Seizures

Question 1

Epilepsy is a _______ that causes

Answer 1

disease

seizures

Question 2

________ is the old technique of drilling into the brain

Answer 2

Trephining

Question 3

List the main types of seizures, and symptoms associated with each.

Answer 3

Focal: originate in one area of the brain.

Symptoms: unusual sensations/behavior/movements such as jerking of a limb.
1. simple focal (patient has no knowledge of seizure)
2. Focal impaired awareness (patient may stare off or have automatisms)
3. Focal complex (starts focal then spreads); arise from temporal lobe; becomes unresponsive

Generalized seizures: entire surface of brain effected
Symptoms: loss of consciousness, muscle stiffness (tonic), and/or rhythmic jerking movements (clonic).
-1. generalized Tonic-clonic (grand Mal): unresponsive, falls to ground, incontinence, tongue/cheek bitten
Aura -> seizure -> post ictal
2. Absence (petite Mal): brief, sudden lapses in attention and activity; mistaken for daydreaming or staring off into space
3. Myoclonic/clonic: single muscle group spasms by sudden, brief jerks/twitches
4. Atonic/tonic (drop attacks): loss or increase of muscle tone
5. Infantile spasms: developmental; affects child head/torso/limbs; begins before 6 months

Question 4

What are the main neurotranmitters involved in seizures?

Answer 4

GABA and Glutamate

Question 5

What are the MOA of Antiseizure medications?

Answer 5

Modification of ion conductance
Hyperpolarize
Na+, Ca+,K+, Cl-

Increase GABA

Decrease Glutamate

Question 6

Drugs for Focal/generalized Seizures

Answer 6

Phenytoin oldest nonsedative (both)
MOA: All
Fosphenytoin = IM

Carbamazepine
MOA: Blocks Na+ channels
drug of choice for focal
Increases its own metabolism and other AED

Phenobarbital Safest - Drug of choice for infants (both)
Sedative
MOA: unknown - probably all

Lacosamide (focal)
MOA: Blocks Na+
Different dose = same reaction; start at lowest dose
Minimal drug interactions

Question 7

Drugs for generalized seizures (not tonic/clonic)

Answer 7

Ethosuximide: Absence
MOA: Ca++ channels

Valporic acid: All -> broad spectrum AED
MOA: unknown - probably all

Question 8

Describe phenytoin

Answer 8

binds to albumin
Toxic at high doses
used for focal and general

AE: Nystagmus, Gingival hyperplasia, Hirsuitism (facial hair)

Question 9

What is the therapeutic index, toxic dose, and lethal dose for phenytoin?

Answer 9

TI: 10-20mcg/ml

Toxic: 30-50

Lethal: >100

Question 10

What medication can kick phenytoin off albumin?

Answer 10

Valporic acid

Question 11

What type of seizures are phenobarbital not effective in?

Answer 11

Absence
Atonic
infantile

Can worsen

Question 12

Describe the most common automatisms seen with seizures.

Answer 12

lip smacking, swallowing, chewing, fidgeting, fumbling, and repetitive movements

Question 13

Differentiate tonic and clonic.

Answer 13

Tonic: Involves muscle stiffness and rigidity

Clonic: Involves rhythmic jerking movements.

Question 14

List Benzodiazepines

Answer 14

MOA: Increase GABA

Diazepam (Valium)

Lorazepam (Ativan) IV most effective for status epilepticus

Clonazepam (Klonipin): PO

Sedative effects so not used for chronic seizures

Question 15

What treatment is for infantile seizures?

Answer 15

Palliative care
steroids
Vigabatrin (GABA analogs)

Question 16

What type of diet can be used to help treat seizures in children?

Answer 16

Ketogenic diet (Low carb)

Question 17

Describe major considerations in status epilepticus and what is happening

Answer 17

rapidly using up glucose

1. ABCs
2. IV anti-seizure medications: benzodiazepines (e.g. lorazepam, diazepam), phenytoin, and phenobarbital
3. During and post-seizure monitoring of cardiovascular, respiratory, and metabolic effects

Question 18

List alternative therapies for seizure management.

Answer 18

Vagus nerve stimulation
Surgical (resect)
Medical marijuana
ketogenic diet

Question 19

What is the order of medications to use in status epilepticus?

Answer 19

Benzo (Ativan/valium) -> phytoin, doesnt work? -> phenobarbital, does work? -> propofol/paralyze/intubate

Question 20

What effect does phenytoin have on NMB?

Answer 20

Chronic phenytoin use decreases NMB

Phenytoin in your system currently enhances NMB

Question 21

What drugs should you avoid if you have seizures?

Answer 21

Drugs that stimulate seizure activity

Methohexital
Sevoflurane
Meperidine (demerol)

Question 22

What are some things to consider during a craniotomy?

Answer 22

Anti-seizure meds, reduced or withdrawn

General or local anesthesia must be light enough not to mask seizure activity