Seizures Flashcards
What type of seizure is focal, emanating from a specific cortical area?
Partial
What type of seizure is NOT focal, emanating from both hemispheres at the same time?
Generalized
Can a partial seizure progress to a generalized seizure?
Yes. But it is still called a partial seizure bc it started out that way, symptomatically.
Describe the EEG findings that would indicated a seizure is taking place.
sharp/slow waves, spikes
Do most seizure pts respond to mono or multidrug tx?
mono
What is the difference between medical remission and disease remission?
Medical remission = free of seizures on 1-2 AEDs
Dz remission = free of seizures post surgery w/o need for AEDs
What is the drug of choice for treatment of primary generalized seizures?
Valproic acid (Valproate)
What are the drugs of choice for tx of partial/tonic-clonic seizures?
VPA, phenytoin, carbamazepine—> (new agents) gabapentin, oxcarbazepine
What are the DOC for absence seizures?
Ethosuximide (ETX) or VPA
What are the broad spectrum DOC for seizures?
Lamotrigine, Topiramate, Levitiracetam, Zonisamide
Which of the AEDs are CYP inducers?
Carbamazepine, Phenytoin, phenobarbitol > Oxar, topiramate
Which receptors does Glutamate act on?
How about GABA?
What happens when they get there?
GLU: AMPA, NMDA, Kainate —-> ^ Na+/Ca2+ influx–> depolarization—> AP
GABA: GABA-A —> ^ Cl- influx—> hyperpolarization—> inhibition of AP
Describe any changes in consciousness in simple partial seizures.
Consciousness preserved. Brief auras w/ no overt behavioral manifestations.
Describe motor and somatosensory symptoms of simple partial seizure.
Jacksonian march: movement of hands—> upper arm—> face.
Sensory: focal tingling on entire side of face or arm, etc.
Describe the autonomic symptoms of simple partial seizures.
^ epigastric sensation +/- N/V
Describe the psychic symptoms of simple partial seizures.
fear, deja vu, jamais vu
Describe any changes in consciousness in complex partial seizures.
Consciousness IMPAIRED. Focal EEG abnormality. Blank stare. Amnesia w/ post-ictal state.
What are some somatic characteristics of complex partial seizure?
lip smacking, chewing.
hand rubbing, picking movements.
When a simple partial seizure —> generalized seizure, this is called:
secondary generalized partial seizure (bilateral cerebral involvement)
In primary generalized seizures, you will see EEG changes evident in ______ cerebral hemispheres.
BOTH
Absence seizures are a subtype of this primary seizure type:
They are characterized by these EEG findings:
Generalized seizure
** EEG findings: 3 Hz spike-wave discharges **
These seizures are a subtype of generalized seizures and are characterized by muscular rigidity and rhythmic jerking, and loss of consciousness.
Tonic-clonic seizures
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:
Generalized
Your pt w/ intractable seizures is not responding to antiepileptic polytherapy. What is next for tx?
Vagus nerve stimulation, then surgery (resection of seizure provoking cortex/hemispherectomy)
How do you define generalized convulsive status epilepticus?
How do you Dx it?
generalized convulsive seizure lasting > 5 mins OR
2+ sequential seizures w/ no recovery of consciousness
Dx: EEG
How do you treat generalized convulsive status epilepticus?
Emperic: thiamine + D50
Lorazepam + phenytoin (except in preg women)
How do you tx infantile spasms?
ACTH
How do you tx absence seizures in a child?
ETX
How do you tx partial seizures in a child?
phenytoin, phenobarbitol, carbamazepine, gabapentin, tiagabine, oxcarbazepine
How do you tx generalized/partial seizures in a child?
levetirazetam, VPA, lamotrigine, topiramate, felbamate, zonisamide
- these are all broad spectrum agents
Define infantile spasms
Brief, bilateral symmetric contractions of the neck, trunk, and extremity muscles.
Caused by genetic enzyme/nutrient deficiency
An infant is having spasms bc of a pyridoxine insufficiency. How do you tx?
Give B6
An infant is having spasms bc of PKU, MSUD (maple syrup urine dz), or GluTx deficiency. How do you tx?
Change diet accordingly
What is West syndrome?
Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression
How do you tx infantile spasms caused by tuberous sclerosis?
Vigabatrin (inhibits GABA breakdown by GABA transaminase)
What are the clinical symptoms that will key you off to an infant having infantile spasms?
body flexing - abdominal crunches
other presentations: head nodding + “lightening attacks”- single momentary body shocks
What is hypsarrhythmia?
^ voltage/chaotic activity between seizures
What are Lennox-Gaustaut seizures?
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
How do you tx Lennox-Gaustaut seizures?
Rufinamide»_space;»> VPA, ketogenic diet, corpus callostomy, VNS
This may trigger childhood absence epilepsy:
Hyperventilation
Will the neurological status and EEG background be changed in childhood absence epilepsy?
No, they will be normal
How do you tx childhood absence epilepsy?
ETX if only absence seizures.
Use VPA/lamotrigine in CAE
What is the etiology of juvenile myoclonic epilepsy?
Chromosome 6 abnormality (hereditary)
What triggers bouts of juvenile myoclonic epilepsy?
Sleep deprivation, EtOH, stress, awakening from sleep, menstruation, photic stimulation (flashing lights- remember video game warnings)
What signs characterize juvenile myoclonic epilepsy?
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
Describe consciousness in juvenile myoclonic epilepsy.
Consciousness is INTACT
pts are aware of their jerking movements
neuro exam + neuroimaging both normal
How do you tx juvenile myoclonic epilepsy?
lifelong levetiracetam, lamotrigine, or zonisamide
What is Benign Rolandic Epilepsy?
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.
How do you tx Benign Rolandic Epilepsy?
VPA + carbamazepine (inactivates voltage gated Na+ channels and is a GABA agonist) + lacosamide (inhibits voltage gated Na+ channels)
What is your work-up in a child that presents w/ their first FEBRILE epileptic seizure?
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
What are people w/ status epilepticus at risk of injuring?
Hippocampus
What is your workup for a child’s first NON-febrile seizure?
EEG recommended
MOA and ADE of Carbamazepine
v Na channels
CYP inducer
MOA and ADE of clonazepam
GABA allosteric agonist
MOA and ADE of ethosuximide
v T-type Ca channels
MOA and ADE of felbamate
v NMDA, ^ GABA
