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6a > Seizures > Flashcards

Seizures Flashcards

1
Q

ILAE for epilepsy

A

> 2 unprovoked seizures occurring >24 h apart
1 unprovoked seizure and a probability of further seizures similar to the recurrence risk after 2 unprovoked seizures (>60% over 10 years)
diagnosis of an epilepsy syndrome

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2
Q

Resolution of epilepsy

A

age-dependent epilepsy and is now > applicable age (e.g. benign Rolandic epilepsy)
OR
remained seizure-free for the last 10 years, with no anti-seizure medications for the last 5 years

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3
Q

Primary seizure

A

unprovoked, not linked to inciting event

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4
Q

secondary seizure

A 
may be caused by:
trauma
illness
intoxication/poison
organ failure
other metabolic disturbances
cerebral tumours
pregnancy
supratherapeutic levels of some anti-convulsants
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5
Q

Generalized seizure

A

abnormal neuronal activity in both cerebral hemispheres causing alteration in LOC
Further classification

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6
Q

Tonic-clonic seizure

A

convulsions of stiffness and jerkiness

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7
Q

Tonic seizure

A

stiff

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8
Q

Clonic seizure

A

jerky

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9
Q

Absence seizure

A

starts in childhood

“Blanking out”

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10
Q

Atonic seizure

A

“Drop attacks”

suddenly falls, usually without LOC

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11
Q

Myoclonic seizure

A

jerking of whole body

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12
Q

Focal seizure

A

usually only involves 1 hemisphere
preseves consciousnes
may progress and cause altered sensorium

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13
Q

Simple focal seizure

A

with motor signs
with somatosensory/special sensory symptoms
with autonomic symptoms/signs
with psychic symptoms (disturbance of higher cerebral function)

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14
Q

Complex focal seizure

A 
dyscognitive
impaired consciousness
clinical manifestations vary with site of origin and degree of spread
- presence an nature of aura
 - automatisms
- other motor activity

Usually lasts 1-2 minutes

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15
Q

Secondary generalized seizure

A

begins focally, with/without focal neurological symptoms
variable symmetry, intensity, duration of tonic and clonic phases
typically 1-2 min
postictal confusion, somnolence, with/without transient focal deficits

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16
Q

Convulsive seizure

A

uncontrolled, rhythmic motor movements

can affect part or all of body

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17
Q

Nonconvulsive seizure

A

don’t result in abnormal motor activity

patients may display confusion, altered mental status, abnormal behaviour, coma

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18
Q

Status epilepticus

A

> 30 minutes of persistent seizures or a series of recurrent seizures without intervening return to full consciousness
Time criterion shortened to 5 minutes –> duration of seizure activity related to outcome
Likelihood of achieving seizure cessation with typical treatments decreases with ictal duration

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19
Q

Common causes of status epilepticus in adults

A 
AED noncompliance/withdrawal of AED: 25-26
alcohol 15-24
drug toxicity 2-10
infection 8
cerebral tumour 5-6
trauma 3-5
cerebrovascular disease/stroke 4-23
metabolic abnormality 4-13
hypoxia, cardiac arrest 4-12
idiopathic 4-5
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20
Q

West Syndrome

A

infantile spasms
cortical malformations
developmental delay –> mental retardation
abnormal EEG (Chaotic)

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21
Q

Lennox-Gastaut Syndrome

A

multitude of seizure types: focal, atonic, etc

significant mental delay and frequent seizures

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22
Q

Juvenile Myoclonic Epilepsy of Janz

A

starts in teens
myoclonic seizures early in the morning
lifelong
normal cognition

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23
Q

Infancy and childhood seizure etiology

A

prenatal/birth injury
inborn error of metabolism
congenital malformation

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24
Q

Adolescence and young adult seizure etiology

A

head trauma

drug intoxication/withdrawal

25
Q

Childhood/adolescence seizure etiology

A

idiopathic/genetic
CNS infection
trauma

26
Q

older adult seizure etiology

A

stroke
brain tumour
acute metabolic disturbances
neurodegenerative

27
Q

Seizure precipitants

A 
metabolic/electrolyte imbalance
stimulants
sedative/ethanol withdrawal
sleep deprivation
antiepileptic medication reduction/inadequate AED tx
hormonal variations
fever/systemic infection
28
Q

Mechanism of seizure generation

A

abnormal increased electrical activity of initiating neurons activates adjacent neurons and propagates until thalamus and other subcortical structures are similarly stimulated

29
Q

Excitation

A

Ionic: inward Na/Ca
NT: glutamate, aspartate

30
Q

Glutamate

A 
brain's major excitatory NT
2 groups of receptors
Ionotropic
Metabotropic
Modulation by glycine, polyamine sites, Zinc, redox
31
Q

Ionotropic glutamate receptors

A

Fast synaptic transmission
NMDA, AMPA, kainite
gated Ca and Na channels

32
Q

Metabotropic glutamate receptors

A

Slow synaptic transmission
Regulation of second messengers (cAMP, inositol)
modulation of synaptic activity

33
Q

Inhibition

A

Ionic: inward Cl, outward K
NT: GABA
GABAa: post synaptic specific recognition sites, linked to Cl
GABAb: presynaptic autoreceptors, mediated by K currents

34
Q

Mechanism of generating hyperexcitable networks

A

excitatory axonal sprouting
loss of inhibitory neurons
losso f excitatory neurons which would normally be “driving” inhibitory neurons

35
Q

EEG background abnormalities

A

significant asymmetries and/or degree of slowing inappropriate for clinical state or age

36
Q

EEG interictal abnormalities

A

associated with seizures and epilepsy
spikes
sharp waves
spike-wave complexes

37
Q

Phenytoin indication

A

iv/oral
focal seizures
secondarily generalized seizures
in hospitals as IV for status epilepticus

38
Q

Phenytoin dose/MOA

A

once a day

block voltage-dependent sodium channels at high firing frequencies

39
Q

Phenytoin SEs

A 
gingival hypertrophy
hirsutism
coarsening of facial features
cerebellar ataxia
peripheral neuropathy
teratogeneicity
40
Q

Carbamazepine indication

A

no iv form
focal seizures
secondarily generalized seizures

41
Q

Carbamazepine dose/MOA

A

started at low dose and built up slowly over days to weeks

Block NaV channels at high firing frequencies

42
Q

Carbamazepine SEs

A

fewer side effects than phenytoin

43
Q

Valproic acid indiations

A 
absence seizures
tonic-clonic (grandmal), myoclonic, atonic, tonic seizures
focal seizures
photosensitive seizures
Lennox-Gastaut syndrome
44
Q

Valproic acid MOA

A

block NaV

May enhance GABA transmission in specific circuits

45
Q

Valproic acid SEs

A 
in pregnancy may cause birth defects
don't use in women of childbearing age
weight gain
menstrual irregularities
transient hair loss
tremors (rare)
46
Q

Lamotrigine indication

A

Primary/genetic generalized epilepsy
lennox Gastaut Syndrome
Focal and secondarily generalized seizures
Good alternative to valproic acid
used extensively as a mood stabilizer by psychiatrists for bipolar, depression

47
Q

Lamotrigine dose/MOA

A

started at low dose and built up over several weeks
block NaV at high firing frequencies
may interfere with pathologic glutamate release

48
Q

Levetiracetam indications

A

monotherapy or as an add-on
partial seizures
seocnady generalized seizures
primary generalized seizures

49
Q

Levetiracetam MOA

A

attaches to a specific binding site (saturable)
reduce CaV currents
Reverses inhibition of GABA and glycine-gated currents

50
Q

Levetiracetam SEs

A 
anxiety
agitation
mood swings
depression
suicidal ideation
51
Q

Warning aura for seizures

A 
epigastric
fear
deja vu
olfactory
gustatory
auditory
visual
somatosensory
autonomic
motor
vague
usually nonspecific
with aura: very focal seizure, usually no post-ictal phase
52
Q

DDx of seizures

A

Syncope - neural/cardiogenic
Psychiatric: panic attacks, fugue state, pseudoseizures
Other neurologic conditions: migraine, paroxysmal movement disorders, sleep disorders, TIA, transient global amnesia, encephalopathy

53
Q

Syncope definition

A

loss of consciousness and postural tone caused by cerebral hypoperfusion with spontaneous recovery
Neural: vasovagal, reflex-mediated, autonomic, valsalva, carotid sinus syndrome, reflex anoxic
Cardiogenic: arrhythmia,s cardiac structural abnormalities

54
Q

Psychogenic non-epileptic seizures

A 
"fake"
stress
suggestible, distractible
occur in wakefulness in the presence ofa witness
Asynchronous asymmetrical movements
eyes closed
consciousness retained/fluctuating
Crying
intractable to anti-epileptic medications
no post-ictal confusion
Belle indifference
long duration
55
Q

seizure management

A 
ABCs
roll on side, don't put anything in mouth
vitals, iv access, O2 if needed
 thiamine bolus
Glucose
56
Q

Status eplepticus treatment

A

Lorazepam or midazolam
0-30 min: Phenytoin, cardiac/resp monitoring
30-60 min( refractory status): phenobarbitol OR valproic acid
>30-60 min: ICU-intube; midazolam bolus and infusion, then other infusions

57
Q

Drug-resistant epilepsy

A

failure of adequate trials of 2 tolerated appropriately chosen and used antiepilpetic drug schedules to achieve sustained seizure freedom

58
Q

Indications for epilepsy surgery

A

Drug-resistant focal epilepsy

  • especially mesiotemporal sclerosis/lesional epilepsies
  • curative goal

Drug resistant drop attacks and GTCs

e. g. Lennox Gastaut syndrome
- palliative goal

59
Q

Seizure precautions

A

avoid:

  • driving
  • operating heavy machinery
  • immersing in water
  • being at heights
  • using fire
  • using power tools
  • childcare

6a (26 decks)

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