Seizures Flashcards
Myoclonic seizures, in particular, may have a focus where in the brain?
Subcortical
What are the ions concentrations that are present at rest within a neuron?
K is in, Na is out
What is the role (physiological mechanism) of antiepileptics in preventing seizures?
Stop the spread of abnormal impulse, not stopping the abnormal impulse from happening
Odd numbers on an EEG represents what? Even?
Even = Right side Odd = Left side
What is the definition of epilepsy?
More than 1, unprovoked seizure
Which gender has a higher prevalence of epilepsy?
Males
What percent of epileptic patients function normally?
80%
What percent of epileptics are free of seizures with medication?
60%
What percent of epileptics report side effects from the medications?
50%
There is an increased incidence of epilepsy with what conditions (2), and in what population?
- Developmental delay
- Psychosis
- Prison population
Can you drive a car with occasional epilepsy?
Nah dawg
What are the endocrine problems with epilepsy meds?
Amenorrhea
Hirsutism
What is the major metabolic effects of epilepsy meds
Osteoporosis
What is SUDEP?
Sudden unexplained death in epilepsy
Are seizures a symptom or a disorder?
Symptom
How do you classify seizures?
By where the seizure begins (partial vs generalized)
What are the 7 types of generalized seizures?
- Tonic
- Clonic
- Tonic-clonic
- Atonic
- Myoclonic
- Absence
- Infantile spasms
What is decerebrate posturing? Decorticate? What does each mean?
Decerebrate = arms extended d/t subcortical lesion
Decorticate = arms flexed d/t cortal insult
Is there always LOC with generalized seizures?
Yes–definition of generalized seizure
What is the usual duration of generalized seizures?
3-5 minutes–more than 5 is status epilepticus
Do seizures in themselves cause brain damage?
No–but aspiration, pneumonia, etc can
True or false: seizures beget seizures
True
What are the EEG patterns of absence seizures?
3 hz spike and slow wave
What are the EEG patterns of frontotemporal seizures?
Frontal temporal spikes
What are the EEG findings of Juvenile myoclonic seizures?
Less than 3-6 hz polyspike and wave
What is the prognosis for absence seizures?
Normal development, and no lasting issues
What is myoclonus?
Intermittent Jerking
True or false: atonic seizures are usually associated with MR
True
What percent of seizures are partial seizures?
80%– the other generalized, obviously
What is the difference between complex and simple partial?
Alteration or LOC or w/ complex
What are the four major simple partial seizures?
- Motor
- Sensory
- Autonomic
- Psychic
What are the three broad types of partial seizures?
- Simple partial
- Complex partial
- With secondary generalization
Left temporal spikes on EEG may be indicative of what?
Mesial Temporal sclerosis–scarring and atrophy of the hippocampus
What is Lennox-Gastaut syndrome?
Seizures of various types that occur 2/2 brain insult early on (usually progression of infantile spasm)
How similar are episodes of recurrent seizures with epilepsy?
Usually similar
What is Todd’s paralysis?
Weakness of a single limb in the postictal state that resolves before 48 hours.
Do epilepsy patients have directed behavior?
No–always non-directed behavior
What are the usual s/sx of nonconvulsive seizures?
- Altered awareness
- Staring/blinking
- Repetitive movements
What are the symptoms that are suggestive of behavioral (nonepileptic) events?
-Continuous, aberrant (variable) behavior with an identifiable emotional trigger
Is there post-event confusion with behavioral (nonepileptic) events?
No
Does behavioral (nonepileptic) events usually respond to treatment?
Nah
What is the preferred method of securing an airway with a seizure?
Nasal tube (NPA)
What is the dietary management for epilepsy? How, generally, does this work?
Ketogenic diet (80% of calories from fat)
Acidifies the blood to control seizures
What are the surgery treatments for epilepsy?
- Seizure focus resection
- Brain stimulation
- Corpus callosum transection
True or false: the meds that are used for treating epilepsy usually prevent almost all seizures?
False–50% is “great” control
What is the classic side effect of phenytoin?
Gingival hyperplasia
What are the common side effects of anticonvulsants?
- Sedation
- Cognitive/behavioral
- Rash
- Weight gain
What are the GI side effects of anticonvulsants?
- Hepatotoxic
- Diarrhea
- Nausea
Drugs that are bound to what or go through what type of metabolism, have a higher incidence of drug-drug interactions?
Protein bound or metabolized by the liver
Erythromycin does what to p450 enzymes?
p450 inhibitor
What is the role of the vagal nerve stimulation in controlling nerves?
Electric shocked q 3-5 minutes to active the RF of the pons
Variable response
What is the definition of status epilepticus?
Frequent seizures without recovery from one seizure to the next or one seizure for more than 30 minutes
What is the incidence of status epilepticus in the epileptic population?
1-4% of epileptic population
What is the morbidity rate of status epilepticus?
20%
What is the treatment for status epilepticus?
- ABCs, oxygen, glucose, IVF
- Lorazepam 1-2 mg IV and Fosphenytoin.
What are the first line drugs for status epilepticus?
Replace any drug they use. O/w Lorazepam and fosphenytoin.
Why give glucose before thiamine?
Glucose will activate the Kreb’s cycle, and use up thiamine, precipitating Wernicke’s encephalopathy
You alway use fosphenytoin, never phenytoin. Why?
Phenytoin is toxic to veins
What is the law of driving and seizure?
Any episode where there is LOC within 6 months
True or false: controlled epilepsy patients are equally safe as uncontrolled DM or heart disease
True
True or false: epileptics are safer drivers than people with OSA
True
What are the major problems with antiepileptic drugs and females?
- Affect menstrual cycle
- Hirsutism
- PCOS
What is the effect of antiepileptic meds on BCP? What should be done if there is breakthrough bleeding 2/2 antiepileptics?
- Lowers effectiveness
- Increase estrogen
What is the chance of malformations with antiepileptic meds?
1/20 (compared to 2/100 normally)
Which antiepileptic meds in particular have teratogenic effects? (2)
- Valproic acid
- Phenobarbital
What is the current recommendation for antiepileptic drug in pregnancy?
Need to stay on drug, but choose the one that is most effective and safest in prego
Why must meds be followed closely with prego?
Change in med [serum]
What is the current recommendation of breastfeeding while on antiepileptic drugs?
Continue breastfeeding
What are the sports that are concerning with epileptics?
Swimming
Gymnastics
What is primary generalized epilepsy? Prognosis?
Idiopathic generalized seizures that recur. May resolve with adulthood, or may need lifelong treatment.
What is the drug of choice for primary generalized epilepsy?
Valproic acid
How long does it take for ischemic infarcts to show on CT?
12-24 hours
What is carbatrol?
Long acting Carbamazepine (dissolving beads)
What is a major side effect of aripiprazole? What type of drug is it?
lowers seizure threshold
is an atypical antipsychotic
What lobe are psychic seizures usually located in?
Temporal
Should Benzos be give to a patient who is seizing, but not in status epilepticus?
No
What is the drug of choice for partial seizure ?
Carbamazepine
What is the drug of choice for status epilepticus?
Phenytoin
