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PR3153 > IC6&7: Seizures and Epilepsy > Flashcards

IC6&7: Seizures and Epilepsy Flashcards

1
Q

What is seizures?

A

Transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in brain

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2
Q

What is epilepsy?

A

It is a conditions that is affected by
1. Min. 2 unprovoked seizures > 24 hours apart
2. 1 unprovoked and probability of further seizures similar to general recurrence risk after 2 unprovoked seizures for next 10 years
3. Diagnosis of epilepsy syndrome

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3
Q

What causes an acute seizure?

A

Recognizable stimulus such as metabolic disorders, toxic substance, infection, inflammation or structural issues

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4
Q

What is a remote seizure?

A

Seizure that occur longer than 1week following disorder known to increase the risk of epilepsy

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5
Q

What is an non-epileptic seizure?

A

Seizures that have s/s similar to that of epilepsy but there is no abnormal discharge

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6
Q

What is an unprovoked seizure?

A

Seizure not caused by anything clinical condition or beyond interval estimated for occurrence of acute symptomatic seizures

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7
Q

What are the 2 types of non-epileptic seizures?

A
  1. Psychogenic non-epileptic seizures
  2. Psychological non-epileptic events
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8
Q

What are the common drugs that are related to lowering of seizures threshold?

A
  1. Antimicrobial - beta-lactam (high doses)
  2. Analgesics - Opioids, tramadol
  3. Antipsychotics - Clozapine
  4. Antidepressant - Bupropion
  5. Immunosuppressants - cyclosporine
  6. Simulants - Dextroamphetamine, metylphenidate
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9
Q

Describe the pathophysiology of seizures and epilepsy.

A
  1. Hyperexcitability: Increase depolarization due to imbalance of neurotransmitter, abnormal intra and extracellular substances, and ion channels
  2. Hypersynchronization: Hippocampal sclerosis (reorganization of local circuits, contribute to synchronization + promotion of epileptiform activity generation)
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10
Q

What are the key features of ILAE classifciation?

A
  1. Location of seizure in brain
  2. Awareness level
  3. Other features of seizure
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11
Q

What are the clinical presentation of focal onset seizures?

A
  1. Motor symptoms: Clonic twitching, speech arrest
  2. Sensory: GI discomfort, numbness, tingling, visual
  3. Autonomic: BP, pallor, HR
  4. Psychic: flashback, hallucinations, mood changes
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12
Q

What are the clinical presentation in generalized tonic clonic seizures?

A
  1. Limbs stiffening, jerking of face and limbs
  2. Breathing issues - labored, heavy
  3. Cyanosis
  4. Possible incontinences, biting of tongue and inner mouth
  5. Headaches, lethargic, confused, sleepy - After seizures
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13
Q

Generalized clonic seizures are ______ and ______ in naure and often occurs in _______.

A
  1. Asymmetrical
  2. Irregular
  3. Neonates, infants, young children
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14
Q

What are the clinical presentation of generalized tonic seizures?

A

Sudden loss of consciousness and rigid posture of entire body lasting 10 to 20 seconds

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15
Q

Generalized tonic seizures are common in ______.

A

Lennox-Gastaut syndrome

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16
Q

Generalized myoclonic seizures involves _______.

A

rapid, brief contractions of bodily muscles on both side

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17
Q

List the clinical presentation of absence sizeures.

A
  1. Basic lapse in awareness for a few seconds
  2. EEG pattern “3 Hz spike wave”
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18
Q

What is the characteristic presentation of atonic seizures?

A

Collapse like “paper doll”

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19
Q

What is the scalp electroencephalography used for?

A

Diagnosis and seizures classification

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20
Q

What are the limitation of scalp electroencephalography?

A
  1. Not all patients will have abnormal EEG
  2. Normal EEG does not exclude possibility of epilepsy
  3. Unable to sense if seizures from deep down the brain
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21
Q

What is the use of a video EEG?

A

To assist in diagnosis of issues that cannot be solved by normal EEG

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22
Q

MRI with gadolinium helps to identify _____.

A

focal lesions

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23
Q

What are the biochemical and toxicology test used for?

A
  1. Rule out electrolytes abnormalities
  2. Measure serum prolactin
  3. Creatine kinase
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24
Q

List 4 psychosocial issues that seizures patients face?

A
  1. Social stigma
  2. Employment
  3. Driving prohibition
  4. Caregiver burden
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25
Q

Describe the first aid measurements that should be done when someone is having seizures.

A
  1. Lay person on floor with something soft under head, facing one side.
  2. Remove sharp objects, glasses and potential objects that can obstruct breathing
  3. Time seizure. If > 5mins, call 911
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26
Q

List 4 things that should not be done when someone is having a seizure.

A
  1. Restrict movement
  2. CPR
  3. Put anything in mouth
  4. Offer food/ water till alert
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27
Q

List 4 non-pharmacological methods used for seizures.

A
  1. Ketogenic diet
  2. Vagus nerve stimulator
  3. Responsive neurostimulator system
  4. Epilepsy surgery
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28
Q

Ketogenic diet is mainly used for seizure prevention in ______.

A

children

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29
Q

Vagus nerve stimulator is used only for _____ seizures.

A

intractable focal

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30
Q

Responsive neurostimulator system helps decrease _______ seizures.

A

partial onset

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31
Q

When is responsive neurostimulator used?

A
  1. PT with localized ≤ 2 epileptogenic foci
  2. Refractory to ≥ 2 antiepileptic medication
  3. Freq and disabling symptoms
32
Q

What are the first generation ASM drugs indicated for focal onset epliepsy?

A

Carbamazepine
Phenobarbital
Phenytoin
Sodium Valproate

33
Q

What are the second generation drugs indicated for focal onset epilepsy?

A

Lamotrigine
Levetiracetam
Topiramate

34
Q

What are the medications indicated for generalised tonic clonic seizures?

A

Carbamazepine
Sodium Valproate
Lamotrigine
Topiramate

35
Q

1st generation ASM have _____ protein binding and ____ water solubility.

A

high, poor

36
Q

How are 1st generation ASM cleared?

A

Hepatically

37
Q

1st generation ASM have _____ DDIs.

38
Q

How are first generation ASM administrated?

A

Oral (Good F)

39
Q

Newer generation ASM have _____ water solubility due to ____ protein binding

A

better, poorer

40
Q

Which of the newer generation is not renally cleared?

A

Lamotrigine

41
Q

Which of the newer ASM have multiple DDIs?

A

Lamotrigine, Topiramate

42
Q

______ is both an inducer and inhibitor.

A

Topiramate

43
Q

Which of the ASM are not inducers nor inhibitors?

A

Gabapentin, pregabalin

44
Q

Most of the drugs are inducers except _____.

A

sodium valproate

45
Q

List the 5 drugs classes that have interaction with ASM.

A
  1. Antidepressants
  2. Antipsychotics
  3. Immunosuppressive therapy
  4. Chemotherapeutics
  5. Antiretroviral
46
Q

What are some DDI effects associated with ASM?

A
  1. Women: reproductive hormones, sexual functions, OC
  2. Men: Sexual function, fertility
  3. Bone health
  4. Vascular risk
47
Q

When is correction need for phenytoin?

A

Albumin < 40g/L

48
Q

What happens when a patient is give more than 400mg of phenytoin?

A

Bioavailability decreases

49
Q

Phenytoin follows ____ order kinetics.

50
Q

What happens when phenytoin concentration is increased?

A

Clearance decreases

51
Q

Valproate can be displaced by ______ compounds

A

Endogenous compounds (Uremia, hyperbilirubinemia)

52
Q

Valproate exhibits _______ protein binding with therapeutic range.

53
Q

When valproate concentration is increased, protein binding ______.

54
Q

Carbamazepine undergoes _____ metabolism.

A

autoinduction

55
Q

List the dose and plasma concentrated side effects of ASM.

A

CNS
GI (N/V - carbamazepine, valproate)
Psychiatric (behavioral disturbance - levetiracetam)
Cognition (speech - topiramate)

56
Q

What are some idiopathic and hypersensitvity related adverse effect

A

Blood dyscrasia
Hepatotoxicity (1st gen except phenobarbital)
Pancreatitis (sodium valproate)
Lupus like reaction
Exfoliative Dermatitis
TEN/SJS

57
Q

Which of the ASM should be avoided in patients are tested positive for HLB-B*1502?

A

Carbamazepine

58
Q

What is a chronic adverse effect of phenytoin?

A

Gingival hyperplasia
Hirsutism
Peripheral neuropathy (at high dose)
Osteomalacia

59
Q

Which ASM drugs will have osteomalacia as a chronic side effect?

A
  1. Phenytoin
  2. Phenobarbital
  3. Carbamazepine
60
Q

What is a chronic adverse effect of sodium valproate?

61
Q

What is one chronic adverse effect present in all ASM?

A

Suicidal ideation

62
Q

Topiramate may cause _____ and ______ as chronic side effects.

A

anorexia, decrease weight

63
Q

What are two chronic side effects of sodium valproate?

A
  1. Increase weight
  2. Alopecia
64
Q

List four indications for TDM in patients on ASM?

A
  1. Establish individual therapeutic range
  2. Assess lack of efficacy
  3. Assess potential toxicity
  4. Assess loss of efficacy
65
Q

When can ASM treatment be stopped?

A
  1. No seizures after minimum of 2 years
  2. Low frequency or increased risk: after 2 years
66
Q

Seizures are considered resolved once patient is free from seizure for ___ years and medication for ___ years.

67
Q

What are the ASM drugs that can be used in women of pregnancy age or pregnant women?

A

Levetiracetam and Lamotrigine

68
Q

What is the ASM contraindicated in woman?

69
Q

What is the medication that may lower lamotrigine?

A

Oral contraceptive

70
Q

ASM can be used in women who are ______.

A

breastfeeding

71
Q

Man treated on valproate are at increased risk of children having _______ disorder.

A

neurodevelopmental

72
Q

What is status epilepticus?

A

Failure of mechanism responsible for seizures termination or initiation of mechanism leading to abnormal prolonged seizures, which can have long term consequences depending on duration and type of seizures.

73
Q

What should be done for status epilepticus in phase 1?

A
  1. Stabilise airway, breathing, circulation
  2. Time seizure
  3. Check vital signs (oxygen, ECG, glucose)
74
Q

What are the medications given to adult if blood glucose is less than 60mg/dl?

A

IV Thiamine + D50W

75
Q

What are the medication given to children at phase 1?

A

IV D25W
IV D12.5W (<2years)

76
Q

What is the drug of choice for status epilepticus at phase 2?

A

Benzodiazepine (Diazepam, Lorazepam, midazolam)

77
Q

What medication can be given at phase 3 for status epilepticus?

A

Phenytoin, valproic, levetiracetam

PR3153 (16 decks)

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