Final Flashcards
What is the pathophysiology of seizures?
Shift in the normal balance of excitation and inhibition w/in CNS
What factors affect seizures/epilepsy?
Endogenous factor
Epileptogenic factors
Precipitating factors
What types of seizures occur in late infancy/early childhood?
Febrile seizures
At what age do well-defined epilepsy syndromes present?
Childhood
When do epilepsies secondary to acquired CNS lesions begin to predominate?
Adolescence/early adult adulthood
When is CVA disease a cause of seizures?
Older patients
What are common causes of seizures regardless of age?
Metabolic disturbances
Hypo/hyperglycemia
Renal failure
Hepatic failure
What are drugs that induce seizures?
Beta lactams Quinolones Alkylating agents Antimalarials Meperidine Tramadol Psychotropics Theophylline Drugs of abuse
Where are focal seizures?
Asymmetric in one hemisphere
What is the characteristic of focal aware seizures?
No loss of consciousness
What are focal aware with motor onset?
May present with motor function
What are focal aware with non-motor onset?
May present with an alteration in sensation, emotions, thinking, or experiences
What is a Jacksonian march?
Tingling in fingertips, to hands or to entire arm
What is Todd’s paralysis?
Affected side of the body is numb/tingling for part or rest of the day after seizure
What is focal impaired awareness seizures?
Transient loss of awareness/consciousness
How do focally impaired awareness seizures typically begin?
With an aura
What are focally impaired awareness seizures associated with?
Postictal amnesia
Where do generalized seizures occur?
Bilateral in both hemispheres
What are the types of generalized seizures?
Absence (atypical/typical) Tonic-clonic Pure tonic Pure Clonic Atonic Myoclonic
What is an typical absence seizure characterized by?
Sudden, brief lapses of consciousness w/o loss of postural control
Only lasts for seconds
Is there any postictal confusion with absence seizures?
No
What are the characteristics of atypical absence seizures?
Longer lapse of consciousness
Less abrupt onset and cessation
More obvious motor signs
What are stereotypical seizures with convulsive episodes?
Tonic-clonic
What are the phases of tonic-clonic seizures?
Initial phase is tonic contraction
After 10-20 seconds, seizure evolves into clonic phase
Ictal phase lasts < 1 min
Postictal phase characterized by unresponsiveness (minutes to hours) and possible bladder/bowel incontinence
What is the characteristic of a pure clonic seizure?
Clonic jerking accompanied by a loss of consciousness
What are the characteristics of a pure tonic seizure?
Continuous muscle contractions
Accompanying respiratory arrest results in cyanosis
What diagnostic test are used in the diagnosis of epilepsy?
Serum prolactin levels (elevated following tonic-clonic seizures)
EEG
What are the treatment goals of epilepsy
No seizure, no SE, and an optimal QOL
What is the most common and severe form of SE?
GCSE (tonic clonic)
What is the relation to type I GCSE and lesions?
Not associated with structural lesions
What is the relation to type II GCSE and lesions?
Associated with structural lesions
What are most episodes of epilepsy d/t?
Acute anticonvulsant QD
Metabolic disorder or concurrent illness
Progression of a pre-existing neurologic disease
What are the major causes of GCSE in infants < 1 yo?
Acute encephalopathy
Metabolic disorders
What are the major causes of GCSE in younger patients?
Nonspecific illness such as fever and/or viral illness
What is the major cause of GCSE in adults
CVA disease
WD of anticonvulsants
Low anticonvulsant serum concentrations
What are medications associated with decreased seizure threshold?
WD of anticonvulsants, benzos, barbiturates, opioids
Abx - B-lactams, carbapenems, quinolones, INH, metro
Analgesics - meperidine, tramadol, fentanyl
Antidepressants, Li
Antiarrhythmics
Immunomodulatory and alkylating agents
