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Clin Med, Path, Pharm > Neuro: Seizures > Flashcards

Neuro: Seizures Flashcards

1
Q

A paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain

A

Seizures

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2
Q

A condition in which a person has recurrent seizures due to a chronic, underlying process

A

Epilepsy

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3
Q

Recurrent seizures from an infection or avoidable cause. Is this epilepsy?

A

No

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4
Q

Definition of epilepsy

A

2 or more UNPROVOKED seizures

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5
Q

Classifications of seziures

A

Focal
Generalized
Unclear

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6
Q

Motor, sensory, autonomic, cognitive seizures are what classification?

A

Focal

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7
Q

Absence, tonic clonic, atonic, and myoclonic seizures are what classification?

A

General

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8
Q

Seizure that arises from a neuronal network within one hemisphere

A

Focal seizures

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9
Q

What determines the difference between a simple and complex focal seizure?

A

Simple –> No LOC

Complex –> Alteration in consciousness

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10
Q

What would you expect an EEG to look like between seizures?

A

normal

may show brief discharges (epileptiform spikes)

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11
Q

In focal seizures WITHOUT dyscongitive features (simple), movement is typically (clonic, tonic)

A

clonic

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12
Q

Focal seizures accompanied by transient impairment of the patient’s ability to maintain normal cognition

A

Focal seizures WITH dyscognitive features (complex)

Pt can’t respond appropriately to visual or verbal commands during seizure and usually doesn’t remember it

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13
Q

Thought to arise at some point in the brain but immediately and rapidly engage neuronal networks in both cerebral hemispheres

A

Generalized seizures

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14
Q

Characterized by sudden, brief lapses of consciousness without the loss of postural control. Seizure lasts for a few seconds and consciousness returns as suddenly as it was lost. No postictal confusion

A

Typical absence seizures (generalized seizure)

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15
Q

Electrophysiologic hallmark of typical absence seizure

A

generalized, symmetric, 3 hz spike-and-wave discharge that begins and ends suddenly. Seen on EEG

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16
Q

Absence seizure with longer lapse of consciousness, associated with diffuse or multifocal structural abnormalities of the brain.

A

Atypical absence seizures

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17
Q

You give anticonvulsants to a pt with a typical absence seizure and a pt with atypical absence seizure. Who will respond better?

A

Typical

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18
Q

Most common seizure type resulting from metabolic derangements

A

Generalized, tonic-clonic seizures

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19
Q

How does tonic-clonic seizure begin?

A

abrupt without warning. Some pts have vague premonitory symptoms minutes to seconds before seizure

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20
Q

Characteristics of tonic-clonic seizures

A

initial phase: tonic contractions
Respirations are impaired, secretions pool in oropharynx and cyanosis develops
Contraction of jaw muscles causes biting of the tongue

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21
Q

When observing a pt undergoing a tonic-clonic seizure, what might you see?

A

cyanosis, increased HR, BP, pupils dilate

After 10-20 seconds, clonic phase begins

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22
Q

How long do typical tonic-clonic seizures last? How long is dangerous?

A

Typical - 1 minute

Dangerous - more than 5 minutes

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23
Q

Describe the postictal phase of tonic-clonic seizures

A 
unresponsiveness
Muscular flaccidity
Excessive salivation
Bowel/bladder incontinence
Confusion
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24
Q

Sudden loss of postural muscle tone lasting 1-2 seconds.

A

Atonic seizures

“drop attacks”

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25
Q

Sudden, brief muscle contraction. Normal, physiologic form is sudden jerking when falling asleep.

A

Myoclonic seizures

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26
Q

Associated with metabolic disorders, degenerative CNS dz, anoxic brain injury. caused by cortical dysfunction

A

Myoclonic seizures

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27
Q

What are the three types of epilepsy syndromes?

A

Juvenile Myoclonic Epilepsy (JME)
Lennox-Gastaut Sydrome (LGS)
Mesial Temporal Lobe Epilepsy

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28
Q

Characterized by bilateral jerks, single or repetitive. More common in the morning, provoked by lack of sleep. 1/3 have absence seizures, many can experience tonic-clonic seizures

A

Juvenile Myoclonic Epilepsy

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29
Q

Treatment of choice for JME

A

Valproate (Depakote)

Remission is relatively uncommon, but responds well to anticonvulsants

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30
Q

Occurs in children, associated with developmental abnormalities, perinatal hypoxia, trauma, and infection

A

Lennox-Gastaut Syndrome

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31
Q

LGS triad

A
  1. Multiple seizure types (tonic and atonic seizures)
  2. EEG showing spike-and-wave discharges/abnormalities
  3. Impaired cognitive function in most cases
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32
Q

Prognosis of LGS

A

Poor, results in poorly controlled epilepsy

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33
Q

Most common syndrome associated with focal seizures with dyscognitive features

A

mesial temporal lobe epilepsy

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34
Q

Mixture of different feelings, emotions, thoughts, and experiences, which may be familiar or completely foreign

A

Mesial temporal lobe epilepsy

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35
Q

MRI findings on mesial temporal lobe epilepsy

A

Hippocampal sclerosis

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36
Q

What causes seizures?

A

Shift in the normal balance of excitation and inhibition within the CNS

37
Q

What are the three clinical observations that can cause seizures?

A
  1. Endogenous factor (factor within ourselves that makes seizures more likely)
  2. Epileptogenic factor (something that transforms normal CNS that makes it more excitable)
  3. Precipitating factors (induce seizures)
38
Q

An otherwise normal child gets a fever and has a seizure. This is an example of what factor?

A

Endogenous

39
Q

Following penetrating trauma to the head, the pt has seizures. This is an example of what factor?

A

Epileptogenic

40
Q

Pt doesn’t get enough sleep and has a seizure. This is an example of what factor?

A

Precipitating factor

41
Q

What is an important factor in determining both incidence and likely causes of seizures/epilepsy?

42
Q

Causes of seizures in neonates/early infancy

A 
Encephalopathy
Trauma
Infection
Congenital
Metabolic D/O
Drugs
Hypoglycemia
(CHIME TD)
43
Q

Causes of seizures in late infancy/early childhood

A

Febrile seizures (most common) occurs during rising phase of fever. 1/3 have recurrence

44
Q

Simple vs complex febrile seizurse

A

Simple: single event, brief, no risk of developing epilepsy
Complex: repeated events, >15 minutes, Do have a risk of developing epilepsy)

45
Q

Causes of seizures in childhood

A

Idiopathic
Trauma
Infection
Tumor

46
Q

Causes of seizures in adolescents

A 
Acquired CNS lesion predominant, idiopathic less common
Trauma
genetic d/o
infection, tumor
illicit drug use
47
Q

Causes of seizures in young adults

A

Alcohol withdrawal
Trauama
Illicit drugs
Brain tumor

48
Q

Result of alcohol withdrawal, symptoms like shakiness, irritability, change in MS, seizure

A

Delirium tremens

49
Q

Causes of seizures in older adults

A 
Cerebrovascular disease
Tumor
Alcohol withdrawal
Metabolic disorders
AD/Degenerative CNS dz
Just being old
50
Q

Initiation phase of seizures is characterized by two concurrent events:

A
  1. High frequency bursts of action potentials

2. Hypersynchronization

51
Q

Pathophys of burst

A

problem with the neuron itself. Allows an influx of calcium that causes Na channels to open up, increasing action potential. Causes spike discharge on EEG. After burst, hyperpolarizing occurs mediated by GABA or K channels

52
Q

What causes the spike discharge on EEG?

A

Synchronized bursts from a sufficient number of neurons

53
Q

What normally prevents burst activity from spreading?

A

hyperpolarization and inhibitory neurons

54
Q

Transformation of a normal neuronal network into one that is chronically hyperrexcitable.

A

Epileptogenesis

55
Q

What are the new findings in genetic causes of epilepsy?

A

Ion channel mutations and
Chromosomal microdeletions
May be the cause of epilepsy in some patients

56
Q

You are taking history from someone who had their first seizure. What 3 things do you want to establish?

A
  1. Actual seizure or just a paroxysmal event?
  2. Cause? (RF, precipitating events)
  3. Is Anticonvulsant therapy required?
57
Q

You are taking history from someone with prior seizurse. What 2 things is the evaluation directed toward?

A
  1. Identify cause and precipitating factors

2. Determine if their current treatment therapy is enough

58
Q

What specifics are you looking for on PE in someone who had a seizure?

A

Signs of infection, trauma, drug/alcohol use, metabolic d/o (jaundice), neuro exam deficits

59
Q

What labs do you order on someone who had a seizure?

A

Glucose!!

CMP, urine and blood tox screen, LP if suspect meningitis

60
Q

What imaging do you order on someone with new-onset seizure?

A

MRI is better than CT
CT used if assessing for infection/bleed/mass
EEG can confirm electrical activity, classify seizure, and locate focus

61
Q

Someone with a suspected seizure d/o has a normal EEG. Now what?

A

doesn’t rule out epilepsy. Repeat EEG or do long term monitoring

62
Q

If this is your first seizure and it is left untreated, how many will have recurrence? How many will have recurrence if the seizure is treated?

A

Half if untreated

25% if treated

63
Q

What lab test can tell you if someone is having a pseudoseizure?

A

Their prolactin level will be normal

64
Q

Seizures and driving

A

PA state law is to suspend driver’s license for 6 months. Must report seizure of LOC to PENDOT

65
Q

Who should perform seizure management? What are the main goals of management?

A 
Neurologist
Goals:
1. control seizures
2. Avoid tx side effects
3. maintain quality of life
66
Q

When is Antiepileptic Drug Therapy started?

A

After 2+ unprovoked seizures (above 50% chance of recurrence)

67
Q

How many patients will be seizure free when using AED?

A

Half with new dx of epilepsy will be seizure free with first AED prescribed

68
Q

What type of AEDs are the most problematic with interactions with warfarin and oral contraceptive therapy? (as well as anti-cancer and anti-infective drugs)

A 
Enzyme-inducing AED's:
Phenytoin (dilantin)
Carbamazepine (Tegretol)
Phenobarbital
Oxycarbazepine (Trileptal)
Topiramate (Topamax)
69
Q

How do you add another AED if the first one does not control epilepsy?

A
  1. Second med is increased to therapeutic levels before first agent is reduced
  2. Second med is titrated up slowly
  3. Temporary increase in side effects during overlap period until first AED is tapered off
70
Q

Prognosis for patients who have failure of initial AED therapy

A

Fewer patients will have successful drug trial

71
Q

What do you need to watch for in AED therapy?

A
  1. Increased risk of suicide
  2. Stevens-Johnson syndrome
  3. Toxic epidermal necrolysis
  4. Drug rash with eosinophilia and systemic symptoms
72
Q

When is the period of highest risk of developing severe complications with AED?

A

First 2 months

73
Q

Mainly used for focal seizures and neuropathic pain. SE: diplopia, hyponatremia

A

Carbamazepine (Tegretol)

74
Q

SE of Phenytoin (Dilantin)

A

nystagmus, slurred speech, ataxia, drowsiness

75
Q

signs of toxicity from phenytoin

A

gum hyperplasia
hirsuitism
Folate deficiency
(monitor LFTs and CBC)

76
Q

Widely effective treatment for all seizures, also used for migraine prophylaxis. Elevated LFTs common as well as weight gain, alopecia, and tremor.

A

Valproic Acid (Depakene)/Divalproex (Depakote)

77
Q

Rash and dizziness common. Most effective drug for focal seizures. 1:1000 get SJS.

A

Lamotrigine (Lamictal)

78
Q

Used for general or focal seizures and has NO interactions with other drugs! May cause decrease in WBC and anger issues

A

Levetiracetam (Keppra)

79
Q

AED that causes weight loss. Often used for focal seizures, pain syndromes, migraines.

A

Topiramate (Topamax)

80
Q

Who should not get topamax?

A

If pregnant or hx of kidney stones

81
Q

What classifies someone as being in remission of seizures?

A

Seizure-free for 2-5 years

82
Q

Predictors of relapse of epilpesy after remission

A
  1. Abnormal EEG before/during withdrawal of AED
  2. Abnormal neuro exam
  3. Mental retardation
83
Q

A seizure lasting >30 minutes or multiple seizures without regaining consciousness. More than half have no prior seizure history.

A

Status Epilepticus

84
Q

Most common cause of status epilepticus

A

Low AED blood level

85
Q

Treatment of status epilepticus

A

ABCs
Check Glucose
Benzos, phenytoin, or keppra IV
General anesthesia is a last resort

86
Q

Surgical option used for refractory epilepsy

A

Vagal nerve stimulation

Reduces seizures by 40% in up to half of those with refractory epilepsy

87
Q

Most common surgical excision of brain lesion in refractory epilepsy

A

Resect mesial temporal lobe sclerotic lesions

88
Q

What % of those who do not get seizure control in the first year ever reach remission?

Clin Med, Path, Pharm (12 decks)

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