Mock test for Seizure Flashcards
Excessive abnormal electrical discharge from cortical neurons
Causes: idiopathic, CNS infection, fever, metabolic
disturbance, cerebral trauma
is the physical findings or changes in behavior that
occur after an episode of abnormal electrical activity in the
brain.
Seizures
occur when a person’s body shakes rapidly and
uncontrollably. à violent, involuntary contractions of the voluntary muscles.
Convulsions
may precede the seizure by hours or days.
–in behavior or mood
typically occur during the _____. This phase may include an aura–subjective
sensation, such as unusual smell or
flashing light
PRODROME
the seizure itself. In some cases, a scream or cry
heralds its onset.
ICTAL PHASE
takes place immediately after the seizure.
The patient typically exhibits
lethargy, confusion, and behavioral
changes
POSTICTAL PHASE
recurrent unprovoked seizures
a chronic seizure disorder, or group of disorders,
characterized by seizures that usually recur
unpredictably in the absence of a consistent
provoking factor.
first described by Hughlings Jackson as an
intermittent derangement of the nervous
system due to a sudden, excessive, disorderly
discharge of cerebral neurons.
Epilepsy
2 kinds of Partial Seizure:
simple and complex seizure
6 kinds of Generalized Seizure
GTC, absence, myoclonic, Clonic, Tonic, Atonic
throw or toss with a quick abrupt
motion
JERKING
an abnormal sensation, typically tingling or pricking
PARESTHESIA
language disorder marked by deficiency in the generation of speech
DYSPHASIA
rare movements when the present feels like the past
Deja vu
most common seizure type
-occurring in approximately 80% of epileptic
patients.
- clinical and EEG changes indicate initial
activation of a system of neurons limited to
part of one cerebral hemisphere that may
spread to other or all brain areas.
Partial Seizure
most common seizure type
-occurring in approximately 80% of epileptic
patients.
- clinical and EEG changes indicate initial
activation of a system of neurons limited to
part of one cerebral hemisphere that may
spread to other or all brain areas.
generally do not cause loss of consciousness.
Partial Seizure
accompanied by impaired consciousness;
however in some cases, the impairment precedes
or follows the seizure.
§ Purposeless behavior is common.
§ The affected person may have a glassy stare, may
wander about aimlessly, and may speak
unintelligibly.
§ Psychomotor (temporal lobe) epilepsy may lead
to aggressive behavior (e.g., outbursts of rage or
violence).
Postictal confusion usually persists for 1-2
minutes after the seizure ends.
COMPLEX PARTIAL SEIZURES
generally do not cause loss of consciousness
SIGNS AND SYMPTOMS: MOTOR SIGNS: convulsive
jerking, chewing motions and lip smackling.
Ø SENSORY AND SOMATOSENSORY
MANIFESTATIONS: paresthesias and auras.
Ø AUTONOMIC SIGNS: sweating, flushing and pupil
dilation.
Ø BEHAVIORAL MANIFESTATIONS: sometimes
accompanied by impaired consciousness, include déjà
vu experiences, structured hallucinations, and dysphasia.
BEHAVIORAL MANIFESTATIONS:
sometimes accompanied by impaired
consciousness, include
§ déjà vu experiences,
§ structured hallucinations,
§ and dysphasia.
SIMPLE PARTIAL SEIZURES
(e.g., picking at clothes) is
common and may follow visual, auditory or
olfactory hallucinations)
Automatism
¡ Entire brain is involved
¡ motor manifestations are bilateral.
¡ diffuse, affecting both cerebral hemispheres.
¡ clinical and EEG changes indicate initial involvement of both
hemispheres
generalized seizures
§ present as alterations of consciousness (absences)
lasting 10-30 seconds.
¡ Staring (with occasional eye blinking) and
loss or reduction in postural tone is typical.
¡ Enuresis
brief loss of consciousness
ABSENCE (Petit mal) SEIZURES
(bilateral massive epileptic myoclonus)
§ present as involuntary jerking of the facial, limb, or
trunk muscles, possibly in rhythmic manner.
§ consist of sporadic jerks, usually on both sides of
the body. Patients sometimes describe the jerks as
brief electrical shocks. When violent, these seizures
may result in dropping or involuntarily throwing
objects.
MYOCLONIC SEIZURES
§ characterized by sustained muscle contractions
alternating with relaxation
§ are repetitive, rhythmic jerks that involve both
sides of the body at the same time.
CLONIC SEIZURES
involve sustained tonic muscle extension
(stiffening).
TONIC SEIZURES
cause sudden loss of consciousness.
unconsciousness, convulsion & muscle rigidity
The individual becomes rigid and falls to the
ground. Respirations are interrupted. The
leg extended, and the back arches;
contraction of the diaphragm may induce
grunting. This tonic phase lasts for about 1
minute.
A clonic phase follows, marked by rapid
bilateral muscle jerking, muscle flaccidity,
and hyperventilation. Incontinence, tongue
biting, tachycardia, and heavy salivation
sometimes occur.
¡ Postictal phase
§ the individual may experience headache,
confusion, disorientation, nausea, drowsiness,
and muscle soreness. This phase may last for
hours.
GENERALIZED TONIC-CLONIC SEIZURES
(grand mal)
seizures occur repeatedly with no recovery of
consciousness between attacks
status epilepticus
characterized by a sudden loss of postural tone so
that the individual falls to the ground. They
occur primarily in children.
ATONIC SEIZURES (drop attacks)
have no identifiable cause.
PRIMARY (idiopathic) SEIZURES
occur _______ to an identifiable cause
¡ Intracranial neoplasms
¡ Infectious diseases (meningitis, influenza,
toxoplasmosis, mumps, measles, syphilis)
¡ High fever (in children)
¡ Head trauma
¡ Congenital diseases
¡ Metabolic disorders (hypoglycemia, hypocalcemia)
¡ Alcohol or drug withdrawal
¡ Lipid storage disorders
¡ Developmental abnormalities
SECONDARY SEIZURES (symptomatic or
acquired seizures)
GTC and partial seizures
valproic acid, carbamazepine, phenytoin
ABSENCE Drugs
ethosuximide, valproic acid
Myoclonic Drugs
clonazepam, valproic acid
Status epilepticus
diazepam, lorazepam, phenytoin
Febrile seizures
phenobarbital
TONIC CLONIC
Lamotrigene, VPA, Topiramide
TONIC CLONIC
Lamotrigene, VPA, Topiramide
Partial seizures drug list
▪ Carbamazepine, phenytoin
▪ Valproic acid, lamotrigine, gabapentin,
benzodiazepines, barbiturates
▪ Adjunct: Tiagabine, topiramate,
levetiracetam, zonisamide
Tonic-clonic (grand mal):
§ Carbamazepine, phenytoin
§ Valproic acid, lamotrigine, gabapentin,
benzodiazepines, barbiturates
§ Adjunct: Topiramate, zonisamide
Absence (petit mal):
§ Ethosuximide
§ Valproic acid (when absence seizures coexist with
tonic-clonic seizures)
§ Clonazepam
§ Adjunct: Lamotrigine, benzodiazepines
Myoclonic syndromes:
§ Valproic acid
§ Clonazepam and other benzodiazepines
§ Adjunct: levetiracetam
Treatment is intravenous diazepam or
lorazepam followed by intravenous
fosphenytoin (or phenytoin) or
phenobarbital
Status epilepticus
by selectively binding to the channel in the
inactive state and slowing its rate of
recovery
blocks voltage-gated sodium channels
by selectively binding to the channel in the
inactive state and slowing its rate of
recovery
blocks voltage-gated sodium channels
MOA: closes Na channels
¡ Oldest nonsedative antiepileptic drug
CNS: ataxia, nystagmus, diplopia
¡ Connective: hirsutism, gingival hyperplasia (20-40%)
“Fetal hydantoin syndrome”
DERMATOLOGICAL EFFECTS: , SJS, and lupus erythematosus.
No effect on infantile spasms or absence seizures
CyP450 inducer (carbamazepine, valproate, warfarin, OCPs)
¡ Displaced from protein binding by aspirin, sulfonamides
Decreased serum concentrations of folic acid, thyroxine, and
vitamin K with long-term use.
Phenytoin (Dilantin/ Epilantin)
includes growth retardation, microencephaly, and craniofacial
abnormalities (e.g., cleft palate) and is possibly due to an epoxide
metabolite of phenytoin.
Fetal hydantoin syndrome
is a prodrug
¡ rapidly converted to phenytoin in the blood,
providing high levels of phenytoin within minutes.
¡ may also be administered intramuscularly (IM).
¡ Phenytoin sodium should never be given IM
because it can cause tissue damage and necrosis.
drug of choice and
standard of care for IV and IM
administration.
Fosphenytoin (Cerebyx)
Congeners of phenytoin
(withdrawn form the market) (1)
Mephenytoin (Mesantoin)(1)
Ethotoin (peganone)
Phenacemide
METABOLITE that contributes most of the antiseizure
activity of mephenytoin.
NIRVANOL
used for trigeminal neuralgia
MOA: closes Na channels
¡ First choice: complex partial and generalized tonic-clonic
seizures.
¡ Tricyclic, antidepressant (bipolar)
Carbamazepine (Tegretol)
ADR:
¡ CNS effects: dizziness, ataxia, diplopia
¡ GI: nausea, vomiting
¡ Metabolic: hyponatremia
¡ Hematopoietic: leukopenia
¡ Derma: rashes, SJS
¡ CyP450 inducer (warfarin, phenytoin, valproate, OCPs),
autoinducer (induces its own metabolism)
§ Common: Diplopia and ataxia (most common),
gastrointestinal disturbances; sedation at high
doses
§ Occasional: Retention of water and
hyponatremia; rash, agitation in children
§ Rare: Idiosyncratic blood dyscrasias and severe
rashes
§ Drug Interactions:
▪ CBZ metabolism is affected by many drugs, and CBZ
affects the metabolism of many drugs.
§ Determination of plasma levels and clearance
may be necessary for optimum therapy.
Exhibits AUTOINDUCTION
Carbamazepine (Tegretol)
FDA approved in 2000 for partial seizures
▪ Complex partial seizures
▪ Primary & secondarily generalized tonic-clonic seizures
§ Is a prodrug whose actions are similar to those of
carbamazepine; it has a short half-life of 1—2
hour.
§ Its activity is due to a 10-hydroxy metabolite
with a half-life of 10 hours.
§ Fewer adverse effects than CBZ, phenytoin
Oxcarbazepine (Trileptal)
Brand name: (ESL) (Stedesa)
Na channel blockers
§ Prodrug
§ Advantage: once daily dosing regimen
Eslicarbazine
¡ closes Na channels
§ Other Mechanisms of Action:
▪ 1) Some inhibition of T-type Ca2+ channels.
▪ 2) Increases GABA production and decreases GABA metabolism.
(Inhibition of GABA transaminase)
¡ 90% protein bound- displaced by phenytoin and aspirin
¡ S/E:
¡ GI disturbance, rare pancreatitis and hepatotoxicity,
sedation and ataxia at high doses,
¡ fetal malformation (spina bifida)
¡ CyP450 inhibitor (phenytoin, carbamazepine,
Phenobarbital)
caused “spina bifida”
§ Indications:
▪ Simple or complex partial, & primary generalized tonic-clonic
▪ Also used for absence, myoclonic, and atonic seizures.
▪ Highly effective for photosensitive epilepsy and
juvenile myoclonic epilepsy.
§ Contraindications:
▪ Liver disease
Valproic Acid (Valproate; Depakene,
Depakote)
Valproic acid ADR
▪ Weight gain (30-50%)
▪ Dose-related tremor
▪ Transient hair loss
▪ Polycystic ovary syndrome and menstrual disturbances
▪ Bone loss
▪ Ankle swelling
¡ Other Mechanism of Action:
§ Also inhibits voltage gated calcium channels (N
and P/Q type)
§ May inhibit synaptic release of glutamate.
§ Adverse Effects:
▪ Rash (10%)
▪ Rare progression to serious systemic illness
▪ Increased alertness
§ Indications:
▪ Adjunct therapy (ages 2 & up):
▪ Simple & complex partial seizures
▪ Generalized seizures of Lennox-Gastaut
Syndrome
▪ Monotherapy (adults):
▪ Simple & complex partial seizures
§ Contraindications:
▪ May make myoclonic seizures worse
Lamotrigine (Lamictal)
¡ is the most distressing of childhood
epilepsies.
¡ The children suffer frequent fits of many
different types, and experience gradual
mental deterioration.
is a form of severe
epilepsy that begins in childhood. It is
characterized by multiple types of seizures and
intellectual disability.
Lennox-Gastaut syndrome
Other Mechanism of Action:
▪ Enhances post-synaptic GABA receptor currents.
▪ Kainatereceptor antagonist (blocks a certain type of
glutamate channel)
S/E: Incidence of renal stone formation or renal calculi in
older patients is associated
§ Indications:
▪ Adjunct therapy for partial and primary generalized
▪ seizures in adults and children over 2.
▪ Decreases tonic and atonic seizures in children with
Lennox-Gastaut syndrome.
§ Contraindications:
▪ History of kidney stones
Topiramate (Topamax)
Topiramate (Topamax):
§ Drug Interactions: decrease blood levels
CBZ, phenytoin, phenobarbital, & primidone
§ is a sulfonamide derivative that has a broad
spectrum of action
§ Other Mechanism of Action:
▪ Inhibits T-type Ca2+ currents.
▪ Binds to GABA receptors.
▪ Facilitates dopaminergic and serotonergic
neurotransmission
§ Indications:
▪ Approved for adjunct treatment of partial seizures in
adults.
▪ Appears to have a broad spectrum:
▪ Myoclonic seizures
▪ Infantile spasms
▪ Generalized & atypical absence seizures
▪ Lennox-Gastaut Syndrome
Zonisamide (Zonegran)
Zonisamide (Zonegran) drug interaction: decrease its half-life by half.
Phenytoin and carbamazepine
Zonisamide (Zonegran) ADR :
▪ Weight loss
▪ Abnormal thinking
▪ Nervousness
▪ Agitation/irritability
▪ Usually well tolerated
§ Amino acid related compound
§ Also binds to collapsin-response mediator protein
(CRMP) thereby blocking the effect of
neurotrophic factors such as BDNF and NT3 on
axonal and dendritic growth
▪ Brain derived neurotrophic factor
Lacosamide (Vimpat)
§ Triazole derivative
§ Prolong the inactive state of the sodium channel
§ Adjunct for Lennox-Gastaut syndrome
Rufinamide (Banzel)
Indications:
§ Second choice for partial and generalized tonic-clonic seizures.
§ Rapid absorption has made it a common choice
for seizures in infants, but adverse cognitive
effects cause it to be used less in older children
and adults.
§ Status epilepticus
Phenobarbital (Luminal)
§ 2-desoxyphenobarbital
§ was metabolized to phenobarbital and
phenylethylmalonamide (PEMA)
§ Indications:
▪ Adjuvant or monotherapyfor partial and generalized
tonic-clonic seizures
▪ May control refractory generalized tonic-clonic
seizures
§ Contraindications:
▪ History of porphyria
Primidone (Mysoline)
Barbiturate drugs: Drug Interactions:
§ Other CNS depressants
§ Increased metabolism of vitamin D and K
§ Phenytoin increases the conversion of_____
Phenobarbital (Luminal) & Primidone
(Mysoline)
Phenobarbital & Primidone ADR:
▪ Agitation and confusion in the elderly.
▪ Worsening of pre-existing hyperactivity and
aggressiveness in children
▪ Sexual side effects
▪ Physical dependence
▪ Only _______ &
______ approved for long-term
treatment.
▪In combination for partial seizures (1)
(2)
▪ Lennox-Gastaut Syndrome, myoclonic, atonic,
and absence seizures
▪ Tolerance develops after about 6 months
clonazepam (2)
clorazepate (1)
_________are used in
treatment of status epilepticus.
▪(1)_____ is painful to inject
▪ (2)_____ is more commonly used in acute
treatment.
Diazepam (1) and lorazepam (2)
Intermittent use for control of seizure clusters
▪____ frequently combined with phenytoin.
Contraindications:
▪_____ in children under 9
▪ Narrow angle glaucoma
Diazepam
§ Interactions:
▪ Blood levels decreased by CBZ, phenytoin,
phenobarbital, & primidone
§ Adverse Effects:
▪ Asthenia (weakness)
▪ Abdominal pain
§ Mechanism of Action:
▪ Inhibition of GABA transporter (GAT-1) – reduces
reuptake of GABA by neuronsand glial cells.
§ Indications:
▪ Approved in 1998 as an adjunct therapy for partial
seizures in patients at least 12 years old.
§ Contraindications:
▪ Absence seizures
Tiagabine (Gabitril)
§ Adjunct therapy for refractory generalized tonicclonic seizure in patients with severe myoclonic
epilepsy in infancy
§ Barbiturate-like effect
§ Potent inhibitor of CYP3A4, CYP1A2, CYP2C19
Stiripentol (Diacomit)
§ Irreversible inhibitor of GABA aminotransferase
(GABA-T)
§ Also inhibits the vesicular GABA transporter
§ Uses: partial seizure and infantile spasms (reserve
drug)
§ ADRs:
▪ Typical: drowsiness, dizziness, weight gain
▪ Irreversible lesion in the retina
Vigabatrin (Sabril)
especially in
thalamic neurons
that act as
pacemakers to
generate rhythmic
cortical discharge.
nhibit lowthreshold (T-type)
Ca 2+ currents
especially in
thalamic neurons
that act as
pacemakers to
generate rhythmic
cortical discharge.
inhibit lowthreshold (T-type)
Ca 2+ currents
