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CFT I > Exam 1 - Seizures > Flashcards

Exam 1 - Seizures Flashcards

1
Q

what is the clinical definition of epilepsy?

A

1 unprovoked seizure, > 24 hours apart

a disease that results in an enduring predisposition to seizures

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2
Q

what is the clinical definition of refractory epilepsy?

A

> 6 seizures per year in the face of standard therapy

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3
Q

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

A

cortical blindness, behavior change, symmetrical proprioceptive deficits

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4
Q

what are the 3 general causes of seizures?

A

idiopathic, structural, & reactive

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5
Q

how is idiopathic epilepsy diagnosed?

A

diagnosis of exclusion

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6
Q

what causes idiopathic epilepsy?

A

genetic cause is suspected but rarely proven

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7
Q

what age of animals get idiopathic epilepsy?

A

1-5 year old animals

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8
Q

are dogs or cats more affected by idiopathic epilepsy?

A

dogs - does happen in cats though

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9
Q

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

A

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

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10
Q

what can cause the progressive form of structural epilepsy?

A

neoplasia

inflammation - infectious or immune-mediated

degenerative

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11
Q

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

A

vascular insult

trauma

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12
Q

what causes reactive seizures?

A

electrolyte imbalances - calcium & sodium

hypoglycemia or other energy failure

endogenous neurotoxins - hepatic encephalopathy

exogenous neurotoxins

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13
Q

are most CNS neurotoxins excitatory or inhibitory?

A

excitatory

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14
Q

what clinical signs are expected with CNS neurotoxins?

A

seizures, tremors, & tetany

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15
Q

what is the symptomatic treatment for CNS neurotoxins?

A

stop the seizures

control the seizures - muscle relaxants

control body temperature - watch for hyperthermia

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16
Q

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

A

gastric lavage with activated charcoal through a stomach tube

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17
Q

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

A

lipid-targeting detergent - dish soap

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18
Q

what clinical signs are seen with bromethalin?

A

high doses - seizures

low doses - delayed paresis

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19
Q

what is the treatment for Bufo toad toxicity?

A

wash the mouth & eyes

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20
Q

what neurological clinical signs are typical with ivermectin toxicity?

A

mydriasis & blindness

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21
Q

what neurological clinical signs are typical with lead toxicity?

A

diffuse forebrain signs

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22
Q

what neurological clinical signs are typical with macadamia nut toxicity?

A

posterior limb paresis & stiffness

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23
Q

what neurological clinical signs are typical with ethylene glycol toxicity?

A

seizures before renal failure

24
Q

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

A

tremors +/- seizures

25
Q

what is the treatment for ivermectin toxicity?

A

intralipid iv infusion

26
Q

what is the treatment for lead toxicity?

A

chelating agents

27
Q

what is the treatment for organophosphate toxicity?

A

atropine +/- 2-PAM

28
Q

what is the treatment for ethylene glycol toxicity?

A

fomepizole

29
Q

what is the treatment for pyrethrin toxicity in cats?

A

bath with dish soap

30
Q

what is status epilepticus?

A

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

31
Q

what are cluster seizures?

A

> 1 seizure within 24 hours

32
Q

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

A

hyperthermia, hypoxia, metabolic acidosis, hypoperfusion, & arrhythmia

33
Q

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

A

energy deprivation, excitotoxicity, & cerebral edema

34
Q

why benzodiazepines for emergency seizure management?

A

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

35
Q

what is the role of keppra in emergency seizure management?

A

help reduce the need of rescue diazepam

36
Q

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

A

respiratory depression

unprotected airway

hypotension

37
Q

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

A

false

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

38
Q

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

A

until the current seizure stops

24 hours off a CRI with no seizures

until referred/transferred

usually - 2 days

39
Q

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

A

proven ingestion of a toxin

proven reaction seizure due to metabolic abnormality

concussive seizure

40
Q

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

A

true

41
Q

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

A

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

42
Q

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

A

benzodiazepine CRI

levetiracetam

phenobarbital

zonisamide

43
Q

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

A

> 5 minutes

IV

44
Q

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

A

30 - 80 minutes

IV or PO

45
Q

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

A

2 - 8 hours

IV or PO

46
Q

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

A

up to 48 hours

47
Q

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

A

5-8 hours

48
Q

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

A

> /= 12 hours

49
Q

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

A

> /= 12 hours

50
Q

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

A

less frequent seizures

not as long-lasting seizures

preventing seizures that are dangerous to others

51
Q

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

A

long term treatment duration is expected

pre-existing dysfunction of an organ system

monitoring isn’t possible in certain drugs

52
Q

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

A

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

53
Q

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

A

true

54
Q

why does the frequency of seizures complicate treatment?

A

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

55
Q

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

A

true

56
Q

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

A

phenobarbital/potassium bromide ***

57
Q

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

A

true

CFT I (30 decks)

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