Seizures Flashcards
partial seizure
1 area of brain, usually temporal lobe
preceded by aura
- smell burning tires
- tunnel vision
- deja vu
- euphoria
Simple vs complex partial seizures
simple - intact consciousness
complex - altered consciousness
Generalized seizure
affects brain diffusely
Petit mall absence
staring spell
smacking lips/quivering of facial muscle
no post-octal state
tx: Ethosuximide. If that fails, then valproic acid
myoclonic
brief involuntary twitch of muscle or group of muscles
Grand mal
tonic/clonic
stiffness, shaking, convulsive
Tonic seizure
muscle stiffening only
Atonic seizure
“drop seizure”
lose tone
confused with syncope
Status epilepticus
persists more than 5 min
recurrence w/o regaining consciousness between seizures
can lead to permanent brain damage or death
tx: Benzodiazepines - diazepam or lorazepam either IV or IM
Cause of seizure in kids
developmental etiology
infection - febrile seizure
trauma
metabolic abnormality
Cause of seizure in adults
tumors
stroke - elderly
Sturge-Weber Syndrome
Congenital neurological and skin disorder d/t vascular malformations
Port-wine stain on face - CN V1 or V2 area
- overabundance of capillaries
- present at birth
GNAQ mutation
causes glaucoma, seizures, hemiparesis, intellectual disability
Tuberous sclerosis
AD
Incomplete penetrance and variable expressivity
TSC1: hamartin protein
TSC2: tuberin protein
Triad: seizures, intellectual disability, angiofibromas
Other findings: ash-leaf spots - hypomelanotic macule, retinal hamartomas, cortical tubers (glioneuronal hamartomas)
Tumor associations: renal angiomyolipoma, cardiac rhabdomyoma, astrocytoma (subependymal giant cell astrocytoma)
Trigeminal neuralgia (Tic douloureux)
“Lightening like” pain, “electric shocks” along division of trigeminal (usually maxillary) triggered by light touch - wind, bedsheets
tx: carbamazepine or other anticonvulsants (phenytoin, gabapentin, topiramate)
Treatment of eclampsia
MgSO4
Anti seizure drugs that block Na+ channels to decrease AP in neurons
phenytoin carbamazepine lamotrigine topiramate valproic acid
Anti seizure drugs that increase GABA activity to reduce neuron excitability
gabapentin phenobarbital valproic acid Benzodiazepines tiagabine vigabatrin levetiracetam
Anti seizure drugs that block T type Ca2+ channels to decrease neuronal APs
Gabapentin
ethosuximide
phenytoin - high doses
Common side effects of all anti seizure meds
lethargy ataxia dizziness HA wt gain diplopia
Side effects specific to phenytoin
“Phenytoin Has Given MDS Frustration”
peripheral neuropathy hirsutism gingival hyperplasia Megaloblastic anemia d/t decreased folate absorption Drug induced lupus Stevens Johnson Sn Fetal hydantoin syndrome
Fetal hydantoin syndrome
cleft lip/palate
congenital heart dz
intellectual disability w/ developmental delay
Antiepiletpics that are teratogens
Phenytoin
Carbamazepine
Valproic acid (spina bifida)
If need to continue in pregnancy, give 4 mg folic acid QD
Drugs that cause Stevens-Johnson Syndrome
“Steve Jobs made APPLE PCS”
Allopurinol Phenytoin Phenobarbital Lamotrigine Ethosuximide Penicillin Carbamazepine Sulfonamides
Drugs known to cause agranulocytosis
Carbamazepine Clozapine Colchicine PTU Methimazole
Hepatotoxic antiepileptics
Valproic Acid
Carbamazepine
