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Neuro block 2 > Seizures > Flashcards

Seizures Flashcards

1
Q

What type of seizure is focal, emanating from a specific cortical area?

A

Partial

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2
Q

What type of seizure is NOT focal, emanating from both hemispheres at the same time?

A

Generalized

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3
Q

Can a partial seizure progress to a generalized seizure?

A

Yes. But it is still called a partial seizure bc it started out that way, symptomatically.

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4
Q

Describe the EEG findings that would indicated a seizure is taking place.

A

sharp/slow waves, spikes

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5
Q

Do most seizure pts respond to mono or multidrug tx?

A

mono

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6
Q

What is the difference between medical remission and disease remission?

A

Medical remission = free of seizures on 1-2 AEDs

Dz remission = free of seizures post surgery w/o need for AEDs

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7
Q

What is the drug of choice for treatment of primary generalized seizures?

A

Valproic acid (Valproate)

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8
Q

What are the drugs of choice for tx of partial/tonic-clonic seizures?

A

VPA, phenytoin, carbamazepine—> (new agents) gabapentin, oxcarbazepine

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9
Q

What are the DOC for absence seizures?

A

Ethosuximide (ETX) or VPA

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10
Q

What are the broad spectrum DOC for seizures?

A

Lamotrigine, Topiramate, Levitiracetam, Zonisamide

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11
Q

Which of the AEDs are CYP inducers?

A

Carbamazepine, Phenytoin, phenobarbitol > Oxar, topiramate

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12
Q

Which receptors does Glutamate act on?
How about GABA?
What happens when they get there?

A

GLU: AMPA, NMDA, Kainate —-> ^ Na+/Ca2+ influx–> depolarization—> AP

GABA: GABA-A —> ^ Cl- influx—> hyperpolarization—> inhibition of AP

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13
Q

Describe any changes in consciousness in simple partial seizures.

A

Consciousness preserved. Brief auras w/ no overt behavioral manifestations.

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14
Q

Describe motor and somatosensory symptoms of simple partial seizure.

A

Jacksonian march: movement of hands—> upper arm—> face.

Sensory: focal tingling on entire side of face or arm, etc.

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15
Q

Describe the autonomic symptoms of simple partial seizures.

A

^ epigastric sensation +/- N/V

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16
Q

Describe the psychic symptoms of simple partial seizures.

A

fear, deja vu, jamais vu

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17
Q

Describe any changes in consciousness in complex partial seizures.

A

Consciousness IMPAIRED. Focal EEG abnormality. Blank stare. Amnesia w/ post-ictal state.

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18
Q

What are some somatic characteristics of complex partial seizure?

A

lip smacking, chewing.

hand rubbing, picking movements.

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19
Q

When a simple partial seizure —> generalized seizure, this is called:

A

secondary generalized partial seizure (bilateral cerebral involvement)

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20
Q

In primary generalized seizures, you will see EEG changes evident in ______ cerebral hemispheres.

A

BOTH

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21
Q

Absence seizures are a subtype of this primary seizure type:

They are characterized by these EEG findings:

A

Generalized seizure

** EEG findings: 3 Hz spike-wave discharges **

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22
Q

These seizures are a subtype of generalized seizures and are characterized by muscular rigidity and rhythmic jerking, and loss of consciousness.

A

Tonic-clonic seizures

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23
Q

A 3 yo child is standing looking at the TV on minute and then suddenly loses muscle tone and falls and starts crying. This atonic seizure is subtyped under this type of seizure:

A

Generalized

24
Q

Your pt w/ intractable seizures is not responding to antiepileptic polytherapy. What is next for tx?

A

Vagus nerve stimulation, then surgery (resection of seizure provoking cortex/hemispherectomy)

25
Q

How do you define generalized convulsive status epilepticus?
How do you Dx it?

A

generalized convulsive seizure lasting > 5 mins OR
2+ sequential seizures w/ no recovery of consciousness

Dx: EEG

26
Q

How do you treat generalized convulsive status epilepticus?

A

Emperic: thiamine + D50

Lorazepam + phenytoin (except in preg women)

27
Q

How do you tx infantile spasms?

A

ACTH

28
Q

How do you tx absence seizures in a child?

A

ETX

29
Q

How do you tx partial seizures in a child?

A

phenytoin, phenobarbitol, carbamazepine, gabapentin, tiagabine, oxcarbazepine

30
Q

How do you tx generalized/partial seizures in a child?

A

levetirazetam, VPA, lamotrigine, topiramate, felbamate, zonisamide
- these are all broad spectrum agents

31
Q

Define infantile spasms

A

Brief, bilateral symmetric contractions of the neck, trunk, and extremity muscles.
Caused by genetic enzyme/nutrient deficiency

32
Q

An infant is having spasms bc of a pyridoxine insufficiency. How do you tx?

A

Give B6

33
Q

An infant is having spasms bc of PKU, MSUD (maple syrup urine dz), or GluTx deficiency. How do you tx?

A

Change diet accordingly

34
Q

What is West syndrome?

A

Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression

35
Q

How do you tx infantile spasms caused by tuberous sclerosis?

A

Vigabatrin (inhibits GABA breakdown by GABA transaminase)

36
Q

What are the clinical symptoms that will key you off to an infant having infantile spasms?

A

body flexing - abdominal crunches

other presentations: head nodding + “lightening attacks”- single momentary body shocks

37
Q

What is hypsarrhythmia?

A

^ voltage/chaotic activity between seizures

38
Q

What are Lennox-Gaustaut seizures?

A

Triad of:

1) 2+ diff types of seizures
2) EEG: slow spike and wave @ 1.5-2.5 Hz “Atypical Absence”
3) Mental: developmental delay

Lasts longer than typical absence seizures

39
Q

How do you tx Lennox-Gaustaut seizures?

A

Rufinamide&raquo_space;»> VPA, ketogenic diet, corpus callostomy, VNS

40
Q

This may trigger childhood absence epilepsy:

A

Hyperventilation

41
Q

Will the neurological status and EEG background be changed in childhood absence epilepsy?

A

No, they will be normal

42
Q

How do you tx childhood absence epilepsy?

A

ETX if only absence seizures.

Use VPA/lamotrigine in CAE

43
Q

What is the etiology of juvenile myoclonic epilepsy?

A

Chromosome 6 abnormality (hereditary)

44
Q

What triggers bouts of juvenile myoclonic epilepsy?

A

Sleep deprivation, EtOH, stress, awakening from sleep, menstruation, photic stimulation (flashing lights- remember video game warnings)

45
Q

What signs characterize juvenile myoclonic epilepsy?

A

tonic-clonic, absence, or myoclonic seizures.
Usually see onset of different seizures presenting at different ages:
Absence @ 7-13yo
Myoclonic jerks @ 12-18yo
Tonic-clonic @ 13-20yo

46
Q

Describe consciousness in juvenile myoclonic epilepsy.

A

Consciousness is INTACT
pts are aware of their jerking movements
neuro exam + neuroimaging both normal

47
Q

How do you tx juvenile myoclonic epilepsy?

A

lifelong levetiracetam, lamotrigine, or zonisamide

48
Q

What is Benign Rolandic Epilepsy?

A

MC form of benign, partial epilepsy in kids
With this condition, seizures affect the face and sometimes the body. As a result, the disorder causes problems for some children. It almost always disappears, though, by adolescence.
* numb mouth* in 50% of pts
lower lip starts jerking, can’t speak.

49
Q

How do you tx Benign Rolandic Epilepsy?

A

VPA + carbamazepine (inactivates voltage gated Na+ channels and is a GABA agonist) + lacosamide (inhibits voltage gated Na+ channels)

50
Q

What is your work-up in a child that presents w/ their first FEBRILE epileptic seizure?

A

1) LP to rule out meningitis (bacterial)
2) DON’T mess with an EEG
3) DON’T mess with AEDs unless seizure is severe–> lorazepam
4) Discharge w/ rectal diazepam (Diastat) in case kid has another that lasts 3+ mins UNLESS parents already give kid diazepam

51
Q

What are people w/ status epilepticus at risk of injuring?

A

Hippocampus

52
Q

What is your workup for a child’s first NON-febrile seizure?

A

EEG recommended

53
Q

MOA and ADE of Carbamazepine

A

v Na channels

CYP inducer

54
Q

MOA and ADE of clonazepam

A

GABA allosteric agonist

55
Q

MOA and ADE of ethosuximide

A

v T-type Ca channels

56
Q

MOA and ADE of felbamate

A

v NMDA, ^ GABA

Neuro block 2 (16 decks)

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