Seizures

Question 1

What is a seizure?

Answer 1

Synchronous neuronal activity of the brain

• 1-2% of ER visits
• most are idiopathic and > 60 due to strokes and neoplasm

Question 2

What are some other causes of seizures?

Answer 2

Children: Genetic, infection, Trauma, congenital and metabolic

Adult: tumor, trauma, stroke and infection

Elderly: stroke, tumor, trauma, metabolic, infection

Question 3

What are some examples of provokes seizures?

Answer 3

Metabolic disturbances
Infections
Focal neurologic lesions
Meds
Toxins

Question 4

What is one simple way to provoke a seizure?

Answer 4

Sleep deprive your patient

Question 5

What is epilepsy?

Answer 5

Seizure disorder that is chronic
more than 2 unprovoked seizures at least 24 hrs apart
- don’t confuse this with febrile seizures

Question 6

What are some tests that one should order when ruling out seizures?

Answer 6

CT and MRI
EEG in all pts
LP- infection
CBC, BMP, Utox and pregnancy

Question 7

What is status epileptus and how is it treated?

Answer 7

> 5 mins of continuous seizures or
recurrent seizure without return to baseline
- Emergency and treat with Benzo (NOT BARBs)
- Mortality of 20%
- depletes all glucose and other metabolites

Question 8

What is Jacsonian motor seizure?

Answer 8

Spread of seizure that goes throughout homunculus

Question 9

What are the other major forms of seizures?

Answer 9

Partial (focal( seizures

Generalized

Question 10

What is a focal seizure?

Answer 10

Affect only a single area of the brain (most commonly medial temporal lobe)
- can progress to generalized

• Simple: Consciousness intact (motor, sensory, autonomic psychic)
• ex: lips smacking, tics or sense of specific smell, deja vu

-Complex: Impaired consciousness
confusion, repetitive motion

Question 11

What is a generalized seizure and what are the subtypes ?

Answer 11

Seizure involved whole brain and conscious is lost
1. Abscence- blank stare

2. Myoclonic- quick repetitive jerks
3. Tonic- Clonic– grand mal (alternating stiffening and movement
4. Tonic- stiffening
5. Atonic- drop seizures fall to floor (commonly mistaken for syncope)

Question 12

What are the treatment for status elipticus?

Answer 12

First line acute: Diazepam/ IV lorazepam

Prophylaxis : Phenytoin

Question 13

What is the first line drugs for simple and complex seizures?

Answer 13

Carbamazepine/Lamotrigine 
as well as:
- Gabapentin
- Phenytoin
- Topiramate 
- Valproic acid

Question 14

What is the first line treatment for absence seizures?

Answer 14

Ethosuximide

2nd: Valproic acid

Question 15

What is the first line treatment for tonic-clonic seizures?

Answer 15

Valproic acid and sometimes carbamazepine or Phenytoin

Question 16

What is the overall treatment goal of anti-seizure meds?

Answer 16

Decreased Glut transmission

Increased GABA transmission

Question 17

What are some ways presynaptic targets diminish glutamate release?

Answer 17

VG Na+ channels (Phen, carb, Lacosamide, top)
VG CA2+ channels (Eth and gabapentin)
K+ channels (Retigabine)
Synaptic vesicle proteins SVA2 (Levetireacetam)

Question 18

What are some ways anti-seizure meds block postsynaptic targets?

Answer 18

AMPA receptors (Phenobarbital and top)
NMDA receptors (Valproic acid)

Question 19

What are some molecule trargets for antiseizure drugs at the inhibitory, GABAergic synapse

Answer 19

GABA transporters (GAT-1 via tiagabine)
GABA-transaminase (GABA-T, Valproic acid)
GABAa (Benxo and barbs)
Synaptic vesicular proteins (Levetireacetam)

Question 20

Where is T-Type VG Ca2+ channels found?

Answer 20

Postsynaptic

Question 21

Where are P/Q and N types Ca2+ channels found?

Answer 21

Presynaptic

Question 22

What are SV2A and CRMP-2?

Answer 22

Vesicle binding proteins