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STEP 2 > Seizures > Flashcards

Seizures Flashcards

1
Q

Seizures that occur in infants (<2 years) tend to be from

A

Febrile, perinatal injury, infection, metabolic, or genetic

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2
Q

For febrile seizures, a good medication to provide the child is ….

A

Acetaminophen

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3
Q

Seizures that occur in children (2 to 10 years) tend to be from

A

Idiopathic (cryptogenic), infection, trauma, febrile

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4
Q

Seizures that occur in adolescents (10 to 18 years) tend to be from

A

Idiopathic (cryptogenic), trauma, drug withdrawal, AVMs

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5
Q

Seizures that occur in adults (18 to 35 years) tend to be from

A

trauma, EtOH, tumor

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6
Q

Seizures that occur in adults (>35 years) tend to be from

A

trauma, stroke, metabolic, EtOH, tumor

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7
Q

What are the two major ways epilepsy is acquired?

A

Structural brain lesions (tumor, stroke, hemorrhage, AVM)

Non-neurologic etiologies

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8
Q

In terms of seizures, these [Below] all cause _______ types of seizures

Hypoglycemia, hyponatremia, hypocalcemia, hyperosmolar states, hepatic encephalopathy, uremia, porphyria, drug overdose (cocaine, antidepressants, neuroleptics, methylxanthines, lidocaine), drug withdrawal (alcohol and other sedatives), eclampsia, hyperthermia, hypertensive encephalopathy, head trauma, and cerebral hypoperfusion.

A

Non-neurologic seizures

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9
Q

In what two ways are seizures classified?

A

Focal vs Generalized

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10
Q

Structural brain lesions tend to cause ______ seizures

A

focal

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11
Q

How are focal seizures divided?

A

Loss of consciousness: “Impaired Awareness” (Complex Partial)

Maintains consciousness: “Aware” (Simple Partial)

Nuances:
-Both simple and complex partial (focal) seizures may evolve into secondary generalized sezuire.

-Focal seizures can change into bilateral tonic-clonic and have associated loss of consciousness and postictal confusion.

-A patient presents with lip smacking with an impaired level of consciousness and this is followed by confusion, think Complex partial seizure.

-A patient presents with uncontrollable twitching of their thumb and is fully aware of their symptoms, think Simple partial seizure.

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12
Q

What describes the abnormal electrical activity arising from a discrete region (or multiple discrete regions) of the brain that can have motor, sensory, autonomic, or psychic (eg, fear, déjà vu, hallucinations) features?

A

Partial (Focal) Seizure

Common features:
- Aura (auditory, visual, olfactory, or tactile hallucinations)
- Automatisms often (lip smacking, picking, swallowing)
- Autonomic activity (sweating)
- Postictal focal neurologic deficits such as hemiplegia, hemiparesis, or Todd paralysis, usually resolve in 24-hrs.

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13
Q

What is the type of seizure that involves both cerebral hemispheres resulting in impaired level of consciousness?

A

Generalized seizures:

Tonic-clonic (Grand-Mal): alternating stiffening and movement (can develop from focal seizures)
Myoclonic: Quick repetative jerks
Tonic: stiffening
Atonic: loss of motor tone
Absence: blanking out

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14
Q

What type of seizure is marked by a sudden loss of consciousness with extension of the back and contraction of muscles (chest and extremities), repetitive, and symmetric movements seen where there’s an alternation between muscle contraction and relaxation?

A

Tonic-clonic (Grand-Mal), a type of Generalized seizure

Etiology often idiopathic

Simple and complex partial seizures may evolve into secondary generalized tonic-clonic seizures

Marked by incontinence and tongue biting, appearance of cyanosis during the ictal period, and postictal confusion and drowsiness. Muscle aches and headaches may also be present.

Diagnosed with 10 Hz activity during the tonic stage and slow waves during the clonic phase (if EEG is normal consider psuedosezuires and cognitive behavioral therapy)

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15
Q

What is the best first step in Dx a seizure?

A

EEG

CT or MRI for evaluation of a focal seizure in search for an epileptogenic focus.

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16
Q

What lab analyte can be elevated in the immediate period of generalized and complex-partial seizures?

A

PRL is elevated in the immediate period of generalized and complex-partial seizures.

Can help distinguish psuedoseizures.

Other labs that might be able to determine etiologies of seizures: CBC, Lytes, Ca, Glu, LFTs, Renal Panel, ESR, Tox.

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17
Q

What is the condition that involve epileptic spasms where the onset is usually within the first year of life, and is typically accompanied by a global developmental delay, and is commonly due to structural brain anomalies (tuberous sclerosis), Down syndrome, or genetic defects (ARX, CDKL5 mutations)?

A

Infantile spasms (West syndrome)

Most commonly in males and presents between 3 to 5 years old.

18
Q

What is the first-line treatment for West Syndrome?

A

Vigabatrin

An antiepileptic medication that reduces excitability in the brain by inhibiting the catabolism of GABA. Primarily used to treat infantile spasms and refractory complex partial seizures.

19
Q

What are the major adverse effects of Vigabatrin?

A

Vigabatrin is teratogenic and can cause neural tube defects and vision loss. Vigabatrin is contraindicated in epilepsy syndromes that are associated with absence seizures because it can precipitate them.

20
Q

What type of seizure can be triggered by hyperventilation in children?

A

Absence seizures

21
Q

What is the most common childhood epilepsy syndrome that is characterized by multiple episodes involve the child appearing to be daydreaming?

What is the characteristic EEG pattern?

What is the Treatment?

What is the prognosis?

A

Absence seizures (pyknolepsy), a form of generalized seizure, is often familial.

These types of seizure occur in children between the ages of 2–12 years (peak incidence: 5–6 years) and females are more commonly affected.

Episodes usually involve their eyes open/fluttering while they are staring off into space (amnestic) for several seconds at a time, multiple times per day, along with smacking, nod heading, or chewing.

EEG:
3 Hz spikes and waves in all regions of the brain is used to diagnose this condition

Treatment:
* 1st line: ethosuximide
* 2nd line: sodium valproate
* 3rd line: lamotrigine

Prognosis:
80% of children are seizure-free with treatment
Usually subsides before adulthood

22
Q

What are the major adverse reactions from Ethosuximide?

A
  • Gastrointestinal symptoms
  • Allergic skin reactions (urticaria, Stevens-Johnson syndrome)
  • Pancytopenia
  • Fatigue
  • Headache
  • Myopia
  • Sedation
  • Dizziness
23
Q

What is the first line treatment for absence seizures?

A

ethosuximide

24
Q

Do absence seizures have a postictal period?

A

No

Absence seizures are generalized (ie, originating from both cerebral hemispheres) and present with staring spells, with or without automatisms, lasting only 10-20 seconds. In contrast to focal seizures, absence seizures are characteristically easily provoked by hyperventilation, however, not associated with a postictal period.

25
Q

Lennox-Gastaut syndrome

Typically is Dx by the age of ___ years old

Caused by:

Presents with :

Special characteristics of the EEG are:

A

Age:
5 years (males more common)

Caused by:
Most commonly due to structural abnormalities from tuberous sclerosis, meningitis, hypoxic-ischemic injuries, and head injuries, but 40% of cases are cryptogenic (idiopathic) but have a genetic predisposition.

Presentation:
Intellectual disability/delayed cognitive development & severe seizures of varying types (atypical absence, tonic).

EEG:
Interictal EEG with a slow spike-and-wave pattern with a frequency < 2.5-Hz.

Treatment:
Lamotrigine
An antiepileptic drug that reduces the excitability of neurons by inhibiting voltage-gated sodium channels and glutamate release in the brain. Lamotrigine is not only used for seizure prophylaxis in patients with Lennox-Gastaut syndrome, but also patients with either focal (partial) seizures or generalized tonic-clonic seizures.

26
Q

What is the major adverse effect of Lamotrigine?

A

SJS (must be titrated slowly)
Blurred vision
Gl upset with N/V
hemophagocytic lymphohistiocytosis (black box warning)

27
Q

A 13 year old male wakes up and has a tonic-clonic seizure, with a history of absence seizures, what is this most likely?

A

Juvenile absence epilepsy

EEG:
3–4 Hz spikes and waves in all regions of the brain

Treatment and prognosis:
60% are seizure-free under treatment (valproic acid), but there is possibility for a transition to juvenile myoclonic epilepsy.

28
Q

What is a genetic form of epilepsy syndrome characterized by recurrent myoclonic seizures, generalized tonic-clonic seizures, or absence seizures, where the onset of seizures occurs between the ages of 8 and 25, and seizures characteristically occur immediately after waking up or following sleep deprivation?

A

Juvenile myoclonic epilepsy, Janz syndrome

Triad of seizures :
- Bilateral symmetrical myoclonic jerks, primarily after awakening, without impaired consciousness
- Generalized tonic-clonic seizures
- Absence seizures with impaired consciousness

Triggers: sleep deprivation, alcohol consumption, flickering lights

EEG:
Irregular 3–5 Hz polyspikes and waves with frontocentral predominance

Treatement and prognosis:
Responds well to antiseizure drug therapy (valproic acid along with trigger avoidance); seizures become less frequent in adulthood but life-long treatment usually required (high risk of recurrence with an increased risk of psychiatric comorbidities.

29
Q

What is the first-line drug for seizure prophylaxis in older patients with partial-onset seizures?

A

Lamotrigine

Blocks sodium and glutamate release

30
Q

What medications are known to be efficacious as a monotherapy for chronic partial and/or tonic-clonic seizures?

A

Levetiracetam
Phenytoin
Carbamazepine
Valproic Acid

31
Q

What medication is used as a first-line medication for children?

A

Levetiracetam

The mechanism of levetiracetam is not well understood, but it is believed to alter synaptic vesicle binding and indirectly alter GABA activity.

Levetiracetam is currently not a first-line drug for seizure prophylaxis in patients with absence seizures.

AMBOSS:
Currently, levetiracetam is only licensed for adjunctive seizure prophylaxis in adolescents (> 16 years old) and/or adults with myoclonic seizures (especially juvenile myoclonic epilepsy), focal seizures, and/or generalized tonic-clonic seizures.

32
Q

What is the major adverse affects for Levetiracetam?

A

Neuropsych changes such as personality changes, fatigue, drowsiness, and headache

33
Q

What is the first-line medication for focal seizures?

A

Carbamazepine
(also used as a second line med for tonic-clonic seizures)

Inactivates Sodium channels

34
Q

What are the adverse effects of Carbamazepine?

A

Diplopia
Ataxia
blood dyscrasias (agranulocytosis, aplastic anemia)
Liver toxicity
Teratogenesis (cleft lip/palate, spina bifida) during the first trimester of pregnancy
Induction of cytochrome P-450
Hyponatremia via SIADH
Derm issues like SJS and DRESS

35
Q

What is the first-line medication for long-term tonic-clonic seizures?

A

Valproate
(also used for focal seizures and second-line for absence seizures)

Inhibits GABA transaminase → ↑ GABA → ↓ neuronal excitability Inactivates Na+ channels and Ca2+ channels

36
Q

What are the adverse effects for Valproate?

A

VALPPROaTTES:
Vomiting
Alopecia
Liver damage
Pancreatitis
p-450 inhibition
Rash
Obesity (weight gain)
Agranulocytosis
Tremor
Teratogenesis (neural tube defects)
Epigastric pain (GI distress)
SIADH

37
Q

What medication is instead used for seizure prophylaxis in patients with focal seizures and/or generalized tonic-clonic seizures, and as a second-line drug to treat status epilepticus, particularly for prophylaxis?

A

Phenytoin

An antiepileptic drug that inhibits voltage-gated sodium channels in the brain, which reduces the excitability of neurons. Used primarily for tonic-clonic and focal seizure prophylaxis. Can also be used as a second-line drug to treat status epilepticus. Adverse effects include Stevens-Johnson syndrome, gingival hyperplasia, hypertrichosis, and fetal hydantoin syndrome.

38
Q

What are the main adverse effects to Phenytoin?

A

PPHENYTOIN:
P-450 induction
Pseudolymphoma
Hirsutism
Enlarged gums
Nystagmus
Yellow-brown skin
Teratogenicity (fetal hydantoin syndrome, IUGR, Intellectual disability, cleft palate, congenital heart defects)
Osteopenia
Neuropathy
Inhibited folate absorption (megaloblastic anemia)
Neutropenia (agranulocytosis)

Toxicity leads to diplopia, ataxia, and sedation.

Rarely what can occur: SJS, DRESS syndrome, drug-induced lupus.

39
Q

Which anti-epileptic is not only used for Focal and generalized tonic-clonic epileptic seizures but also Migraine prophylaxis and Idiopathic intracranial hypertension?

A

Topiramate

Enhances Na+ channel inactivation and and increases GABA action

40
Q

What are the adverse affects of Topiramate?

A

Sedation
Slow cognition
Stones (kidney)
Skinny (weight loss)
Sight issues (glaucoma)
Speech and word finding difficulties

41
Q
A
42
Q
A

STEP 2 (14 decks)

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