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Clinical Neuro > Seizures > Flashcards

Seizures Flashcards

1
Q

What are the seizure criteria and how many must the episode match to be considered a seizure?

A
  • Hypersalivation, urination and/or defecation - PS signs
  • Tonic/tonic-clonic movements or rhythmic contractions of facial or appendicular muscles
  • Altered mentation or decr responsiveness
  • Postictal period - abnormal behavior or mental state noted; blind, frantic, ataxia, dullness
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2
Q

What are things that could causes a seizure-like episode?

A
  • Narcolepsy/cataplexy, REM sleep movement disorders
  • Syncope
  • cardiac dz
  • hypoglycemia
  • myoclonus
  • anemia
  • e- abnormalities
  • Atlanto-axial luxation
  • COMS
  • vestibular events
  • head bobbing
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3
Q

Define a seizure. What are some possible causes of a a seizure?

A

Hypersynchronous electrical activity causing abnormal and excessive discharge of neurons in the brain

  • Decr inhibition (GABA, glycine)
  • incr excitation (glutamate, aspartate)
  • high estrogen levels/low progesterone
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4
Q

Why is spaying an epileptic patient often indicated?

A

Because estrogen decreases seizure threshold and progesterone enhances GABA and inhibits glutamate

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5
Q

What are the phases of seizures?

A

Pre-ictal: may be a partial seizure

Ictal: seizure

Post-ictal: confused, absent menace

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6
Q

What is the difference between cluster seizures and status epillepticus?

A

Cluster - more than 1 seizure in 24 hours

Status epillepticus - longer than 5-20 min or not normal b/t events

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7
Q

What is epilepsy and what are the 4 etiologies?

A

Epilepsy = more than 1 seizure

Etiologies:

  1. Familial/idiopathic/primary: presumed genetic 1-4 yrs
  2. Symptomatic/Secondary - known underlying cause (neoplasia, infection, inflammation)
  3. Reactive
  4. Cryptogenic - suspect cause though not identified
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8
Q

What is a generalized seizure?

A

Focus in one cortex that reaches thalamus and disseminated throughout the brain

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9
Q

What is the difference between a simple and complex focal seizure?

A

Simple - consciousness unimpaired

Complex - consciousness impaired: fear, anger, behavioral abnormality, autonomic, “psychomotor”

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10
Q

What is a simple partial seizure?

A

Disturbance of motor function only, no loss of responsiveness

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11
Q

What is a complex partial seizure?

A

Disruption of the sensorium +/- motor (fly biting/flank chewing), decreased responsiveness

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12
Q

What are your initial diagnostics for a seizure work-up?

A

Hx, exam findings, MDB, rads, abd U/S, fundic exam, endocrine status, hepatic function, current anti-convulsants levels

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13
Q

What are three advanced diagnostics you can use for a seizure workup?

A

Advanced imaging - CT vs. MRI (gold standard)

Electroencephalogram (EEG)

CSF analysis - infectious dz titers

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14
Q

What are diseases that could cause seizures that follow the DAMNITV scheme?

A

Congenital - hydrocephalus

Metabolic

Neoplasia - primary vs. metastatic

Infectious/Inflammatory - viral, protozoal, fungal, MUE, GME, NME

Vascular event - stroke vs. hemorrhage

Epilepsy - familial vs. cryptogenic

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15
Q

What are metabolic causes for seizures?

A
  • Hypo- or hyperglycemia
  • DM, insulinoma
  • Electrolyte disturbances (Na, Ca, Mg)
  • Renal failure
  • Hepatic dz/failure - PSS
  • Toxins
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16
Q

What types of neoplasia can cause seizures?

A

Primary - meningioma, glioma, lymphoma, insulinoma

Secondary Metastatic - lymphoma, hemangiosarc

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17
Q

What are inflammatory/infectious causes of seizures?

A

Autoimmune, MUE, GME, NME, infectious: tick borne dz, protozoal (Toxo, Neospora), fungal (crypto, blasts, aspergillus), viral (rabies, distemper)

18
Q

What are some vascular events that can cause seizures?

A

Ischemic/stroke, hemorrhagic, underlying endocrine disorders, underlying infectious dz

19
Q

What are the causes of seizures in cats?

A
  • Epilepsy
  • thiamine deficiency
  • infectious (cuterebra, crypto, FIP, FIV, Toxo)
  • Hypertensive encephalopathy (CRF, hyperthyroid)
  • Meningioma, LSA
  • PSS in kittens
  • Vascular
20
Q

What are important factors that play a role in quality of life when managing epilepsy?

A

Underlying cause, seizure freq and severity, owner compliance, stress associated w/ seizure event, stigma assoc w/ certain AEDs

21
Q

What are goals of therapy for management of epilepsy?

A

Decr frequency, decr severity, and good quality of life

22
Q

What are AEDs that block Na channels?

A

Phenytoin, Valproate, Topiramate

23
Q

What are AEDs that block Ca channels?

A

Topiramate, Gabapentin/Pregabalin

24
Q

What AEDs enhance GABA?

A

Benzos, barbiturates

25
Q

What AED inhibits glutamate?

A

Topiramate

26
Q

What are the most common anticonvulsants?

A

Phenobarbital, KBr, Levetiracetam (Keppra), Zonisamide, Pregabalin (Lyrica)

27
Q

Describe phenobarbital

A

MOA: incr neuronal responsiveness to GABA, anti-glutamate, decr Ca flow into neurons

Half-life: 40-90 hours

Ideal b/w 25-35 mcg/ml and monitor q 6mo

28
Q

What are some side effects of phenobarb?

A

PU/PD/PP

hepatotoxicity (esp. when blood >35mcg/ml)

auto-inducer of cP450

sedation/ataxia

29
Q

Describe KBr

A

MOA: traverse neuronal Cl channel and hyperpolarize neuronal membrane to cause an incr seizure threshold

Half-life: 28d, steady state @ 4 mo

Excreted via kidneys

30
Q

What are some side effects of KBr?

A

Coughing (pneumonitis in cats) - DO NOT USE IN CATS

Pancreatitis - may develop elevated triglycerides

vomiting

31
Q

Describe Levetiracetam

A

MOA: inhibit voltage-gated Ca channel, neuro protective

Half-life: 3 hours

Given PO TID to QID

32
Q

What are the side effects of Levetiracetam?

A

Few to no side effects - transient sedation

33
Q

Describe Zonisamide

A

MOA: block T-type Ca and voltage gated Na channels, bind to Cl channels associated with GABA

Half-life: 15 hours in dogs

34
Q

What are the side effects of Zonisamide?

A

Ataxia, lethargy, KCS, vomiting, polyarthropathy, suppression of thyroid hormone synthesis, hepatotoxicity, renal tubular acidosis, calcium oxalate urolithiasis

35
Q

Describe Gabapentin

A

MOA: structural analog to GABA and enhances action, inhibit voltage gated Na/Ca channels

Half-life: 3- 4hrs

*Terrible anticonvulsant, great for pain

36
Q

Describe pregabalin (lyrica)

A

MOA: Gabapentin analog - decr Ca influx resulting in decr glutamate and substance P

Half-life: 7hrs

Expensive human product

don’t routinely monitor drug levels

37
Q

What are principles for monitoring AED use in epileptic patients?

A
  • Use a single agent to its maximal effect before adding or switching to another AED
  • monitor levels for phenobarb, KBr, and Zonisamide
  • monitor side effects
38
Q

What are some alternative treatments for epilepsy?

A

Vagal nerve stimulators - internal and external

Ketogenic diet - not easy in dogs

Food allergies - novel protein or reduced antigen food?

39
Q

What are the effects of status epilepticus?

A

Results in neuronal cell death from excitotoxicity from glutamate and influx of Ca through NMDA glutamate receptors

40
Q

What are the goals of emergency management therapy for seizures?

A
  • Stop seizures!
  • support systemic function
  • protect brain function
  • assess underlying cause
41
Q

What are your emergency management medications options for seizures?

A

Bolus diazepam (IV or per rectum)

midazolam (IV or intranasal)

AED loading dose (Phenobarb, KBr)

CRIs of prop, midazolam, dexmed, Levetiracetam

42
Q

Which disease is which?

A

Clinical Neuro (7 decks)

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