Neuro Lecture 1 Flashcards
One organ without pain receptors?
Brain
<p>
| Three divisions of the nervous system </p>
<p>
| Central Peripheral Enteric</p>
Which cranial nerves aren’t peripheral nerves?
CN II (optic) because they are surrounded by dura mater
Which has more neurons, enteric or spinal cord?
Enteric
What neurotransmitter does the enteric nervous systemic use?
Serotonin
what deals with neurology disorders commonly diagnosed in childhood? Ex- cerebral palsy
Child neurology
If a child has a tremor, whom should they be seen by?
An adult neurologist
How are most diagnoses made?
By history
laboratory, diagnostic, and imaging findings must be…
clinically correlated
In neurology do you diagnose based on labs?
No, must all be clinically correlated
What is a seizure?
Hypersynchronous brain activity
What is epilepsy?
An abnormally low seizure threshold.
A tendency for “unprovoked” seizures
How many people will have a seizure in their lifetime?
10%
Is a seizure caused by strobe lights provoked or unprovoked?
Unprovoked
What age ranges are more prone to seizures?
under 2 and over
65 years
<p>
| Why are males at more risk for seizures?</p>
<p>
| Less neurons since testosterone kills brain cells</p>
What is remission in epilepsy?
Gone 2-5 years without a seizure (includes being on meds)
What diet can help with seizures that aren’t controlled by meds?
ketogenic
What is the difference b/w generalized and focal seizures?
Focal is on one part of the brain, generalized is throughout
What does convulsive mean?
Involve positive motor activity
simple partial seizure
starts in a locus and spreads contiguous
What type seizure that spreads to a non-contiguous area. Change in mental status (90% of time), look like staring spells.
Complex partial seizure
What type seizure is a focal motor seizure. Ex- rhythmic jerking on their hand. There is a simple partial seizure in the motor strip.
Simple partial seizure
What is a simple partial seizure in a non-motor area called? Ex- see sparkling lights, weird feelings they can’t tell the difference b/w big and little things.
An aura
Is an aura a feeling you get before a seizure?
No, it is a seizure going on
What are the 2 types of generalized seizures?
Non-convulsive
Convulsive
What are seizure where a person then totally falls limp to the ground. Absence seizure of the muscles.
Atonic generalized seizure
What does a clonic seizure look like?
Rhythmic jerking movements
What is a single non-rhythmic jerk?
Myoclonic
What type generalized convulsive seizure is often found in infants, looks like colic?
Spasm
What type seizure is usually at night and is bicycling in bed with an outstretched arm.
Hypermotor
What do secondarily generalized convulsive seizures look like?
GTC (generalized tonic clonic seizures)
Does an EEG diagnose epilepsy?
No, history does
How many people will become epileptic sometime in their life?
3%
How are EEGs described?
Nonspecific and nonsensitive
What does the EEG record?
Superficial cortex
Where will an EEG not capture seizures?
In sulci or deeper in the brain
What type seizures can has normal or abnormal EEGs?
focal onset
what type seizures are typically long? (>20 sec)
Focal seizures
What type seizures are typically short? (<20 seconds)
generalized seizures
which type seizures tend to morph?
Focal onset seizures
What is the phase after a seizure where a patient is confused, sleepy, can’t talk?
post-ictal state
What type epilepsy usually has a post-ictal phase?
Focal-onset
If someone has a starting spell, what are 2 types seizures they could have?
Complex partial (focal) absence (generalized)
Kid is constantly falling?
Atonic seizure
What med is only used for atonic and absence epilepsy?
ETS (Ethosuximide)
2 meds only used for partial onset seizures?
CBZ (carbamazepine)
OXC (Oxcarbazepine)
Will you get a mixture of focal and generalized seizures?
No, very rare
What happens if you give CBZ to a person with generalized seizures?
status epilepticus
what is a seizure that is too long?
status epilepticus
What is the first line treatment for status epilepticus ?
Benzos- if at home DZP (rectal gel)
if in hosptial- LZP (lorazepam)
What is second line treatment for status epilepticus?
Any appropriate anti-epileptic drug you can push
What 2 drugs can’t you push therefore can’t give for status epilepticus?
Phenytoin (PHT)
lamotrigine (LTG)
what does lamotrigine given too fast lead to?
Steven-Johnson’s syndrome
What can phenytoin given through IV lead to?
Heart stopping (alkaline solution)
how long about does it take for anti-epileptic drugs to be therapeutic once given?
20 minutes or so
What is the 3rd line treatment for status epilepticus?
Coma (about 1/3 of these kids will never come out)
If someone presents seizing, what should you assume?
Status epilepticus
What can the benzos suppress and lead to having to do what?
Suppress breathing, have to intubate
Which seizure types can go into status epilepticus?
All of them
What things can look like seizures but aren’t?
Provoked convulsions febrile convulsions (type of provoked) Tic disorders self stimulation movement disorders migraine variants pseudoseizure (stress rxn) Syncope
If two appropriate anticonvulsant medications at reasonable doses have not controlled the seizures, what is this called?
Intractable seizure
What do you do for people with intractable epilepsy?
Pre surgical workup, Video EEG and high- resolution MRI of the brain.
May be candidates for epilepsy surgery or vagal nerve stimulation (VNS) therapy
What does VNS do?
Stimulates the left vagus nerve then actively stimulates the brain stem and cause changes in neurotransmitter concentration. Makes about 1/3 of patients seizure free
If a person failed two meds, then a third med worked, what is it classified as?
Intractable epilepsy in remission.
What is catamenial epilepsy?
Have an increase in seizures 3 days before menstrual period.
What drug is a strong mood destabilizer?
Levetiracetam (levetiRageAttack)
Do P450 inducers affect peak?
No
What do P450 inducers affect?
1/2 life and averages become shorter
If you take a medication with carbamazepine what might need to happen?
Need to take that other med more times a day
What is a potent P450 inducer?
Carbamazepine
How will carbamazepine affect OCPs?
reduces 1/2 life
What is ethosuximide used for?
Absence and atonic seizures
What are some side effects of ethosuximide?
N/V/D abdominal cramping
tastes really bad, most kids can’t keep it down
(remember “sucks”)
What is the most potent mood stabilizer?
Lamotrigine
What does the same thing as carbamazepine but with fewer sider effects?
Oxcarbazepine
What drug causes gingival hyperplasia? and hirsutism?
Phenytoin
What drug will lower your IQ by 10-20 points? Also is an appetite suppressant.
Topiramate (Topamax)
What drug is an appetite inducer? Also causes polycystic ovaries.
Valproic acid
What is like topamax, but less side effects?
Zonisamide (but is an aromatic sulfa drug)
