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Y4R3 - Medicine II 🩺 > L4: Epilepsy > Flashcards

L4: Epilepsy Flashcards

1
Q

Def of Seizure

A
  • A transient neurologic sign and/or symptom due to abnormal, excessive, synchronous neuronal activity in the brain.
  • Defined as acute symptomatic seizures or provoked seizures.
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2
Q

Cause of Seizure

A
  • 25% have a clearly identifiable, temporally associated cause.
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3
Q

Incidence of Seizure

A
  • A very common neurological problem.
  • Affects 10% of individuals at some point in their lives.
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4
Q

Def of Epilepsy

A
  • Disease of the CNS characterized by:
  1. Enduring predisposition to generate epileptic seizures
  2. Neurobiological, cognitive, psychological, and social consequences of this condition.
  • Defined as two or more unprovoked seizures
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5
Q

Cause of Epilepsy

A
  • Having no identifiable acute, proximal cause
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6
Q

Incidence of Epilepsy

A
  • The most common try disorder of brain.

It has an age-specific incidence:
- Highest in the very young (20 y)
- Highest in the very old (75y).

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7
Q

Difference between Seizure & Stroke in one sentence

A
  • Seizure → Event
  • Epilepsy → Recurrent unprovoked seizures
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8
Q

Etiology of Seizures

A
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9
Q

Etiology of Seizures

  • Those who have identifiable Causes
A
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10
Q

Etiology of Seizures

  • Those who don’t have identifiable Causes
A

Often have a genetic or unidentified environmental cause as:

  • Genetic epilepsy syndromes
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11
Q

Criteria of Dx of Epilepsy

A
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12
Q

Pathophysiology of Seizures

A
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13
Q

Pathophysiology of Seizures

  • Cellular Mechanism of Seizure Generation
A
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14
Q

Pathophysiology of Seizures

  • The Basic Mechanism of neuranal Excitability
A

Action Potential

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15
Q

Pathophysiology of Seizures

  • Hyperexcitable State may result from …..
A
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16
Q

Action potentials occur due to depolarization of the neuronal membrane, with membrane depolarization propagating down the axon to induce neurotransmitter release at the axon terminal.

A

..

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17
Q

Classification of Seizures

A
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18
Q

Def of Focal Seizures

A

Start in network of cells on one side of the brain

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19
Q

Types of Focal Seizures

A
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20
Q

Def of Generalized Seizures

A

Start in network of cells on both side of the brain

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21
Q

Types of Generalized Seizures

A
  1. Generalized Tonic-Clonic Seizures
  2. Absence Seizures
  3. Myoclonic Seizures
  4. Tonic Seizures
  5. Atonic Seizures
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22
Q

Awarness in Focal Aware Seizures (Simple Partial)

A

Awareness remains intact, even if the person is unable to talk or respond during a seizure.

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23
Q

Source of Focal Aware Seizures (Simple Partial)

A

Arise from any area of the cerebral cortex & produce a vast array

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24
Q

Source of Focal Aware Motor Seizures (Simple Partial)

A

Arising from the Motor cortex

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25
Q

CP of Focal Aware Motor Seizures (Simple Partial)

A
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26
Q

Source of Focal Sensory Motor Seizures (Simple Partial)

A

Arising from the Sensory cortex

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27
Q

CP of Focal Aware Sensory Seizures (Simple Partial)

A
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28
Q

Source of Focal Aware Cognitive &Emotional Seizures (Simple Partial)

A

Arising from the Temporal lobe

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29
Q

CP of Focal Aware Cognitive & Emotional Seizures (Simple Partial)

A
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30
Q

Def of Focal Impaired Awareness Seizures (Comple Partial)

A

Focal seizures associated with impaired awareness at any time during a seizure.

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31
Q

Source of Focal Impaired Awareness Seizures (Comple Partial)

A

Arise from the temporal lobe.

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32
Q

CP of Focal Impaired Awareness Seizures (Comple Partial)

A
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33
Q

Duration of Focal Impaired Awareness Seizures (Comple Partial)

A

0.5 - 3 min

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34
Q

Source of Focal to Bilateral Tonic-Clonic Seizures

A

Start in one side of the brain and spreads to both sides.

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35
Q

CP of Focal to Bilateral Tonic-Clonic Seizures

A
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36
Q

Another Name for Generalized Motor (Tonic-Clonic) Seizures “GTCS”

A

Grand mal epilepsy

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37
Q

Duration of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

A

between 30 seconds and 2-3 minutes.

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38
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

A
  • No preceding Aura or warning
  • Ictal Stages
  • Post-Ictal Stages
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39
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

  • Aura
A

No preceding Aura or warning

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40
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

  • Ictal Stage
A
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41
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

  • Tonic Phase of Ictal Stage
A
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42
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

  • Clonic Phase of Ictal Stage
A
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43
Q

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

  • Post-Ictal Stage
A
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44
Q

Another Name of Generalized Non-Motor (Absence) Seizures

A

Petit mal epilepsy

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45
Q

Epidemeology of Generalized Non-Motor (Absence) Seizures

A

Begin in childhood or adolescence

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46
Q

Duration of Generalized Non-Motor (Absence) Seizures

A

Lasts for just a few seconds

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47
Q

CP of Generalized Non-Motor (Absence) Seizures

A
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48
Q

Epidemeology of Myoclonic Seizures

A
  • Occur in children, adolescents or young adults as part of “juvenile myoclonic epilepsy”.
  • Occurs more on awaking up or falling asleep
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49
Q

CP of Myoclonic Seizures

A

Characterized by:
- Sudden, involuntary, brief jerks of a muscle or group of muscles.

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50
Q

Stimulus from Myoclonic Seizures

A

Provoked by fatigue or sleep deprivation.

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51
Q

Epidemeology of Tonic Seizures

A

Occur in individuals with mental retardation.

52
Q

Duration of Tonic Seizures

A

10-20 seconds, with rapid return of consciousness or awareness.

53
Q

CP of Tonic Seizures

A
  • Sudden loss of consciousness & rigid posture of the entire body.
  • They typically arise from sleep, & can occur repeatedly throughout the night.
54
Q

Epidemeology of Atonic Seizures

A

Associated with individuals with mental retardation.

55
Q

CP of Atonic Seizures

A

Sudden drop attacks in which the patient loses tone and falls to the ground.

56
Q

DDx of Seizures

A
57
Q

DDx of Seizures

  • Syncope
A
58
Q

What is Syncope Mostly Confused with?

A

Most commonly confused with GTCS

59
Q

What is syncope preceded by?

A

lightheadedness, diaphoresis, and anxiety.

60
Q

Characters of Syncope

A

A sudden, brief loss of consciousness that results from reduced cerebral blood flow.

61
Q

What is syncope accompanied by?

A

Multifocal jerking movements that last for only 3-10 seconds.

62
Q

Diffrentiation between syncope & Seizures

A

After syncope, Patients regain consciousness and coherence within a few seconds (no postictal state).

63
Q

DDx of Seizures

  • Migraine & TIA
A
64
Q

What is Migraine/TIA mostly Conused With?

A

Simple and Complex focal seizures.

65
Q

How to diffrentiate between Migraine/TIA & Seizures?

A
66
Q

DDx of Seizures

  • Movement Disorders
A
67
Q

What are movement Disorders mostly confused with?

A

May be confused with motor seizures, especially myoclonus and hemiballismus

68
Q

How to diffrentiate between Movement Disorders & Seizures?

A
  • Most seizures are discrete events that Are separated in time by hours, days or months.
  • Most movement disorders tend to be relatively continuous activities.
69
Q

DDx of Seizures

  • Sensory Symptoms
A
70
Q

Dysfunction of the sensory end organ (e.g. eyes in patients with visual symptoms), before concluding that the problem is coming from the brain.

A

..

71
Q

DDx of Seizures

  • Sleep Disorders
A
72
Q

DDx of Seizures

  • Psychogenic Nonepileptic Seizures (Pseudo-seizures)
A
73
Q

What are (Pseudo-seizures) mostly confused with?

A

Easily mistaken for epileptic seizures.

74
Q

Def of (Pseudo-seizures)

A
  • Attacks resemble seizures but secondary to psychiatric disorders “emotionally triggered attacks”
75
Q

Characters of (Pseudo-seizures)

A
76
Q

INVx for (Pseudo-seizures)

A
  • The EEG record during the episode does not show the seizure activity “normal EEG”.
  • The gold standard in diagnosis remains simultaneous video and EEG monitoring.
77
Q

Approach for a person with 1st Seizure

A
78
Q

Dx of Seizures

A
79
Q

Dx of Seizures

  • Hx & Ex
A
80
Q

Dx of Seizures

  • Labs
A
81
Q

Dx of Seizures

  • Neuroimaging
A
82
Q

Dx of Seizures

  • EEG
A
83
Q

Significance of EEG

A
  • Differentiate epileptic seizures from conditions that mimic them.
  • Classify seizure types
  • Tailor therapy.
84
Q

The yield of EEG increases with ……

A
  • Sleep deprivation
  • Performing multiple studies
  • Performing the study in close proximity to the seizure.
85
Q

TTT of Seizures

A
86
Q

TTT of Seizures

  • TTT of Provoked Seizures
A
87
Q

TTT of Seizures

  • TTT of Unprovoked Seizures & Epilepsy
A
88
Q

ASMs may be prescribed for patients after a first unprovoked seizure if there is:

A
89
Q

TTT of Seizures

  • General Principles in drug therapy
A
90
Q

The choice of ASM is usually based on:

A
91
Q

Examples of ASM

A
92
Q

Dose & SE of Phenobarbital

A
93
Q

Dose & SE of Phenytoin

A
94
Q

Dose & SE of Carbamazpine

A
95
Q

Dose & SE of Valproate

A
96
Q

Dose & SE of Lamotrigine

A
97
Q

Dose & SE of Gabapentine

A
98
Q

Dose & SE of Topiramate

A
99
Q

Dose & SE of Oxcarbazepine

A
100
Q

Dose & SE of Levetiracetam

A
101
Q

Dose & SE of Zonisamide

A
102
Q

Dose & SE of lacosamide

A
103
Q

Dose & SE of Rufinamide

A
104
Q

Dose & SE of Esclicarbazepine

A
105
Q

Drug of Choice

  • Focal seizures and secondarily Generalized seizures
A

Phenytoin, Carbamazepine, Oxcarbazepine, Levetiracetam,
Lamotrigine

106
Q

Drug of Choice

  • Primary generalized tonic-clonic seizures
A

Valproate, Lamotrigine

107
Q

Drug of Choice

  • Abxence Seizures
A

Valproate, Ethosuximide

108
Q

Drug of Choice

  • Juvenile myoclonic epilepsy
A

Valproate, Levetiracetam

109
Q

Drug of Choice

  • Patient taking multiple medications
A

Levetiracetam, Lacosamide

110
Q

Drug of Choice

  • Medication expense is a concern
A

Phenytoin, Carbamazepine, Valproate

111
Q

Drug of Choice

  • Pregnancy
A

Lamotrigine, Levetiracetam (avoid valproate)

112
Q

Drug of Choice

  • Hepatic Failure
A

Levetiracetam, Topiramate, Gabapentin

113
Q

Drug of Choice

  • Renal Failure
A

Carbamazipine, Oxcarbazepine, Lamorigine

114
Q

Withdrawing ASMs

A
115
Q

Ideal candidates for medication withdrawal have:

A
116
Q

Def of Status Epilepticus

A
  • A single seizure lasting more than five minutes or two or more seizures between which the patient does not recover.
  • It is a life-threatening medical emergency.
117
Q

TTT of Status Epilepticus

A
118
Q

TTT of Status Epilepticus

  • Life Support
A
119
Q

TTT of Status Epilepticus

  • Abort Seizures
A
120
Q

TTT of Status Epilepticus

  • Abort Seizures (Phase I)
A

Intravenous lorazepam (0.1 mg/kg) or diazepam (0.15 mg/kg)

121
Q

TTT of Status Epilepticus

  • Abort Seizures (Phase II)
A
  • Intravenous phenytoin (15-20 mg/kg)
  • Valproate (25-40 mg/kg) or Levetiracetam (1000- 3000 mg)
122
Q

TTT of Status Epilepticus

  • Abort Seizures (Phase III)
A
123
Q

TTT of Status Epilepticus

  • Abort Seizures (Phase IV)
A
  • Pentobarbital is loaded at a dose of 5 mg/ kg followed by IV infusion of 1-10 mg/kg/hr, titrated gradually upwards to a burst- suppression pattern on EEG
124
Q

TTT of Status Epilepticus

  • Determine the etiology
A
  • Once seizure control is established, focus on determining the etiology
  • History, examination, Laboratory studies, Neuroimaging and sometimes CSF examination.
125
Q

TTT of Status Epilepticus

  • Prevent Further Episodes
A
  • Correct the proximate cause of status epilepticus if detected.
  • Patients with known epilepsy need ASM regimen modification to prevent seizure recurrence.

Y4R3 - Medicine II 🩺 (16 decks)

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