Exam 4 Flashcards
- A 7 year-old girl is brought to clinic with concern for staring spells.
- Several times per day she will stop and stare for 5 to 15 seconds.
- She will not respond to her name or to gentle shaking during this time after the episodes she is back to her normal self.imes she will rub her hands together or make chewing movements while staring.
- She does not report any warning before the staring occurs.
- She does not remember things said to her while staring
- These episodes occur at home and school
- No other types of spells have been noted
- Birth Hx: Born at term after an uneventful pregnancy weighing 7 pounds 6 ounces and home on day of life #2
- Family history: Maternal grandmother developed seizures after a stroke at age 65. Older sister diagnosed with ADHD at 6 years.
- Growth and Development: met early milestones on time; Has done well in school until this year – now in 2nd grade and struggling with remembering material presented in class.
- Past Medical History: no chronic illnesses, no hospitalizations or ED visits
- Past Surgical History: none
- Allergies: NKDA
- Medications: none
- Absence seizure- generalized both sides of brain effected
- chewing movements and moving both hands= automatism, both hands used so generalized seizure
•9 year-old right handed boy brought to the ER after an apparent seizure
–Came into his parents room unable to speak with left-sided facial twitching
–Then collapsed with approximately 2 minutes of generalized jerking
- He has not been ill lately and had “a normal day” acting like his normal self prior to the event
- Birth Hx: Born at 37 weeks after an uneventful pregnancy weighing 6 pounds 4 ounces. Home after 5 days due to jaundice treated with phototherapy.
- Past Medical History: Well-controlled asthma, no hospitalizations or ED visits
- Past Surgical History: none
- Allergies: NKDA
- Medications: Albuterol MDI to use as needed
- No history of seizures or neurodevelopmental problems in primary relatives.
- Growth and Development: met early milestones on tikme; Has done well in school and is now getting As and Bs in regular 4thgrade classes. No hint of developmental regression.
Examination in ED (30 minutes after episode): 25-50th percentile for height, weight and head circumference. No dysmorphic features. Breathing comfortably on room air. Drowsy but arousable and able to follow commands. Recognizes parents and comforted by them. Per parents, seems to be increasingly back to normal. The remainder of his examination is entirely normal.
EEG attached
Focal loss of awareness with progression of bilateral tonic-clonic
When do you not treat seizure?
when do you treat a seizure?
No treatment:
- only 1 seizure. Normal MRI. Normal EEG.
- 50:50 chance of having another
anti-epileptic medications:
- 2 (or more) unprovoked seizures
- after 1 seizure + MRI or EEG abnormality
- specific epilepsy syndromes with known high risk of seizures
Principles of anti epileptic drug use
- Use single drug when possible
- titrate drugs slowly to reduce side effetcs
Mechanism of action of antiepileptic medication
- Ions the primary target
-
voltage gated
- sodium channels
- block
- calcium
- potassium
- sodium channels
-
ligand gated
- GABA- inhibitory
- Glutamate- excitatory
-
voltage gated
Antiepileptic drugs that block voltage gated Na+ channel
Phenytoin, carbamazepine, lamotrigine
balance problems of dose is too high
Antiepileptic drug that blocks calcium channel
- Ethosuximide
- block T-type
Antiepileptic medication that acts via GABA A enhanced signaling
Benzodiazepines, barbiturates
Which antiepileptic drug causes: Impaired cognition (School age) and Word finding difficulty
Topiramate
Which antiepileptic drug causes: Hyponatremia, Increased risk in older patients
Carbamazepine, oxcarbazepine
Which antiepileptic drug causes: increased risk of birth defects (Neural tube defects) and Decreased IQ
Valproate
Which antiepileptic drug causes:Depression, impaired cognition
Phenobarbital
Which antiepileptic drug is best used for absence seizures, but is Ineffective for other seizure types.
Ethosuximide
What antiepileptic drug is best for focal seizures?
First line: Phenytoin, Carbamazepine
Alternative: Oxcarbazepine
Best medications for broad spectrum, focal or Generalized epilepsy?
- First line: Lamotrigine, Valproate (Generalized)
- Alternative: Topiramate, Levetiracetam, Phenobarbital, Valproate (Focal)
