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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

What is the difference between seizures and epilepsy?

A

Seizure is an isolated incident

Epilepsy – recurrent unprovoked seizures

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2
Q

What are common leading factors that contribute to a patient having epilepsy?

A
    • altered connection / structure of neurons
    • Decreased GABA synthesis / Receptors
    • Excess glycine – activating GABA receptors
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3
Q

What is a partial seizure and what is key difference between partial and general seizure?

A
  • Very Brief
  • Consciousness NOT impaired
  • No Post-ictal symptoms
  • Clonic (repeatitive) movements of face, arm, or leg
  • Can have changes in sensation or psychiatric symptoms
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4
Q

What is the difference between partial seizure and complex partial seizure?

A

Complex:

  • consciousness impaired with manifestations of automatic functions without patient’s knowing input
    • gestures, chewing, lip smacking, repeating speech
    • patient unable to recall and has post-ictal state
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5
Q

What are the different location/etiology of complex partial seizures?

A 
Temporal Lobe Origin 
-- Preceded by an Aura of some kind of indication
-- Autonomic Symptoms
-- Postictal Phase
Frontal Lobe Origin
-- Arrest of current activity
-- Motor manifestations / blank stare
-- Brief On/Off attacks
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6
Q

What is an Absence seizure?

A
  • Abrupt Cessation of Activity
  • Change in Facial expression – blank stare
  • No Aura / Less than 30 seconds / No post-icle
  • Clonic Eye Movements – blinking/nystagmus
  • Autonomic Phenomena – dilation, sweating, pallor
  • *Preservation of Actions/Speech** «- Actions?
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7
Q

What seizures are considered generalized seizures?

A
  • Absence
  • Tonic
  • Atonic
  • Clonic
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8
Q

Would full body clonus be considered a Clonic Seizure?

A
  • NO.
    Clonic Seizure is focal or multifocal, but NOT generalized.
    – if the clonus migrates, indicates there is an abnormality
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9
Q

What is the difference between a Tonic Seizure and Atonic Seizure?

A

Tonic – brief, sudden onset of EXTENSOR tonicity with impaired consciousness
Atonic Seizures – Sudden loss of muscle tone with a brief loss of consciousness – very rare

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10
Q

What can be a precursor to Absence or Tonic seizures?

A

Myoclonic Seizures can be seen just prior to Absence or Tonic/Clonic seizures
– Sudden, very brief Shock-like, jerk-like motions

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11
Q

If a seizure is sustained for more than 30 minutes or repetitive seizures?

A
  • Status Epilepticus
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12
Q

How would you need to evaluate a patient if they have new onset seizures?

A

Initial Work up
– General Lab Work – Glucose/Chem/CBC, etc
Second Line – after patient recovers
– LP, LFT, Toxo, EEG, MRI

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13
Q

What do Valproic Acid, Carbamazepine, Oxcarbazepine, and Phenytoin all have in common?

A

They all block sodium channels from rapid repetitive firing.

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14
Q

Phenytoin and Carbamazepine have similar mechanisms, but how are they different?

A

Phenytoin – changes from first-order to zero order as dose increases (within therapeutic range).
Carbamazepine - Unpredictable absorption, induces P450s, and can cause Spina Bifida

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15
Q

If there is generalized clonic activity that is very sudden and brief lasting, appearing as shocks of movement, what might be classified as?

A

Myoclonic Seizures

    • Generalized shock-like actions
    • Can be confined to the face
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16
Q

What kind of health maintenance is important for patients who are chronically on Phenytoin?

A
    • Dental Check Ups

- - Checking/Looking for gingival hyperplasia

17
Q

If a patient is currently undergoing status epilecticus?

A

Fosphenytoin – IV Phenytoin

18
Q

What is a frequent consequence of taking Phenytoin and Carbamazepine?

A

CNS Toxicity – Ataxia, Diplopia, etc.

19
Q

What drug with a similar mechanism to Phenytoin has less CNS side effects?

A

Oxcarbazepine

20
Q

What is the first line therapy for Absence Seizures and why is it better than the other choices?

A

Ethosuximide

- long half-life, not protein bound, well-absorbed

21
Q

What is the mechanism of action of Ethosuximide?

A

Reduces low-threshold calcium currents that flow in the thalamic neurons

22
Q

When would Valproic Acid be indicated for use?

A
  • A patient with Absence seizures, but also tonic-clonic seizures
  • Not first line for Absence Seizures
  • Can be used for most anything. Generalized Tonic-Clonic, Partial, and Myoclonic Seizures
23
Q

If a patient is on Valproic Acid, what might need to be monitored?

A
  • Hepatotoxicity

- If Female, make sure not pregnant. Spina Bifida

24
Q

What are the mechanisms of action of Valproic Acid?

A
  • Blocks repetitive firing of Na+ channels
  • Reduces low-threshold Calcium currents
  • Increases GABA concentrations
25
Q

What drug acts antagonistically at the allosteric glycine site on the NMDA receptor?

A

Felbamate

    • used when seizures are resistant to other drugs
  • aplastic anemia and hepatic failure
26
Q

What can be used as an adjunctive therapy to partial seizures?

A

Gabapentin

Pregabalin

27
Q

What is unique about how NMDA channels are activated?

A

They require both NMDA and Glycine to activate the gated channel

28
Q

What drug inhibits repetitive actions of Na+ channels and does NOT interfere with other drugs (doesn’t bind proteins or induce)

A

Lamotrigine

– FDA approved for bipolar, used well for seizures

29
Q

What seizure drug can cause Stevens-Johnson syndrome?

A
  • Lamotrigine
30
Q

What drug blocks the spread of seizures by blocking glutamine receptor subtype, which is typically used as add-on therapy for partial seizures?

A

Topiramate

  • weight loss
  • prevents migraines
31
Q

What drugs inhibits the reuptake of GABA in the clefts?

A

Tiagabine

- add on therapy for partial and complex seizures

32
Q

What can be added for treatment for myoclonic and generalized tonic-clonic seizures?

A
  • Levetiracetam - Keppra
33
Q

What drug reduces the voltage-dependent transient inward currents of both sodium and calcium channels?

A

Zonisamide

- adjunctive therapy for ADULTS with partial seizures

34
Q

What drug can cause permanent vision damage?

A

Vigabatrin

35
Q

What agent can be used to irreversibly inhibit GABA metabolism, causing them to remain around longer?

A

Vigabatrin

36
Q

What are the drugs that should be limited use in women of child bearing age?

A
  • Valproic Acid

- Carbamazepine

Neurology (11 decks)

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