Epilepsy,seizure ,status Epilepticus And Covid-19 Flashcards
What are seizures and epilepsy
Seizures are sudden abnormal electric discharges from the brain that result in changes in the sensation,behavior ,movement ,perception or consciousness
Epilepsy is derived from the Greek word epilepsia meaning seizure.
It is the chronic disorder of recurrent seizures
What is Coronavirus(what family does it belong,what characteristic do the members show),coronavirus disease 2019,where does the virus infect?
Coronavirus is an enveloped, positive single-strand RNA virus. It belongs to the Orthocorovirinae subfamily, as the name suggests, whose members show characteristic ‘crown-like’ spikes on their surfaces.
•Coronavirus disease 2019 (COVID-19) is a contagious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This kind of virus infects the nose, sinuses or upper throat. The first known case was identified in Wuhan, China, in December 2019. It was initially reported to the WHO on December 31st, 2019 and that was how WHO derived the acronym COVID-19 meaning Coronavirus disease 2019.
On January 30, 2020, the WHO declared Covid-19 outbreak a global health emergency and on March 11, 2020, the WHO declared Covid-19 a global pandemic.
•Global cases of COVID-19 continue to rise, causing havoc to several economies. As of January 22nd, 2022, confirmed COVID-19 infections numbered over 359 million individuals worldwide and have resulted in over 5.62 million deaths. In Ghana COVID-19 infections numbered over 156,392 and have resulted in 1,384 deaths. All 16 administrative regions had recorded cases of COVID-19 by June 30, 2020 due to internal migration between the hotspots and other regions.
•From observation of patients presenting to health centres around the world suggests that, over 80% of symptomatic individuals with COVID-19 develop mild or uncomplicated illness, and approximately 14% develop severe disease requiring hospitalization and oxygen support, while 5% may have very severe illness requiring admissdion to an Intensive Care Unit (ICU) with ventilators for care
True or false
True
What is the Cause of CoVid disease,the virus was first isolated from three people with what ?
What is the mode of transmission
Although the virus is widely believed to have originated from animals, there is insufficient scientific evidence to identify the specific animal reservoir or the original mode of transmission of the disease to humans.
•However, SARS CoV-2 was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.
The spread of the disease in humans, however, is currently known to be from person to person, mainly through droplets arising from people sneezing, coughing, speaking or exhaling, which deposit on surfaces.
•The virus may be transferred from contaminated surfaces to mucosal surfaces (eyes, nose, mouth), via the hands.
•Aerosol transmission is also possible when people have prolonged exposure to high concentrations of droplets in relatively closed spaces.
Which four people are at risk of COVID -19
Individuals who have had close contact with a person with known or suspected COVID-19 ( at least, last 14 days)
•International travelers (high at risk countries of infection)
•Aged people
•People with chronic underlying medical conditions such as cardiovascular disease,diabetes, chronic respiratory disease, hypertension and immunosuppression.
What is the pathophysiology of CoVId-19
Inflammation of the lungs will cause what ?
SARS-CoV-2 virus can infect a wide range of cells and systems of the body. COVID‑19 is most known for affecting the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs).
•The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the receptor for the enzyme Angiotensin-Converting Enzyme-2 (ACE-2), which is most abundant on the surface of type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a “spike” to connect to the ACE-2 receptor and enter the host cell.
- ACE-2 receptors are also expressed in myocardial cells, renal epithelial cells, enterocytes, and endothelial cells in multiple organs, which may explain the extrapulmonary manifestations associated with the disease.
- Inflammation of the lungs will cause fever, shortness of breath and cough
What are the most common symptoms ,less common symptoms,serious symptoms of this Covid-19 disease
State four of each
Most common symptoms:
●Fever
●Cough
●Tiredness
●Loss of taste or smell
Less common symptoms:
●Sore throat ●Headache ●Diarrhea ●Rashes on skin, or discoloration of fingers or toes ●Red or irritated eyes
Serious symptoms:
●Difficulty breathing
●Loss of speech or mobility, or confusion
●Chest pain
●Loss of appetite,
When the Coronavirus disease affects the lungs ,the heart,the brain,spleen,pancreas,liver,kidney,GIT system state theee symptoms of each that show
Lungs:dyspnea
Chest pain
Cough
Pancreas:pancreatitis
Pancreatic injury
Heart: Chest pain Myocardial inflammation Palpitations T serum troponin
Brain: Brain fog Delirium Fatigue Sleep disturbances Depression/anxiety/PTSD/OCS
Spleen:
Decreased T and B lymphocytes
Atrophy of lymphocyte follicles
Liver:
Liver injury
Increased Aspartate aminotransferase
Increased Alanine aminotransferase
Renal:
Renal impairment
Acute kidney injury
GIT:
Diarrhea
Nausea
Sore throat
Blood vessels: Inflammation Vessel damage Coagulopathy Microangiopathy
State six signs of coronavirus disease
Fever (body temperature ≥ 37.5oC) •Tachypnea •Tachycardia •Cyanosis •Flaring of nostrils •Signs of consolidation on chest examination
- Use of accessory muscles of respiration (plus intercostal in-drawing etc.)
- Restricted chest wall movement (unilateral or bilateral)
- Drowsiness
- Restlessness or confusion
- Low blood oxygen saturation by pulse oximeter (SPO2 < 93%)
What are the four main investigations for COVID and four supportive ones
DIAGNOSTIC
•Polymerase chain reaction assay for SARS-COV-2 by nasal swabs
•Chest X-Ray (Patchy consolidation)
•Chest Computed Tomography: Ground glass changes
•Antibody testing
SUPPORTIVE •Full Blood Count (FBC): Raised leukocytes but lymphocytopenia •Liver Function Test •Electrocardiogram (ECG/EKG) •Blood Film for Malaria Parasites •Renal Function Test
State five ddx of coronavirus disease
What is the coMplication of this disease
Pneumonia •Tuberculosis •Asthma •Pleural effusion •Chronic Obstructive Pulmonary Disease •Congestive Cardiac Failure •Lung collapse
Complication
Acute Respiratory Distress Syndrome (ARDS)
How is coronavirus disease prevented
State the vaccines available
Wear a mask in public, especially when physical distancing is not possible
•Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
•Maintain a safe distance from others (at least 1 metre), even if they do not appear to be sick
•Clean your hands often. Use soap and water, or an alcohol-based hand rub
Stay home if you feel unwell. •Monitor your health daily •Get vaccinated; Vaccines available include; oPfizer vaccine oJohnson and Johnson oModerna vaccine oAstraZeneca vaccine oSputnik V vaccine
How is coronavirus disease treated
(Treatment objectives,non pharmacological treatment for kids,for all age groups) state five of the treatments for each
Treatment objectives;
•To prevent person to person transmission
• To alleviate symptoms of the disease
•To prevent and/or manage complications of the disease
• To treat secondary bacterial or other infections
• To eradicate the COVID-19 infection
Non Pharmacological;
●For children
•Tepid sponging to control fever i.e. children < 5 years
•Adequate fluids e.g. breast milk, porridge, coconut water
•Feed as can be tolerated during the episode. Give an extra meal per day for two weeks after recovery
Non Pharmacological
●For all age groups
•Early quarantine of suspected cases and self-quarantine of all contacts of confirmed cases with follow up
•Mechanical ventilation for respiratory distressed patients
•Cessation of smoking
• Physical exercise and Rest
•Lukewarm salt solution gargle 3 to 4 times daily
•Psycho-social support by counselling patients and contacts
What is the pharmacological management of coronavirus disease
State the drugs and how they work
●Pharmacological
•Anti-Viral Drugs
•. Remdesivir was the first drug approved by the FDA. The broad-spectrum antiviral is a nucleotide analog prodrug
Use of Corticisteroids as Supportive Care
•Use of corticosteroids improve survival in hospitalized patients with severe COVID-19 disease requiring supplemental oxygen.
•In other words, patient who requires mechanical ventilation needs it for bronchodilation and anti-inflammatory
ANTITHROMBOTICS
•A review of COVID-19 hypercoagulopathy describes both microangiopathy and local thrombus formation.
• Systemic coagulation defect leading to large vessel thrombosis and major thromboembolic complications, including pulmonary embolism, in critically ill patients.
•While sepsis is recognized to activate the coagulation system, the precise mechanism by which COVID-19 inflammation affects coagulopathy is not fully understood.
What is the pharmacological treatment of confirmed asymptomatic cases
State the first line and second line treatment
1st line treatment
Hydroxychloroquine, Oral
2nd line treatment
Chloroquine, Oral
What is the TREATMENT(Confirmed cases with Mild/Moderate symptoms) for COVID disease
First line and second line
TREATMENT(Confirmed cases with Mild/Moderate symptoms)
•1st Line Treatment
•Hydroxychloroquine, Oral
And
•Azithromycin or Doxycycline
•2nd Line Treatment
•Chloroquine, Oral
And
•Azithromycin or Doxycycline
What are the four drugs used to treat confirmed cases of COVID disease with severe disease
TREATMENT(Confirmed cases with severe diseases) •Hydroxychloroquine, Oral •Azithromycin or Doxycycline •Convalescent plasma •Methylprednisolone, IV
What are the nine major causes or triggers of seizures (remember VITAMIN DE) and give four examples of such causes under each cause
About (60-70 ) % of all cases have unknown origin
• -Vascular causes( common in focal types of seizures)
-acute ischemic strokes
-intra-cerebral hemorrhage
-subarachnoid hemorrhage
-anoxia( anoxic brain injury) (absence or supply of oxygen), extreme hypoxia
Specifically, anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues although there is adequate blood flow to the tissue. Hypoxia is a condition in which there is a decrease of oxygen to the tissue in spite of adequate blood flow to the tissue.
- -Infectious causes
- meningitis
- encephalitis
- Brain abscess- traumatic causes
- traumatic brain injury leading to
- epidural hematoma
- subdural hematoma - autoimmune causes
- systemic lupus erythematosus
- traumatic causes
Quick way to remember : VITAMIN D,E
- metabolic causes
- hypoglycemia
- hyponatremia
- hypocalcemia
- increased in metabolic waste ( urea , ammonia)
- hyperthyroidism
- idiopathic causes
- epilepsy
- Neoplastic causes
- brain tumor
- meningioma
- etc
- drugs causes
- opiods
- TCA’s
- cocaine
- ampitamines
- metronidazole
- alcohol withdrawal
- etc
- degenerative diseases like Alzheimer’s disease and demyelinating diseases like multiple sclerosis
- everything else
- eclampsia
- fever
- genetic causes
What are the causes of epilepsy
What are the causes of seizures in newborns and infants and kids before the age of 20yrs,people after the age of 20yrs,people older than 65 years
Can be caused by any process that disrupts the stability of the neuronal cell membrane
It’s idiopathic
Newborns:
Congenital brain defects ,birth injuries,metabolic problems such as anoxia,hypoglycemia,hypocalcemia,périnatal seizures
After 20:
Traumatic brain injury
Brain tumour
Infection
Older than 65: CVA Tumor Delirium Alzheimer’s disease Infection Brain trauma Chronic alcoholism
Why do seizures develop?
Hat protects the brain
The brain is dived into four structural parts name them
The cerebral hemisphere accounts for how much of total Brain mass and how many lobes does it have
Mention em
What are the functions of the brain
Seizures develop due to an imbalance between inhibitory and excitatory signals in the brain.
The brain is a sensitive organ protected by the rigid bone of the skull . The brain is divided into four structural parts: cerebrum, diencephalon, brainstem and cerebellum. The cerebral hemisphere accounts for about 83% of the total brain mass and it has five lobes: frontal, parietal, occipital, temporal and insular lobes.The brain coordinates the functions of the body by controlling the activities of the neurons which are specialized nerves that conduct electrical impulses throughout the central nervous and peripheral systems. To fulfil their functions of controlling cognitive activities, sensory perception and skeletal muscle contractions, the nerve cells (neurons) of the brain must work in harmony.
What is the pathophysiology of seizures
Seizure occurs basically due to excessive firing of the neurons and fast spread of these impulses over the brain.
-that is , there are two phenomenons in the pathophysiology of a seizure:
•Hyper excitability of a neuron
•hyper synchronization
- Hyper synchronization means that a hyper-excitable neuron leads to excessive excitability of a large group of surrounding neurons. This means that when a large electrical impulse is generated in one part of the brain from a focus of tissues millions of neurons in the brain fire excessively in addition bringing on a seizure.
•In summary the hyperexcitable state associated with epilepsy results from excessive excitatory transmission, reduced inhibitory neurotransmission, or both. If abnormal, excessive electrical activity spreads over an area large enough, then a seizure may develop.
What is the pathophysiology of epilepsy(state the abnormal first)
State the abnormal neuronal activity
Excitatory and Inhibitory Synaptic Signaling
- Neurons talk to each other by passing chemical signals called neurotransmitters across small gaps known as synapses. Presynaptic neurons release neurotransmitters which then diffuse across the synapse before binding to the receptor on the postsynaptic neuron. This process is called synaptic transmission. - The binding of a neurotransmitter to its corresponding receptor exerts specific effects on the postsynaptic cell, for example by influencing its membrane potential. Accordingly, we can broadly divide neurotransmitters into excitatory and inhibitory.
Excitatory and Inhibitory Synaptic Signaling
-brief on synaptic transmission
• Synthesis of acetylcholine occurs in the presynaptic neuron
•Acetylcholine is stored in vesicles within the presynaptic neuron
•The influx of calcium ions following the depolarization of the presynaptic terminal initiates the fusion of vesicles with the presynaptic membrane
•Neurotransmitter is released into the synaptic cleft by a process known as exocytosis
•Neurotransmitter diffuses across the synaptic cleft and binds to nicotinic acetylcholine receptors on the postsynaptic membrane
•Acetylcholine is broken down by acetylcholinesterase into choline and acetate
•Choline is taken up the presynaptic neuron for further production of acetylcholine
Excitatory and Inhibitory Synaptic Signaling
-Neurotransmitters can be broadly divided into excitatory and inhibitory:
•Excitatory neurotransmitters increase the likelihood of postsynaptic neuron depolarization and generation of an action potential
•Inhibitory neurotransmitters reduce the likelihood of postsynaptic neuron depolarization and generation of an action potential.
•An example of the excitatory neurotransmitter is glutamate, whereas GABA is an inhibitory neurotransmitter. Some neurotransmitters, including dopamine, may exert both excitatory and inhibitory effects by binding to different receptors.
Excitatory Synaptic Signaling
-Glutamate is the most abundant neurotransmitter in the vertebrate nervous system. It exerts its effects via ionotropic receptors such as kainate, AMPA or NMDA receptors as well as metabotropic receptors – mGlu1-mGlu8.
-Upon binding of glutamate molecules to a receptor such as AMPA receptor(The α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (also known as AMPA receptor, AMPAR, or quisqualate receptor) is an ionotropic transmembrane receptor for glutamate (iGluR) that mediates fast synaptic transmission in the central nervous system (CNS).), its integral ion channel opens and ions( sodium and potassium ) flow across the postsynaptic neuronal membrane.
Inhibitory Synaptic Signaling
- GABA is the major inhibitory neurotransmitter in the mammalian nervous system. Similarly to glutamate, it acts via ionotropic receptors – GABAA receptors– as well as metabotropic receptors – GABAB receptors. - the binding of GABA to GABAA receptors induces the opening of ion channels that are selectively permeable to chloride ions. Consequently, GABA causes chloride ions to flow across the postsynaptic membrane. As chloride ions are more abundant extracellularly, they will flow down their concentration gradient into the cell, producing a hyperpolarising current and hence generating a hyperpolarising inhibitory postsynaptic potential. - This takes the postsynaptic membrane away from the action potential threshold, thus inhibiting the postsynaptic cell.
Abnormal neuronal activity:
Abnormal neuronal activity
-Normally brain tissues prevent hyper excitability by several inhibitory mechanisms involving negative ions like chloride ions.
-Disturbance in this normal excitability leads to hyper-excitability
- In this state there is increases excitatory transmission of impulses and decreases inhibitory transmission
•Mechanism of seizure formation
• Excitation of a group of nerves. This is caused by inward currents of Na, Ca and involvement of excitatory neurotransmitters like Glutamate and Aspartate.
- Too little inhibition.
- Epileptogenesis, hyperexcitability and hyper synchronization of neurons that facilitates spread. There has to be abnormal synchronization – a property of a population of neurons to discharge together independently. Alone, a hyperexcitable neuron cannot generate a seizure.
What are the two major types of seizures and the groups under them and explain each of them
Focal seizures:they result from abnormal electrical activity in one area of your brain .
They can occur with or without loss of consciousness
a.Focal seizures with impaired awareness:these seizures involve a change or loss of consciousness or awareness. They stare into space and not respond normally to the environment or they perform repetitive movements such as hand rubbing,chewing,swallowing,or walking in circles
b.Focal seizures with consciousness:These seizures may alter emotions or change the way things look,smell ,feel,taste or sound, but they don’t lose consciousness
They may result in involuntary jerking of a body part such as an arm or a leg, and spontaneous sensory symptoms such as dizziness,tingling and flashing lights
Generalized seizures :seizures that appear to involve all parts of the brain.
a.Absence seizures:previously known as petit mal seizure often occurs in kids and is characterized by staring into space or subtle body movements such as eye blinking or lip smacking . These seizures may occur in clusters and cause a brief loss of awareness
Episodes last less than 15secs
Tonic seizures:Tonic seizures cause stiffening of your muscles . They usually affect muscles in your back ,arms and legs and may cause you to fall to the ground
Atonic seizures:also knows as drop seizures cause a loss of muscle control which may cause sudden collapse or fall down
Clonic seizures:they’re associated with repeated or rhythmic jerking muscle movements. They usually affect the neck,face and arms
Myclonic seizures:usually appear as sudden brief jerks or twitches of arms and legs
Tonic-clonic seizures:previously known as grand mal seizures are the most dramatic type of epileptic seizures and can cause an abrupt loss of consciousness,body stiffening,shaking,and sometimes loss of bladder control,biting of tongue
Name five clinical manifestations of seizures
Can range from mild to severe and vary depending on the type of seizure
Temporary confusion A staring spell Uncontrollable jerking movements of the arms and the legs Loss of consciousness and awareness Cognitive or emotional symptoms such as fear,anxiety or deja vu Loss or alteration of basic senses Trembling or shaking Incontinence Numb and prickling sensation
State five tests used to evaluate or diagnose seizures
History Neurological exam Blood tests Lumbar puncture(between L3 and L4) An electroencephalogram (EEG) Computerized tomography (CT) Magnetic resonance imaging(MRI) Positron emission tomography (PET) Single photon emission computerized tomography (SPeCT)
State five ddx of seizures
Encephalitis Heatstroke Hypernatremia in emergency medicine Hyperosmolar hyperglycemic nonketonic coma Hypocalcemia I’m emergency medicine Hypoglycemia Hyponatremia Medication induced dystonic reactions Neuroleptic malignant syndrome Neurological manifestation of uremic encephalopathy Withdrawal syndrome
State and explain the five first aid steps for a person having a seizure
1.stay with the person until they are awake and alert after the seizure Time the seizure Remain calm Check for medical ID 2.keep the person safe Move or guide the person away from harm 3.turn the person to their side If they’re not awake or aware Keep airways clear Loosen tight clothes around the neck Put something small and soft under the head 4.call 911 if: Seizure last more than 5 minutes Patient doesn’t return to their usual state Person is injured,pregnant or sick Has repeated seizures First time seizure Difficulty breathing Seizure occurs in the water 5.do not restrain the person Don’t put any objects in their mouth Rescue medicines can be given if prescribed by a health professional
What is the emergency management of a person having a seizure
To maintain a Patent airway and prevent aspiration
Patient is placed in the side lying position
Seizure precautions are maintained,suction catheter and oral airway
Provide oxygen
Prevent complications (example aspiration ,injury)
The bed is placed in a low position
With side rails up and padded
What is the non pharmacological management of seizures(state the triggers to avoid and what lifestyle changes must be made)
Triggers: Missed or late medication which is the number one reason Stress or anxiety Lack of sleep or fatigue Hormonal changes Illness Alcohol or drug use Drug interactions from prescribed drugs or over the counter drugs Overheating or overexertion Poor diet or missed meals Flashing lights or hyperventilation
Life style changes: 1.Dietary: Avoid caffeine Avoid insulin spikes or eat a low glycemic diet No alcohol 2.Maintain a regular schedule 3.Get enough of sleep 4.avoid stress Use relaxation techniques 5.Avoid seizure triggers Flashing lights in only one to three percent of people w epilepsy
Pharmacological management of seizures and how the drugs work
How do phenytoin,cerebyx and carbamazepine work?
How do benzodiazepines and barbiturates work?
How do Valproic acid and lamotrigine work
Anticonvulsant-carbamazepine 500mg: Carbamazepine is used to treat certain types of seizures (epilepsy). It is also used to relieve pain due to trigeminal neuralgia (tic douloureux) and in the treatment of bipolar disorder (manic-depressive illness). Carbamazepine works in the brain and nervous system to control seizures, pain, and bipolar disorder.
Valproic acid: Valproic acid is an anticonvulsant (or anti-epileptic) medicine. It’s not fully understood how this medicine works for treating bipolar disorder. However valproic acid is thought to reduce or prevent manic episodes by increasing the amount of a chemical called gamma-aminobutyric acid (GABA) in the brain
Antiseizures:Phenytoin 50mg IV-Phenytoin, sold under the brand name Dilantin among others, is an anti-seizure medication. It is useful for the prevention of tonic-clonic seizures and focal seizures, but not absence seizures. The intravenous form, fosphenytoin, is used for status epilepticus that does not improve with benzodiazepines.
Phenytoin,fosphenytoin sodium(cerebyx ),carbamazepine work by blocking the initiation n or spread of seizures and suppress seizure spread through inhibition of specific voltage gated calcium channels
Valproic acid and lamotrigine inhibit sodium dependant action potentials thereby blocking the burst and firing of neurons
Benzodiazepines and barbiturates interact with GABA(gamma aminobutyric acid) receptors that facilitate seizure control
Lamotrigine, sold as the brand name Lamictal among others, is a medication used to treat epilepsy and stabilize mood in bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastaut syndrome.
What is Lennox-Gastaut syndrome
Lennox-Gastaut syndrome is a severe condition characterized by recurrent seizures (epilepsy) that begin early in life.
Lennox-Gastaut syndrome is a type of “epileptic encephalopathy.” This terms means that the frequent seizures and very abnormal EEG
What’s the surgical
Management of seizures
Selective amygdalohippocampectomy:two structures within the temporal lobe rat are commonly the genesis of seizure activity are removed
Temporal lobectomy:focal resection of part of the temporal lobe,usually on the right side is performed
Sub-pial resection:fine cuts are made into the motor areas of the brain that don’t control motor function but they prevent the spread of the seizure
Hemispherectomy:an entire damaged side of the brain is removed
Corpus callostomy:Fibres that connect the Two halves of the brain are cut
Vagus nerve stimulation:
A device implanted underneath the skin of the chest stimulates the vagus nerve in the neck sending signals to the brain that inhibit seizures
Deep brain stimulation:
Doctors implant electrodes within certain areas of the brain to produce electrical impulses that regulate abnormal brain activity . The electrodes are attached to a pacemaker like device placed under the skin of your chest which controls the amount of stimulation produced
State six complications of epilepsy
Car accidents:you could injure yourself or others if you have a seizure while driving
Drowning:people w epilepsy are 15-19 more times likely to drown than the rest of the population
Never swim alone
Emotional health difficulties:depression,anxiety and suicidal thoughts and actions are possible complications
Falling:certain types of seizures affect your motor movements functions during a seizure and you can fall to the ground ,hit your head on a nearby object or break a bone
Pregnancy related complications:women w epilepsy can get pregnant and have healthy babies but extra precaution is needed
Some anti seizure medications can cause birth defects
Status epilepticus:severe seizures
Ones that are prolonged or happen very frequently can cause status epilepticus
Sudden unexplained death in epilepsy (SUDEP) :this is possible in people w epilepsy but it’s rare
Drug toxicity:
If a person has arrhythmia you don’t give azithromycin in CoVId patients cuz azithro can cause abnormal electric charges in the heart true or false
Doxycycline targets atypical organisms but ceftriaxone targets specific organisms true or false
True
True
Benzodiazepines example is diazepam true or false
What is status epilepticus
What are the two major classification of this disease
State the types of epilepticus under each major class
True
DEFINITIONS
A condition characterized by epileptic seizures that
are sufficiently prolonged or repeated at sufficiently brief intervals so as to produce an unvarying an enduring epileptic condition (WHO 1973)
A seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between the attacks don’t occur and if there’s no recovery it can cause Brain damage
It occurs for five minutes or more than five minutes
…
Status epilepticus is a condition resulting either from
the failure of the mechanisms responsible for seizure
termination or from the initiation of mechanisms which can lead to abnormally prolonged seizure
CLASSIFICATION OF STATUS EPILEPTICUS Generalized convulsive status epilepticus: Tonic Clonic Status epilepticus Clonic status epilepticus Tonic status epilepticus Mycoclonic status epilepticus
Generalized non convulsive status epilepticus:
Absence status epilepticus
Simple partial (focal) Status epilepticus
Complex partial Status epilepticus
What is refractive status epilepticus
It is status epilepticus that is resistant to one first line treatment(benzodiazepines or ,bdz) and one second line treatment (phenytoin,phenobarbital,or Valproic acid) and an Antiepileptic drug is refractive status epilepticus
Others regard refractory status epilepticus as failure of benzodiazepine and 2 antiepileptic medications, i.e., Lorazepam + phenytoin + phenobarb. Up to 30% patients in SE fail to respond to two antiepileptic drugs (AEDs) and 15% continue to have seizure activity despite use of three drugs.
It develops in some Status epilepticus patients
What is the pathophysiology of status epilepticus
PATHOPHYSIOLOGY
On a neurochemical level, seizures are sustained by
excess excitation and reduced inhibition.
Glutamate is the most common excitatory neurotransmitter and the NMDA (N-methyl-D-aspartate) receptor subtype js involved
Gamma amino-butyric acid (GABA) is the most common inhibitory neurotransmitter. Failure of inhibitory processes is increasingly thought to be the major mechanism leading to status epilepticus
Neuronal death occurs after thirty minutes of continuous seizures
Neuronal death is probably brought about by inability to handle large increases in intracellular calcium brought about by prolonged exposure to excitatory neurotransmitters
What are the causes of status epilepticus
State the drugs that at can cause SE and the antidote for it
In adults the most common precipitatant was Cerebrovascular disease SE varies significantly with age Stroke(acute or remote) Tumour Hypoxic injury Subarachnoid hemorrhage Head trauma Drugs example cocaine ,theophylline,isoniazid (INH) may cause seizures and is unique in having a specific antidote,(pyridoxine (vitamin B-6),Flumazenil,Fluoroquinolones
What are the clinical manifestations of SE
Muscle spasms Falling Confusion Unusual noises Loss of bowel or bladder control Clenched teeth Irregular breathing Unusual behavior Difficulty speaking A daydreaming look
What are the investigations for SE
Obtain patients IV access Monitor vital signs ABC Head CT Blood glucose,CBC,renal function,calcium,magnesium,electrolytes,AED or antiepileptic drugs levels cEEG monitoring Brain MRI Lumbar puncture Toxicology panel:Isoniazid,TCAs,theophylline,cocaine,sympathomimetics,organophosphates,cyclosporine) Cyclosporine is used together with other medicines to prevent the body from rejecting a transplanted organ (eg, kidney, liver, or heart). It belongs to a group of medicines known as immunosuppressive agents Other relevant tests per need
What is the management of SE(aims of management,pharmacological treatment)
https://emcrit.org/ibcc/sz/
SE is a medical emergency and must be treated immediately in critical care setting
Pharmacological intervention is more effective at an early stage of SE than after a delay
Objectives: Termination of status epilepticus Prevention of seizure reoccurrence Management of precipitating causes Management of complications
TReatment: in stabilization phase,standard first aid for seizures should be initiated
- in initial therapy phase,a benzodiazepine (specifically IM midazolam,IV lorazepam or IV diazepam) is recommended as initial therapy
- in second phase,options include IV fosphenytoin,valproic acid, or levetiracetam. If none of these are available,IV phenobarbital is a reasonable alternative
- In third phase,If a patient experiences 40plus minutes of seizure activities,treatment considerations shouod include repeating second line therapy or anesthetic doses of thiopental,midazolam,pentobarbital or propofol
What are the cVS and respiratory complications of SE (early and late)
Cardiac arrhythmia can occur due to autonomic over activity,acidosis, and hyperkalemia
Further complicated by shock due to lactic acidosis
Early signs n include tachycardia and hypertension
Late signs(after thirty minutes):cardiac arrest,bradycardia,hypotension,shock
RS:mechanical impairment from tonic muscle contraction
Disturbed respiratory centre function
Massive autonomic discharge producing increased bronchial constriction and secretions,aspiration pneumonia and neurogenic pulmonary edema
Early signs:tachypnea or apnea w co2 retention
Late signs:apnea,variations in breathing patterns,aspiration pneumonia
What are the renal and metabolic complications of SE and state early and age signs in metabolic complications of SE
Renal impairment may occur from a combination of rhabdomylosis with myoglobinuria Late after thirty minutes: Uremia Acute tubular necrosis Hypotension with poor renal function
Metabolic:increased lactate production from
Maximally exercised muscles results in metabolic acidosis within minutes after the start of SE
Variable respiratory contribution to acidosis from carbon dioxide retention
Degree of acidosis doesn’t correlate with the extent of neuropathological damage
After cessation of seizures,lactate is rapidly metabolized resulting in spontaneous resolution of acidosis
Initially hyperglycemia develops due to catecholamines and glucagon release
Later,hypoglycemia occurs due to increased plasma insulin,increased cerebral glucose consumption
And excessive muscle activity
Early:lactic acidosis
Hyperglycemia
Hyerkalemia
Late afternoon thirty minutes: Lactic acidosis Liver failure Hypoglycemia Elevated prolactin
What are the autonomic nervous system complications of SE
Late and early
Hyperthemia can result from excessive muscle activity and hypothalamic dysfunction
Alternatively it may be due to and underlying infection that’s responsible for the initiation of SE
Early:
Mydriasis -dilation of the pupil of the eye.
Salivary and tracheobronchial hypersecretions
Excessive sweating
Bronchial constriction
Late-hyperpyrexia
