Seizure Disorders Flashcards
1
Q
Definition of Seizure
A
–A sudden, excessive, disorderly discharge of neuronal activity in the brain
2
Q
Definition of “Seizure Disorder/Epilepsy”
A
a tendency to have recurrent seizures in the absence of any immediately treatable cause such as hypoglycemia or alcohol withdrawal
3
Q
Definition of “Convulsion”
A
bodies muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body
4
Q
A sudden, explosive, disorderly discharge of cerebral neurons causing an alteration in brain function
- Onset? 2
- What does it involve? 4
- Temporarily alters what?
- Often manifests as what?
A
- Sudden or transient
- Involves motor, sensory, autonomic, or psychic manifestations
- Temporarily alters systemic arousal
- Often manifests as convulsions but there are many different kinds of seizures
5
Q
- What is epilepsy?
2. How may it manifest? 3
A
- A condition in which seizures occur without known, correctable cause(s), thus seizures occur and reoccur
- —The term epilepsy is all-encompassing and says nothing about the type of seizure, however the specific area of the brain affected may suggest the specific type of seizure - May also manifests as
- strange sensations,
- emotions, and/or
- behavior including convulsions, muscle spasms, and loss of consciousness
6
Q
Epilepsy - Pathophysiology
What is epilepsy a result of?
Causes? 3
A
Result of complex genetic mutations and environmental factors can cause
- Abnormal brain wiring
- Chemical (neurotransmitter) imbalances
- Abnormal connections made when attempting to repair an injury
7
Q
Epilepsy - Pathophysiology:
- Hypersensitive neurons may exhibit what?
- What is this easily activated by? 6
A
- a sudden or violent depolarization
- hyperthermia,
- hypoxia,
- hypoglycemia,
- hyponatremia,
- sensory stimulation,
- certain sleep phases
8
Q
Epilepsy - Pathophysiology:
Epileptogenic neurons act differently in which ways to cause this? 3
A
- fire more intensely,
- more often, and
- with greater amplitude than normal neurons.
9
Q
Epilepsy - Pathophysiology
1. 1. At the threshold point, cortical excitation spreads to which areas? 3
- Inhibitory neurons in the what 3 areas react to cortical excitation?
A
- subcortical,
- thalamic
- brain stem areas
- cortex,
- anterior thalamus
- basal ganglia
10
Q
Other causes of Seizures?
4
A
- Physiologic stress
- Sleep deprivation
- Fever
- Withdrawal from ETOH or sedative drugs
11
Q
Describe the difference between provoked and unprovoked seizures.
A
- Provoked seizures: Triggered by certain provoking factors in an otherwise healthy brain
- Unprovoked seizures: Occur in the setting of persistent brain pathology
12
Q
What are some provoking factors for seizures?
4
A
- Metabolic abnormalities
- Alcohol withdrawal
- Illicit drug intoxication and withdrawal
- High fever in children
13
Q
The type of seizure a person has depends on a variety of many things such as?
5
A
- The area of the brain affected
- Underlying cause of seizure
- Focal or Generalized
- Occurrence during wakefulness or sleep
- Known triggers
14
Q
Exacerbations of known, previously controlled seizure disorders are common. May be due to:
2
A
- noncompliance with medications
2. alcohol use
15
Q
Epilepsy: Most deaths are due to what?
What are the remainder due to? 3
A
- Most deaths are due to the underlying cause of epilepsy
- The remainder are due to
- accidents (trauma, burns, aspiration)
- suicide
- sudden unexpected death SUDEP
16
Q
What is SUDEP?
A
defined as sudden, unexpected, nontraumatic, nondrowning death in a patient with epilepsy
17
Q
Describe the prodrome in epileptic pts?
Common symptoms of prodrome?6
A
May experience feeling, sensations or changes in behavior hours or days before seizure
- Déjà vu
- Smells, sounds, taste
- Fear/panic
- Dizzy/lightheaded
- HA
- nausea
18
Q
What is the aura of a seizure?
A
First symptom of a seizure and considered part of the seizure
19
Q
- What is the middle phase of a seizure called?
- What is the timeline of this phase?
- Common symtpoms of this phase? 7
A
- “ictal phase”
- Begins from first symptom to end of seizure
- Loss of awareness (often called “blackout”)
- Confused, feeling spacy
- Distracted/daydreaming
- Difficulty talking
- Unable to swallow
- Repeated blinking of eyes
- Lip smacking or chewing movements
20
Q
- Whats the ending phase of the seizure called?
- How long can it take for the person to recover?
- Common symtpoms? 6
A
- Called “postictal phase”
- Recover immediately or minutes to hours
- Common symptoms
- Slow to respond
- Sleepy
- Confused
- Injuries
- —-Bruising, cuts, broken bones
- HA
- Nausea
21
Q
What is the definition of Loss of Consciousness?
A
A state of complete or partial unawareness or lack of response to sensory stimuli as a result of hypoxia caused by respiratory insufficiency or shock; from metabolic or chemical brain depressants such as drugs, poisons, ketones, or electrolyte imbalance; or from a form of brain pathologic condition such as trauma, seizures, cerebrovascular insult, brain tumor, or infection
22
Q
- What are focal (partial) seizures?
2. What are the two categories?
A
- Those with onset limited to part of one cerebral hemisphere
- Focal seizures without impairment of consciousness
- Focal seizures with impairment of consciousness
23
Q
- What are generalized seizures?
2. What are the kinds of these seizures? 4
A
- Those that involve the cerebral cortex of both sides of the brain
- Absence (petit mal)
- Tonic-Clonic (grand mal)
- Myoclonic
- Clonic, Tonic, Atonic
24
Q
- Focal Seizures: The initial discharge arises from where?
2. What are the categories? 4
A
- from a focal, unilateral area of the brain without impaired consciousness
- Motor (Jacksonian March)
- Sensory
- Autonomic
- Psychic
25
1. Jacksonian seizures are initiated with abnormal electrical activity within what area of the brain?
2. Describe how it moves through the body?
3. What is the first sensation felt as?
4. Other symptoms often associated with a Jacksonian seizure are what?
5
1. primary motor cortex.
2. They are unique in that they travel through the primary motor cortex in succession, affecting the corresponding muscles, often beginning with the fingers.
It then affects the hand and moves on to more proximal areas.
3. This is felt as a tingling sensation.
4.
- sudden head and eye movements,
- tingling,
- numbness,
- smacking of the lips
- sudden muscle contractions
26
FOCAL SEIZURES: Without impaired consciousness.
What can they experience? 2
(how long does this last)
What do you have to rule out for these seizures?
1. Prodrome or Aura: Warning sign of impending seizure activity
2. “Todd’s paralysis” (temporary, unilateral, 30min-36hours)
Stroke
27
1. What can a FOCAL SEIZURES: Without impaired consciousness progress to? 2
2. What will show the locality?
1. Can progress very quickly from a seizure (no change of consciousness) ==>
- a seizure (consciousness altered, as in staring spell, automatisms) or
- generalized seizure (tonic-clonic) seizure.
2. EEG
28
1. Focal seizures with impaired consciousness produces what?
2. Where do 70-80% arise from?
3. Many evolve from what?
4. What do they present with?
1. Unresponsiveness
2. 70-80% arise from the temporal lobe
3. Many evolve from simple focal seizures
- -Simple partial onset followed by impaired consciousness
4. Present with automatisms
29
1. What is the most common type of focal seizure?
2. Clinical signs, symptoms and supporting EEG changes indicate involvement of what at onset?
3. How long do they usually last?
4. WHat are the symptoms that they can experience after the seizure?
1. Focal seizure with impaired consciousness
2. one hemisphere
3. Last from 30 seconds to 2 minutes
4. Confusion and tiredness may follow for about 15 mins, may take hours to be fully normal
30
Generalized Onset Seizures
Clinical symptoms include?
2
1. Disturbances in consciousness
| 2. Involve varying bilateral degrees of symmetric motor responses without evidence of localization to one hemisphere.
31
Examples of Generalized Onset Seizures?
1. Absence ("petit mal")
2. Myoclonic
3. Atonic (Drop)
4. Febrile seizure
5. Idiopathic tonic-clonic ("grand mal")
6. Post-Traumatic Epilepsy
32
1. What are absence siezures?
2. What are these seizures expressed as?
3. What are these referred to as?
1. Generalized, non-convulsive epileptic events
2. Expressed mainly as disturbances in consciousness
3. Referred to as “petit mal seizures”
33
Absence Seizures (petit mal seizures)
1. Describe the onset and progression of the seizure?
2. What can they evolve into?
3. Describe the onset and termination of the seizure?
4. Describe how the pt reacts to seizure?
5. How long do they last?
6. Who should be screened for this?
1. Typically occur only in childhood and cease in adulthood
2. Can evolve into generalized motor seizures
3. Onset and termination of attacks are abrupt
4. Impairment is so brief patient is unaware of it
5. Last about 10 seconds
6. Grade school children who are doing poorly in school potentially should be screened
34
Symptoms of Absence Seizures
(petit mal seizures)?
6
1. Blank stare
2. Motionless
3. Stop talking in mid sentence
4. Can have mild clonic, tonic or atonic components
5. May have automatisms
6. No postictal period
35
```
1. Atypical Absence Seizures
are what?
2. Describe their resolution?
3. Are accompanied by what?
4. Occur most often in who?
5. What should we know about treatment with these types of seizures?
```
1. Lapses of awareness that have a gradual onset
2. Do not resolve as abruptly
3. autonomic features or loss of muscle tone
4. Occur most often in children with mental impairment
5. Don’t respond as well to antiepileptic drug treatment
36
What are Myoclonic Seizures?
| how can they occur? 4
```
Rapid recurrent brief muscle jerks that can occur:
Bilaterally
Unilaterally
Synchronously
Asynchronously
```
37
1. Myoclonic jerks can range from? 2
2. May terminate into what?
3. When can these occur?
4. What do they often cluster around? 2
1.
- Small movements of the face or hands
- Bilateral spasms that simultaneously affect the head, limbs and trunk
2. May terminate into a generalized tonic-clonic (grand mal) seizure
3. Can occur at any time
4. Often cluster shortly after waking or while falling asleep
38
1. Atonic Seizures are also called?
2. Occur most often in what kind of people?
3. What are these characterized by?
4. Describe the pattern of this seizure? 3
1. “Drop attacks”
2. Occur most often in children with diffuse encephalopathies
3. Are characterized by sudden loss of muscle tone that may result in falls with self-injury
4. Can occur in a
- repetitive
- rhythmic
- successive manner
39
1. What is the most common cause of convulsions in children?
| 2. Occur in what ages?
1. Fever
| 2. 6 months- 5 years
40
1. Febrile seizures occur at what temperature?
2. Chance of recurrance is the greatest when?
3. What are they not associated with that makes them different?
1. Temp is usually >38 C (100.4 F)
2. Chance of recurrence is greatest if the first seizure occurs before 1 year or there is a family history.
3. Are not associated with nor do they cause mental impairment, poor school performance or behavior problems.
41
1. What are the two types of febrile seizures?
2. Describe how the body reacts?
3. Conscious or unconsciousness?
4. What is generally not needed for the workup?
5. How should we treat?
1. Simple and Complex
2. During body becomes stiff and arms and legs begin twitching
3. Lose consciousness
4. Blood test, Imaging, and EEG generally not needed
5. Treat with IV lorazepam only for prolonged seizures
42
1. What are Tonic-clonic Seizures?
| 2. What are the types and where do they arise from? 2
1. "Grand mal" (generalized tonic-clonic seizure) is a major motor seizure which involves all extremities and characterized by a sudden loss of consciousness
2. It may be either
- primary, i.e. arising from deep brain structures or represent a
- focal seizure with secondary generalization.
43
1. What is a tonic seizure characterized by?
2. How does the body react?
3. How is breathing affected?
4. Lasts how long?
1. Characterized by sudden loss of consciousness
2. Becomes rigid and falls to ground
3. Respiration is arrested
4. Usually lasts for less than a minute
44
1. What is a clonic seizure characterized by?
2. May last how long?
3. The seizure is followed by what?
1. Jerking of the body musculature
2. May last for 2-3 minutes
3. Followed by a stage of altered level of consciousness
45
What may be complications of tonic-clonic seizures?
1. Tongue and lips may be bitten
2. Urinary or fecal incontinence
3. Patient may be injured
46
What are the different manifestations that may occur immediately following the tonic-clonic seizure?
3
1. May recover consciousness
2. Drift into sleep
3. Have further convulsions without recovery of consciousness between attacks (status epilepticus)
47
What are symtpoms that can be seen in the postictal phase of tonic-clonic seizures?
6
1. Headache
2. Disorientation
3. Confusion
4. Drowsiness
5. Nausea
6. Soreness of muscles
48
1. What are Secondary Generalized Seizures?
2. How long can this last?
- Recovery?
3. What may they begin with? 2
1. Seizure that becomes generalized (spread to both side of the brain) after the initial event (focal seizure) has already begun
2. Usually last 1-3 min., but may take a lot longer for a person to recover
49
Signs and symptoms of secondary generalized seizures?
4
How do we dignose these? 2
Treatment? 1
1. Stiffening of muscles
2. Loss of consciousness
3. Tongue/cheek may be bitten
4. Tonic/clonic phases
Diagnosis
1. EEG
2. MRI
Treatment
1. Carbamazepine
50
Post Traumatic Epilepsy
1. Severity depends on what?
2. Majority develop seizures with what timeframe?
3. 2/3 of these pts have what? 2
4. What kind of head injuries cause this? 4
1. Depends on degree of head injury
2. Majority develop seizures within 1-2 years
3. 2/3 have focal or secondarily generalized seizures
4. Head injuries
- Penetrating head wounds
- Cerebral contusion
- Intracerebral hematoma
- Unconsciousness or amnesia lasting more than 24 hours
51
What are our three objectives for seizure diagnosis?
1) Determine if patient has epilepsy
2) Classify the seizures and type of epilepsy accurately and determine if the clinical data fit a particular epilepsy syndrome
3) Identify, if possible, a specific underlying cause
52
What should we ask on the history for any seizure?
| 9
1. Patients description of the experience
- -Aura?
2. Witness’s accurate observation
3. How it started
4. At what age
5. Family history
6. History of focal trauma or other insult
7. Recent drug use
8. ETOH (withdrawal)
9. CNS infection
53
What may the PE show for seizures?
| 5
1. Exam between seizures shows no abnormality
2. Lateralized or focal signs postictally suggest seizures may have a focal origin
3. Postictal (Todd's) paralysis?
4. Other focal abnormalities?
5. Bruits? heart murmur?
54
Differential: 4 conditions can mimic a seizure and are worth knowing about?
1. REM behavior disorder
2. Transient ischemic attack
3. Transient global amnesia
4. Migraine
55
1. What is REM behavior disorder?
| 2. How is the diagnosis made?
1. REM behavior disorder — REM behavior disorder is a parasomnia that consists of sudden arousals from REM sleep immediately followed by complicated, often aggressive, behaviors for which the patient is amnestic.
2. Diagnosis is clarified by overnight sleep testing
56
1. What are TIAs?
2. What are they characterized by?
3. Postictal state may include what?
1. Transient ischemic attack (TIAs) may last seconds to minutes.
2. Characterized by "negative" symptoms and signs (such as weakness or visual loss)
3. lateralizing "negative" symptoms such as weakness
57
What is Transient global amnesia?
Deficit of short-term memory that begins abruptly and persists for minutes to hours, without other cognitive or motor impairment.
A condition of vascular etiology.
58
1. What is the most important diagnostic test for epilepsy?
Why? 3
EEG is the most important diagnostic test for epilepsy
1. Classifying seizures correctly
2. Identifying epileptic syndromes
3. Making therapeutic decision
59
1. What is the study of choice for imaging for seizures?
| 2. Should be obtained in which pts? 5
1. MRI
2.
- all patients over 20 suspected of having epilepsy for possibility of underlying neoplasm
- children with partial seizures,
- abnormal neurologic finding
- focal slow wave abnormalities on EEG.
- ID structural brain pathology
60
Labs to do on seizure pts?
| 8
```
Establish baseline
1. Anti-epileptic drug (AED) levels
R/O Acute/chronic systemic disease
2. CMP
3. TSH
4. CBC
5. Drug screen (blood or urine)
6. Blood sugar levels
7. Lumbar puncture if indicated
8. EKG
```
61
1. What is Status Epilepticus?
| 2. Prognosis?
1. Any seizure lasting > 30 min or a prolonged flurry of seizures without return to previous level of consciousness between seizures.
2. Life-threatening, especially if generalized tonic-clonic status; if patient arrives in ED still seizing, assume they are in SE and treat accordingly.
62
Causes of Status Epilepticus include?
| 3
1. Drug noncompliance or sudden withdrawal
2. Fever
3. Drug or alcohol withdrawal
63
Initial approach to Status Epilepticus? 3
Remember ABC’s
1. Airway – roll to side, head tilt, oral airway
2. Breathing – oxygen, intubation
3. Circulation – cardiac monitor, maintain blood pressure
64
Status Epilepticus
| 1. Workup? 7
1. Blood draw for
- glucose,
- lytes,
- Ca++,
- Mg++,
- CBC,
- drugs of abuse,
- AED levels
65
Status Epilepticus
Treatment? 3
If not effective after 20 min what should we do? 2
If this still fails?
1. Start IV and give thiamine and glucose
2. Ativan (Lorazepam) 2mg/min (8-10mg)
3. Fosphenytoin (20mg/kg) IV (150mg/min) OR
Phenytoin 20mg/kg IV (50mg/min)
1. Phenobarbital 20mg/kg IV (watch respirations!)
2. Depacon 15-20mg/kg IV
If continued failed measures then general anesthesia with ventilator assistance with neuromuscular junction blockade
66
Status Epilepticus
Treatment for refractory SE?
4
1. Pentobarbital coma
2. Midazolam (Versed) drip
3. Propofol (Diprivan) drip
4. Continuous monitoring
67
```
Treatment Decisions of Seizures
1. Provoked?
2. Unprovoked:
First Seizure? 2
Second Seizure? 3
```
1. Treatment directed to the provoking factor
2. First Seizure
- Usually no treatment
- Treatment can be initiated if risk of recurrence is high
2. Second Seizure
- Diagnosis of epilepsy is established and risk of a third seizure is high
- Most physician treat at this stage
- In children, some may wait for a third seizure
68
Treatment Options for Seizures:
1st and foremost?
Then what are our options? 5
*Neurology referral
1. Medication
2. Surgery
3. Ketogenic Diet
4. Vagal Nerve Stimulator
5. Biofeedback
69
What are the three major basic mechanisms of MOA?
| 3
1. Affecting voltage dependent sodium or calcium channels
2. Increasing inhibitory neurotransmission (GABA)
3. Decreasing excitatory neurotransmission (glutamate and aspartate)
70
1. Na+ channel blockers effective for what kind of seizures?
| 2. T-type calcium channel blockers effective for what kind of seizures?
1. tonic-clonic and partial seizures
| 2. absence seizures
71
What drug is first line for focal and generalized tonic-clonic siezures? 2
1. Tegretol(carbamazapine)
| 2. Dilantin(phenytoin)
72
1. What drug is first line for absence seizures?
| 2. What drug is first line for atypical absence seizures?
1. Zarontin(ethosuximide)
| 2. Depacon(valproic acid)
73
Common side effects of medications
4
1. Lethargy
2. Memory difficulties
3. Cognitive or concentration difficulties (difficulties staying focused)
4. Hyperactivity
74
Levitiracetam (Keppra)
is used for what?
What is dosage based on? 3
Side effects? 4
Pregnancy Cat?
Second-Line for Generalized Tonic-Clonic
Dosage is based on
1. medical condition,
2. kidney function and
3. response to treatment
1. Somnolenc
2. Ataxia
3. HA
4. Behavioral changes
Pregnancy cat C
75
1. What is Carbamazepine (Tegretol) used for?
2. MOA?
3. Pregnancy Cat?
4. Complications? 3
5. What do we need to monitor for?
6. BBW?
1. First-line for Focal and Generalized Tonic-Clonic
2. Blocks Na+ channels
3. Pregnancy D
4.
- Bone marrow suppression,
- liver toxicity,
- rash
5. Monitor CBC & LFT’s
6. Warnings: serious and sometimes fatal dermatologic reactions to include toxic epidermal necrolysis and Stevens-Johnson (SJS)
76
1. What is phenytoin (dilantin) used for?
2. MOA? 2
3. What can high doses cause? 3
1. First-line for Focal and Generalized Tonic-Clonic
2.
- Alters Na+ and Ca++ conductance membrane potentials
- Blocks sustained high-frequency repetitive firing
3. High doses
- Inhibits release of serotonin and norepinephrine
- Promotes uptake of dopamine
- Inhibits monoamine oxidase activity
77
Phenytoin (Dilantin)
1. Preg. Cat.?
2. Complications? (whats the most common?) 5
3. Monitor what? 3
4. What is steady state and when is it reached?
5. BBW?
1. Pregnancy D
2.
- Gingival hypertrophy***,
- hirsutism,
- coarsened facial features,
- megaloblastic anemia,
- lupus-like syndrome
3. Monitor
- CBC
- LFT’s
- Plasma levels
4. Steady State plasma concentration of 10-20 mcg/mL (reached in 5-10 days)
5. Warning:
Cardiovascular risk associated with rapid infusion
78
Valproic Acid (Depakote)
is forst line for what?
6
First-line for
1. Focal,
2. Generalized Tonic-Clonic,
3. Absence,
4. Atypical Absence
5. Myoclonic
6. Atonic
79
1. Valproic Acid (Depakote) MOA?
2. Preg. Cat.?
3. Complications? 5
4. BBW?
5. What should we monitor? 3
1. Increase levels of GABA
2. Pregnancy D
3.
- Tremor,
- weight gain,
- liver dysfunction (high risk under age 2 – Black Box Warning),
- pancreatitis,
- teratogenic effects
4. liver dysfunction (high risk under age 2 – Black Box Warning),
5. Monitor:
-LFT’s,
-CBC
-drug levels
Therapeutic range=50-100 mg/L
80
1. Lamotrigine (Lamictal) is first line for what? 2
2. MOA?
3. Preg Cat?
4. Complications? 5
5. BBW?
6. Especially effectve in who?
1. First-line for Focal and Absence
2. Stabalizes neuronal membranes by acting on amino acid release and inhibiting Na+ channels
3. Pregnancy C
4.
- Dizziness,
- HA,
- nausea,
- somnolence,
- skin rash
5. (Black Box Warning for SJS)
6. Effective in treatment of children with newly diagnosed absence seizures
81
```
1. Gabapentin (Neurontin)
is used for what? 2
2. MOA?
3. Preg Cat?
4. Complications? 5
```
1. Second-line for Focal and Generalized Tonic-Clonic
2. Reduce presynaptic GABA release
3. Pregnancy C
4.
- Somnolence,
- dizziness,
- ataxia
- HA,
- tremor
82
```
1. Topiramate (Topramax)
first line for?
2. MOA?
3. Pregnancy Cat?
4. SE? 7
5. Monitor what? 2
6. Complications? 2
```
1. First-line for Focal
2. Blocks Na+ channels, enhances GABA activity
3. Pregnancy C
4.
- Somnolence,
- fatigue,
- dizziness,
- cognitive slowing,
- paresthesias,
- nervousness,
- confusion
5. Monitor liver and renal status
6. Narrow angle glaucoma and kidney stones
83
1. Phenobarbital is used for what? 2
2. MOA?
3. Pregnancy category?
4. SE? 2
5. Warnings? 4
6. Monitor? 3
1. Second-line for Focal and Generalized Tonic-Clonic
2. Enhances GABA, interferes with transmission of impulses from thalamus to cerebral cortex
3. Pregnancy D
4.
- Sedation in adults & children, irritability
- Restless muscle movements in eyes, tongue, jaw
5. Warnings:
- sleep apnea,
- COPD,
- renal problems,
- suicide
6. Monitor
- Drug concentration=therapeutic range 15-40 mg/L
- CBC,
- Liver function test
84
```
1. Ethosuximide (Zarontin)
first line for?
2. MOA?
3. Common side effects? 4
4. Monitor what? 2
5. Preg Cat?
```
1. First-Line for Absence
2. Depresses motor cortex
3. Common side-effects
- Stomach aches, cramps, N/V
- Hiccups, drowsiness, fatigue
- Rashes, SLE
- Bone marrow suppression
4.
- Monitor hepatic disease
- renal impairment
5. Pregnancy C
85
```
1. Oxcarbazepine (Trileptal)
is forst line for what?
2. MOA? 3
3. Preg Cat?
4. SE? 4
5. Complications? 3
```
1. Focal
2. MOA
- Blocks voltage sensitive Na+ channels
- Stabilizes neural membranes
- Inhibits repetitive firing and decrease synaptic impulse propagation
3. Pregnancy C
4.
- Dizziness,
- HA,
- N/V,
- somnolence
5.
- Hyponatremia,
- angioedema,
- severe rash
86
Felbamate (Felbatol)
1. Is used for what?
2. MOA?
3. Preg Cat?
4. SE? 4
5. Complications? 3
1. Second-line for Focal and Generalized Tonic-Clonic
2. MOA
Inhibitory effects of GABA and benzodiazepine receptor binding
3. Pregnancy C
4.
-Weight loss,
-nausea,
-insomnia,
-HA
5.
- Hepatic failure,
- aplastic anemia,
- suicide
87
Zonisamide (Zonegran)
1. What is this used for?
2. MOA?
3. Preg cat?
4. SE? 6
1. Only for adjunctive therapy for Focal (without impairment of consciousness)
2. MOA
Blocks voltage dependent Na+ & Ca++ channels
3. Pregnancy C
4.
- Sleepiness,
- dizziness,
- rash,
- fever,
- sore throat,
- easy bruising
88
Tiagabine (Gabitril)
1. Is used for what?
2. MOA?
3. Preg Cat?
4. SE? 5
5. Monitor what? 4
1. Second-line for Focal
2. MOA
Increases GABA activity in the CNS
3. Pregnancy C
4.
- Dizziness,
- tiredness,
- nervousness,
- weakness,
- confusion
5. Monitor
- CBC,
- Renal function test,
- LFT’s
- blood chemisty
89
1. For seizure disorders what is our goal?
2. What do we have to check for the majority of these? 3
3. What do we need to remember about drug dosing? 2
1. Goal is mono-therapy
2. Many require a least baseline creatinine, Monitor CBC and LFT’s
3.
-Most AED’s have to be started at low dose and gradually increased
-Never stop drugs abruptly
90
1. When can we DC a drug on a seizure pt?
2. Over how long should we withdraw it?
3. What if the seizure reoccurs?
1. Can DC drugs when patient has been seizure free for 3 years
2. Dose reduction should be gradual over weeks to months and should be withdrawn one at a time
3. If seizures reoccur, treatment is reinstituted with the previously effective drug regimen
91
What are our surgery options for seizure disorders?
| 4
1. Anterior Temporal Lobectomy
2. Corpus Callosotomy
3. Amygdala-hippocampectomy
4. Vagus Nerve Stimulation (VNS)
