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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
Childhood/adolescence seizure etiology
idiopathic/genetic CNS infection trauma
26
older adult seizure etiology
stroke brain tumour acute metabolic disturbances neurodegenerative
27
Seizure precipitants
``` metabolic/electrolyte imbalance stimulants sedative/ethanol withdrawal sleep deprivation antiepileptic medication reduction/inadequate AED tx hormonal variations fever/systemic infection ```
28
Mechanism of seizure generation
abnormal increased electrical activity of initiating neurons activates adjacent neurons and propagates until thalamus and other subcortical structures are similarly stimulated
29
Excitation
Ionic: inward Na/Ca NT: glutamate, aspartate
30
Glutamate
``` brain's major excitatory NT 2 groups of receptors Ionotropic Metabotropic Modulation by glycine, polyamine sites, Zinc, redox ```
31
Ionotropic glutamate receptors
Fast synaptic transmission NMDA, AMPA, kainite gated Ca and Na channels
32
Metabotropic glutamate receptors
Slow synaptic transmission Regulation of second messengers (cAMP, inositol) modulation of synaptic activity
33
Inhibition
Ionic: inward Cl, outward K NT: GABA GABAa: post synaptic specific recognition sites, linked to Cl GABAb: presynaptic autoreceptors, mediated by K currents
34
Mechanism of generating hyperexcitable networks
excitatory axonal sprouting loss of inhibitory neurons losso f excitatory neurons which would normally be "driving" inhibitory neurons
35
EEG background abnormalities
significant asymmetries and/or degree of slowing inappropriate for clinical state or age
36
EEG interictal abnormalities
associated with seizures and epilepsy spikes sharp waves spike-wave complexes
37
Phenytoin indication
iv/oral focal seizures secondarily generalized seizures in hospitals as IV for status epilepticus
38
Phenytoin dose/MOA
once a day | block voltage-dependent sodium channels at high firing frequencies
39
Phenytoin SEs
``` gingival hypertrophy hirsutism coarsening of facial features cerebellar ataxia peripheral neuropathy teratogeneicity ```
40
Carbamazepine indication
no iv form focal seizures secondarily generalized seizures
41
Carbamazepine dose/MOA
started at low dose and built up slowly over days to weeks Block NaV channels at high firing frequencies
42
Carbamazepine SEs
fewer side effects than phenytoin
43
Valproic acid indiations
``` absence seizures tonic-clonic (grandmal), myoclonic, atonic, tonic seizures focal seizures photosensitive seizures Lennox-Gastaut syndrome ```
44
Valproic acid MOA
block NaV | May enhance GABA transmission in specific circuits
45
Valproic acid SEs
``` in pregnancy may cause birth defects don't use in women of childbearing age weight gain menstrual irregularities transient hair loss tremors (rare) ```
46
Lamotrigine indication
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
Lamotrigine dose/MOA
started at low dose and built up over several weeks block NaV at high firing frequencies may interfere with pathologic glutamate release
48
Levetiracetam indications
monotherapy or as an add-on partial seizures seocnady generalized seizures primary generalized seizures
49
Levetiracetam MOA
attaches to a specific binding site (saturable) reduce CaV currents Reverses inhibition of GABA and glycine-gated currents
50
Levetiracetam SEs
``` anxiety agitation mood swings depression suicidal ideation ```
51
Warning aura for seizures
``` 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
DDx of seizures
Syncope - neural/cardiogenic Psychiatric: panic attacks, fugue state, pseudoseizures Other neurologic conditions: migraine, paroxysmal movement disorders, sleep disorders, TIA, transient global amnesia, encephalopathy
53
Syncope definition
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
Psychogenic non-epileptic seizures
``` "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
seizure management
``` ABCs roll on side, don't put anything in mouth vitals, iv access, O2 if needed thiamine bolus Glucose ```
56
Status eplepticus treatment
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
Drug-resistant epilepsy
failure of adequate trials of 2 tolerated appropriately chosen and used antiepilpetic drug schedules to achieve sustained seizure freedom
58
Indications for epilepsy surgery
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
Seizure precautions
avoid: - driving - operating heavy machinery - immersing in water - being at heights - using fire - using power tools - childcare

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