Exam 1 - Seizures

Question 1

what is the clinical definition of epilepsy?

Answer 1

1 unprovoked seizure, > 24 hours apart

a disease that results in an enduring predisposition to seizures

Question 2

what is the clinical definition of refractory epilepsy?

Answer 2

> 6 seizures per year in the face of standard therapy

Question 3

what are common changes observed in the post-ictal phase?

Answer 3

cortical blindness, behavior change, symmetrical proprioceptive deficits

Question 4

what are the 3 general causes of seizures?

Answer 4

idiopathic, structural, & reactive

Question 5

how is idiopathic epilepsy diagnosed?

Answer 5

diagnosis of exclusion

Question 6

what causes idiopathic epilepsy?

Answer 6

genetic cause is suspected but rarely proven

Question 7

what age of animals get idiopathic epilepsy?

Answer 7

1-5 year old animals

Question 8

are dogs or cats more affected by idiopathic epilepsy?

Answer 8

dogs - does happen in cats though

Question 9

what is the difference between progressive & non-progressive structural epilepsy?

Answer 9

you expect worsening forebrain signs in the progressive form & signs may improve or resolve in the non-progressive form

Question 10

what can cause the progressive form of structural epilepsy?

Answer 10

neoplasia

inflammation - infectious or immune-mediated

degenerative

Question 11

what can cause the non-progressive form of structural epilepsy?

Answer 11

vascular insult

trauma

Question 12

what causes reactive seizures?

Answer 12

electrolyte imbalances - calcium & sodium

hypoglycemia or other energy failure

endogenous neurotoxins - hepatic encephalopathy

exogenous neurotoxins

Question 13

are most CNS neurotoxins excitatory or inhibitory?

Answer 13

excitatory

Question 14

what clinical signs are expected with CNS neurotoxins?

Answer 14

seizures, tremors, & tetany

Question 15

what is the symptomatic treatment for CNS neurotoxins?

Answer 15

stop the seizures

control the seizures - muscle relaxants

control body temperature - watch for hyperthermia

Question 16

for decontamination of CNS neurotoxins, what should be done for ingested toxins?

Answer 16

gastric lavage with activated charcoal through a stomach tube

Question 17

for decontamination of CNS neurotoxins, what should be done for cutaneous toxins?

Answer 17

lipid-targeting detergent - dish soap

Question 18

what clinical signs are seen with bromethalin?

Answer 18

high doses - seizures

low doses - delayed paresis

Question 19

what is the treatment for Bufo toad toxicity?

Answer 19

wash the mouth & eyes

Question 20

what neurological clinical signs are typical with ivermectin toxicity?

Answer 20

mydriasis & blindness

Question 21

what neurological clinical signs are typical with lead toxicity?

Answer 21

diffuse forebrain signs

Question 22

what neurological clinical signs are typical with macadamia nut toxicity?

Answer 22

posterior limb paresis & stiffness

Question 23

what neurological clinical signs are typical with ethylene glycol toxicity?

Answer 23

seizures before renal failure

Question 24

what neurological clinical signs are typical with pyrethrin/permethrin toxicity in cats?

Answer 24

tremors +/- seizures

Question 25

what is the treatment for ivermectin toxicity?

Answer 25

intralipid iv infusion

Question 26

what is the treatment for lead toxicity?

Answer 26

chelating agents

Question 27

what is the treatment for organophosphate toxicity?

Answer 27

atropine +/- 2-PAM

Question 28

what is the treatment for ethylene glycol toxicity?

Answer 28

fomepizole

Question 29

what is the treatment for pyrethrin toxicity in cats?

Answer 29

bath with dish soap

Question 30

what is status epilepticus?

Answer 30

> 5 minutes of continuous epileptic seizure activity or > 1 seizure without recovery between

Question 31

what are cluster seizures?

Answer 31

> 1 seizure within 24 hours

Question 32

what critical systemic effects can happen as a result of seizures?

Answer 32

hyperthermia, hypoxia, metabolic acidosis, hypoperfusion, & arrhythmia

Question 33

what critical neurologic effects can happen as a result of seizures?

Answer 33

energy deprivation, excitotoxicity, & cerebral edema

Question 34

why benzodiazepines for emergency seizure management?

Answer 34

they act quickly, reliably stop seizures in progress, & are widely available in a wide variety of formulations

Question 35

what is the role of keppra in emergency seizure management?

Answer 35

help reduce the need of rescue diazepam

Question 36

what are the risks of using a loading dose of phenobarbital/propofol for stopping seizures?

Answer 36

respiratory depression unprotected airway hypotension

Question 37

T/F: a surgical plane of anesthesia will abolish seizure activity & help with long-acting seizure control

Answer 37

false anesthesia doesn't provide long-acting control, but it gives you time to make a plan

Question 38

how long will you hospitalize a patient presenting for cluster seizures or status epilepticus?

Answer 38

until the current seizure stops 24 hours off a CRI with no seizures until referred/transferred usually - 2 days

Question 39

when looking at if seizures will occur again, what causes can make it likely to not happen?

Answer 39

proven ingestion of a toxin proven reaction seizure due to metabolic abnormality concussive seizure

Question 40

T/F: certain reactive seizures can be ruled out quickly

Answer 40

true

Question 41

when looking at if seizures will occur again, what causes can make it likely to happen in the future?

Answer 41

idiopathic epilepsy, structural forebrain disease, status epilepticus, cluster seizures as presenting complaint, or persistent neurological abnormality

Question 42

when looking at intermediate term seizure management, what drugs will be effective within hours & stay effective for hours?

Answer 42

benzodiazepine CRI levetiracetam phenobarbital zonisamide

Question 43

on a benzodiazepine CRI as intermediate term seizure management, how long until cmax is reached? how is it administered?

Answer 43

> 5 minutes IV

Question 44

on levetiracetam as intermediate term seizure management, how long until cmax is reached? how is it administered?

Answer 44

30 - 80 minutes IV or PO

Question 45

on phenobarbital as intermediate term seizure management, how long until cmax is reached? how is it administered?

Answer 45

2 - 8 hours IV or PO

Question 46

using a benzodiazepine CRI for intermediate term seizure management, how long is the duration of effect?

Answer 46

up to 48 hours

Question 47

using levetiracetam for intermediate term seizure management, how long is the duration of effect?

Answer 47

5-8 hours

Question 48

using phenobarbital for intermediate term seizure management, how long is the duration of effect?

Answer 48

>/= 12 hours

Question 49

using zonisamide for intermediate term seizure management, how long is the duration of effect?

Answer 49

>/= 12 hours

Question 50

in the real world, what are the goals for minimizing seizures?

Answer 50

less frequent seizures not as long-lasting seizures preventing seizures that are dangerous to others

Question 51

in the real world, what are the goals for minimizing adverse effects?

Answer 51

long term treatment duration is expected pre-existing dysfunction of an organ system monitoring isn't possible in certain drugs

Question 52

what are the general impacts of adverse effects on your patient on seizure drugs?

Answer 52

direct effect on patient's health - organ toxicity direct effect on patient's quality of life - sedation/ataxia/polyphagia indirect effect on efficacy of the medication - a medication that isn't given is 0% effective

Question 53

T/F: when evaluating seizure meds, you should make changes gradually whenever possible & only change one thing at a time

Answer 53

true

Question 54

why does the frequency of seizures complicate treatment?

Answer 54

natural variation in the frequency of seizures complicates the assessment of efficacy

Question 55

T/F: any seizure drug can cause an adverse effect in a given patient & may be unpredictable

Answer 55

true

Question 56

between phenobarbital/potassium bromide & levetiracetam, which group is more likely to cause adverse effects?

Answer 56

phenobarbital/potassium bromide ***

Question 57

T/F: there are dose-dependent effects of seizure drugs

Answer 57

true