

A

febrile status epilepticus

34
Q

To dx a febrile seizure in a child >1 month old, what must be ruled out?

A

hypoglycemia, hyponatremia, and dehydration

35
Q

What increases risk of recurrence of febrile seizure?

A

younger age at onset

36
Q

If there is a family hx of seizures, what should you be thinking for dx of child with febrile seizures? What is this?

A

GEFS+

Generalized Epilepsy with Febrile Seizures Plus

  • onset 6 mo to 6 yo
  • multiple sz types
  • drug resistant
  • self-limited
  • resolves by puberty
  • normal development
37
Q

What is an extreme form of GEFS+?

A

Dravet Syndrome a/w Reflex sz

38
Q

What is the MC epileptic encephalopathy? When does it occur and what is the triad that goes with it?

A
  • West Syndrome
  • onset first 2 y
  • triad
    • epileptic spasms (baby jerking forward, chin to chest)
    • hypsarrhythmia on EEG (pure chaos)
    • psycomotor arrest/regression
39
Q

What is the treatment and what is the most often prognosis?

A

ACTH, prednisone, Vigabatrin

Most have intellectual disability; 50% develop Lennox-Gastaut syndrome or other forms of epilepsy

40
Q

male in preschool, intellectual disability, multiple sz types (predominantly tonic seizures)

less than 3 Hz EEG

rarely achieve seizure freedom

A

Lennox-Gastaut Syndrome

41
Q
  • onset 7-8 yo, cant talk, is drooling
  • m >f
  • previously well, presenting with focal sz involving lower face or early morning generalized tonic-clonic seizure

Dx?

Prognosis?

A
  • Benign epilepsy with Centrotemporal Spikes (Rolandic Epilepsy)
  • MRI normal, prognosis v good, AED not always needed
42
Q
  • 5-7 yo (f>m)
  • abrupt blank stare with eyelid fluttering lasting <30 seconds
  • 3Hz spike wave complex

Dx?

Tx?

A

Absence Seizures

ethosuximide

43
Q

What type of seizure usually has a structural cause and responds to carbamazepine?

A

partial complex

44
Q

What is the MC genetic generalized epilepsy?

How does it present?

What is the tx?

A

Juvenile Myoclonic epilepsy

  • generalized tonic/clonic seizure provoked by sleep deprivation, stress, etoh, flashing lights with myoclonic jerks in the morning
  • female tx - levetiracetam
  • male tx - valproic acid
45
Q

two seizures occurring back to back without return to patient baseline or one seizure lasting at least 5 minutes is considered -

A

status epilepticus and a medical emergency

46
Q

What happens in the brain with a prolonged seizure?

A

protein phosphorylation, NT modulation, GABA receptor endocytosis and degradation, glutamate receptor recruitment into synapsis, neuropeptide modulation

longer goes on, harder to turn off

47
Q

What are three ways to treat status epilepticus?

A
  • IM midazolam
  • IV lorazepam
  • rectal diazepam

BENZOS

48
Q

Should I be concerned about pregnant women with epilepsy?

A
  • 10x increase mortality in women with epilepsy during pregnancy and post partum period
  • route of major congenital malformations
  • AED exposure in utero increases major congenital malformation incidence (esp. valproic acid)
49
Q

What three drugs should I definitely avoid giving my pregnant epilpetic pt?

A

topiramate

valproate

phenobarbital

50
Q

What AEDs are okay to give in pregnancy?

A

lamotrigine and levetiracetam

51
Q

Valproate is likely to cause what congenital issue while barbituates risk…

A

valproate - neural tube defects, hypospadias

barbituates - cardiac malformations

52
Q

What should I warn my nonpregnant pt on OCP and AED?

A

AEDs can increas rate of metabolism of OCP - should use second form of protection

Neuro Round 2 wk 1 (15 decks)

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