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Neuro > Seizures > Flashcards

Seizures Flashcards

1
Q

Define seizure

A

Clinical manifestation of excessive hypersynchronous neuronal activity

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2
Q

What causes seizures?

A

Inadequate neuronal inhibition (GABA and glycine)
Excessive neuronal excitation (aspartate and glutamate)
Both

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3
Q

Define epilepsy

A

Enduring disorder of the brain characterized by recurrent seizures (symptom, not a dz)

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4
Q

Define cluster

A

2 or more seizures within 24h

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5
Q

Define status epilepticus

A

Seizure lasting longer than 5 min or 2 or more seizures without recovery to consciousness

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6
Q

Define refractory/pharmacoresistant epilepsy

A

Failure to achieve freedom from seizures despite adequate trials of two or more well-tolerated AED regimens

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7
Q

Define generalized (grand mal) seizure

A 
Bilateral involvement and loss of consciousness
Salivation, urination and or defecation
Typically less than 3 min
Presents as:
- Tonic
- Clonic
- Tonic-clonic
- Myoclonic
- Atonic
Focal
Focal with secondary generalization
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8
Q

Define generalized focal or partial seizure

A

Ictal onset consistent from one seizure to another
Electrical activity arises from opposite hemisphere
Difficult to assess consciousness in patients (not recommended anymore)
Lateralized and/or regional signs
- Motor
- Autonomic
- Behavioral

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9
Q

Three components of seizure

A

Preictal
Ictal
Post ictal

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10
Q

Prodome/preictal

A

Prior to onset of seizure
- Hours to days
- Should not be confused with focal seizure signs
Clients may not report this
- Confusion, hiding, attention seeking, etc

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11
Q

Ictus

A

May be generalized, focal, or focal to generalized
Lasts seconds to minutes
- Duration of seizure measured during this period only

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12
Q

Post ictal

A

After seizure
Can last minutes to days
Behavior changes and neuro symptoms may be seen (may be only sign of seizure)

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13
Q

Etiology based classification

A

Idiopathic or structural

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14
Q

Idiopathic epilepsy subtypes

A

Genetic (incomplete penetrance of several genes)
Suspected genetic
Unknown cause

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15
Q

Idiopathic epilepsy basics

A 
Common neuro dz
- Affects 1-5% of entire dog population
- About 3 mill ppl in USA
Refractory in about 25% of cases
- Canine is excellent animal model
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16
Q

Breeds commonly affected by idiopathic epilepsy

A

Australian shepherd, border collie, goldens, collies
Arabian foals
Aberdeen Angus, Brown Swiss, Swedish Red

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17
Q

Testing for idiopathic epilepsy

A

None yet
Dx of exclusion

Factors supportive of dx:

  • Seizures between 1-5y
  • Normal interictal period
  • Normal dx testing
18
Q

Idiopathic epilepsy of unknown cause

A

Classification of seizures where the cause is not determined but genetic epilepsy is unlikely

  • Dx testing normal
  • Signalment
19
Q

Idiopathic/Unknown epilepsy in cats

A

Unknown versus presumptive unknown

- Subtypes

20
Q

Structural epilepsy

A

Epileptic seizures dt brain activity

  • Degenerative
  • Anomalous
  • Metabolic
  • Neoplastic
  • Inflammatory
  • Traumatic
  • Vascular

Diseases confirmed by diagnostic testing
- MRI, CSF, biopsy/necropsy, DNA testing

21
Q

Seizure like episodes

A 
Syncope
Vestibular
Narcolepsy, cataplexy, REM sleep disorder
Cervical muscle spasm/ AA luxation
Head bobbing
Feline hyperaesthetic syndrome
Panic attack
Intermittent decerebrate rigidity
Neuromyotonia or neurokymia
Toxicity
22
Q

What are the three questions for all seizure cases?

A

Is it a seizure?
What is the cause?
Does it require Tx?

23
Q

Is it a seizure?

A

Start with Hx

  • Ask open ended questions
  • Specifically describe what happened before, during, and after event
  • How long did it last?
  • Abnormalities during interictal period?

Ask client to video episode

24
Q

Performing a neuro exam

A

Look for evidence of other cerebral or thalamic abnormalitis

  • Blindness, decreased menace response
  • Circling, proprioceptive deficits
  • Hemi-inattention syndrome
  • Behavior changes
25
Q

Diagnostic tests

A

Electroencephalogram (EEG)
MRI
CSF analysis
Infectious disease titers, metabolic screening tests

26
Q

How does one decide when to start tx?

A 
Consider the disease
- Tx any underlying issue causing symptom of a seizure
Consider seizures
- Kindling phenomenon
Consider pt (quality of life, etc)
27
Q

T/F: treatment is often started after 1 seizure

A

False; no benefit

28
Q

T/F: the earlier a treatment is started, the better the potential for seizure control

A

True

29
Q

T/F: Prolonged or repetitive seizures can increase morbidity, mortality, and require prolonged hospitalizaiton

A

True; increases financial burden

30
Q

When is seizure treatment required?

A

Identifiable structural lesion present or prior history of brain disease or injury
Acute repetitive seizures or status epilepticus
- Ictal event >5min or 3 or more generalized seizures within 24h period
Two or more isolated events within a 6 month period
Prolonged, severe or unusual post ictal events

31
Q

Client communicaiton

A

Seizure control
- Target is 50% reduction in seizures or more
- Decrease frequency, duration, and intensity
Unrealistic that there will be no seizure
Pt may require lifelong tx
Frequent reevaluations and monitoring
Do not judge efficacy of medication until reaches steady state
Potential for ER visits
Possible drug side effects
DO NOT change medication doses

32
Q

Which drug should be used first?

A

Based on tolerability in pt

33
Q

Efficacy of monotherapy anticonvulsants

A

Phenobarbital: 60-80% of dogs
Bromide: 70-80%
Zonisamide and levitiracetam
- Excellent based on experience (lack of research)
- Less side effects than phenobarbital and bromide

34
Q

Efficacy in Polytherapy

A 
Phenobarb: 70-80%
Bromide: 65%
Zonisamide: 58-90%
Levetiracetam: 57-97%
Pregabalin: 7/9
Gabapentin: 50%
35
Q

Recommendation for owners

A

At home, after a seizure

  • Give extra dose of anticonvulsant after pt is awake and aware to swallow
  • Exception is bromide

Owner should record every seizure
- Date, time, duration of each phase

36
Q

Monitoring therapeutic blood levels

A

After steady state reached after starting Tx, changing dose, or immediately after loading
- Provides baseline
Seizures are not controlled
- Helps determine if dose change or additional medication is needed
Signs of possible dose related toxicity
Every 6-12 months to verify no changes in pharmacokinetics
- Variable usefulness

37
Q

Recommendations for monitoring

A

CBC chem in all pts every 6 mo
Phenobarbital and bromide levels
- After reaching steady state
- Every 6 mo

38
Q

Recommendation for owners

A

Pt that tend to cluster

  • Consider pulse dose of short acting drug over 48h period
  • Levitiracetam and gabapentin work well, if the pt is not already on these meds for maintenance

AVOID ER

39
Q

Emergency Tx

A 
Seizures lasting longer than 5 min
3 or more seizures within 24h
ABCs
Get vital parameters
IV access
40
Q

Emergency drug therapy

A 
Levetiracetam
Benzodiazepams (add something else on board)
- Diazepam
- Lorazepam
- Midazolam

If no IV access:
keppra SQ or IM
Diazepam rectally
Midazolam IM

41
Q

Emergency seizure management

A

Run bloodwork to eval for hypoglycemia, renal, or hepatic dz
Collect blood for levels before loading
- In pt on AED therapy
- Without serum separator for Pb

42
Q

T/F: Propofol CRI is controversial in seizure pts

A

True; will stop motor activity but not seizure; use inhalant anesthesia

Neuro (3 decks)

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