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RUSVM SAM 1 > Seizures > Flashcards

Seizures Flashcards

1
Q

What is epilepsy?

A

Disease condition characterized by recurrent portion or generalized seizures

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2
Q

What are the two forms of epilepsy ?

A

Primary (idiopathic)—>no known cause

Secondary(symptomatic)—> has discernible intra- or extra- cranial cause

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3
Q

T/F: partial/focal seizures are most indicative of symptomatic epilepsy

A

True

-usually from post-trauma, space-occupying lesions, or cortical developmental disorders

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4
Q

What type of partial seizures are most common?

A

Partial motor seizures, caused by a lesion in the motor cortex

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5
Q

What signs do you see in a partial motor seizure?

A

Brief episodes of abnormal movment in the contralateral body part

  • jerking of one or both limbs
  • chewing gum fits
  • flexing to one side of body
  • head turning
  • head bobbing
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6
Q

T/F: head bobbing in a partial seizure starts and stops spontaneously but can be stopped by distracting the dog

A

True

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7
Q

What signs can you see in a partial seizure that causes abnormal behavior?

A

Aggression or rage
Excessive salivation
Licking or chewing
Sudden voracious consumption o food/water
Uncontrolled running/vocalizing/trembling

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8
Q

What is a characteristic sign of absent seizures ?

A

Brief loss of consciousness that appear to be “staring into space” or “blanking out”
Can be associated with loss of muscle tone or muscle twitches

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9
Q

A partial sensory seizure is due to a lesion where?

A

In the sensory cortex

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10
Q

What signs would you see in a dog with partial sensory seizures?

A

“Fly-biting” or “Tail chasing”

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11
Q

T/F: partial seizures may become generalized seizures

A

True

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12
Q

What is a generalized seizure?

A

Abnormal activity over the entire cortex —> widespread activation of the brain

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13
Q

What are the forms of generalized seizures?

A 
Generalized tonic-clonic seizure 
Tonic seizure 
Clonic seizure 
Atonic seizure 
Absence seizure 
Incomplete
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14
Q

What is an atonic seizure?

A

Loss of muscular activity but consciousness is maintained

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15
Q

What are the phases of a generalized tonic-clonic seizure?

A

Preictal phase - minutes (aura) or hours (prodromal) before convulsion
Ictal period -actual seizure with loss of consciousness
—> tonic phase - widespread muscle contraction
—> clonic phase -alternating contraction and relaxation of muscles
Postictal phase -gradual return to consciousness

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16
Q

Limbs extended rigidly
Opisthotonos
Apnea and cyanosis

What phase of a seizure is this?

A

Tonic phase

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17
Q

Animal appears to be running or paddling and chewing
Can have salivation, deification, and urination

What phase of a seizure is this?

A

Clonic

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18
Q

Animal with varying degrees of depression, fatigue, fright, dazed appearance, aimlessness, pacing, thirst or hunger

What phase of a seizure is this??

A

Postictal period

Occasionally can have neurological deficits such as blindness, paresis, or in coordination

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19
Q

T/F: cluster seizures are seizures that are separated by minutes to hours where the animal returns to full consciousness in between episodes

A

True

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20
Q

_____________ is where there is continuous seizure activity for more than 5 minutes and the animal does not return to full consciousness between episodes

A

Status epilepticus

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21
Q

How can you differentiate between seizures during sleep and excessive sleep movement??

A

Attempt to wake animal

—> excessive sleep movement, animal wakes normally with no pot-ictal signs (confusion/ataxia)

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22
Q

What is the difference in treatment for primary/idiopathic vs secondary epilepsy ?

A

Primary-> anticonvulsant drugs

Secondary-> treat underlying disease

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23
Q

In general practice, ___________ is the most important cause of provoked seizures

A

Toxicity

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24
Q

When do seizures usually develop in cats and dogs with idiopathic epilepsy

A

1-5years

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25
Q

What would your differential list be for young animals with seizures?

A

Primary/idiopathic
Toxicity
Congenital abnormalities
Infectious disease

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26
Q

What would be your differential list for older animals with seizures ?

A

Neoplastic

Systemic metabolic disease

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27
Q

What breeds commonly have seizures?

A 
Golden retrievers 
German shepherds 
Border collies 
Poodles
Shelties 
Welsh corgis 
Cocker spaniels
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28
Q

T/F: the older the animal is when seizures start, the more severe the epilepsy is likely to be and the more difficult it will be to treat

A

False

the YOUNGER the animal is when seizures start, the more severe the epilepsy is likely to be and the more difficult it will be to treat

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29
Q

Episodic weakness can appear like seizures to owners, what are causes of episodic weakness?

A 
Syncope 
Narcolepsy, Scotty cramp, episodic falling 
Sudden onset of vestibular disease 
Hypoglycemia 
Hyperkalemia 
Hypocalcemia 
Cardiovascular disease 
Myasthenia gravis 
Polymyositis
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30
Q

What information in a history would suggest a seizure?

A

Neurological abnormalities

—> changes in personality and behavior, circling, unilateral proprioceptive defects

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31
Q

What would be important aspects of a physical exam to rule-in/out seizures?

A

Cardiovascular abnormalities —> syncope secondary to hypoxia
Neoplasm —> metastases
Systemic infection —> distemper or FIP
Abnormalities in skull —> trauma, hydrocephalus
Retinal exam—> active/healed rential lesions (toxo/FIP/distemper)

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32
Q

When you do a neurological exam, localized lesions are suggestive of what DDX?

A

Primary tumors
Focal inflammation
Infarction
Brain trauma

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33
Q

When doing a neurological exam and lesions appear to be multifocal, what is your DDX?

A

Secondary neoplasia
Infectious disease
Degenerative disease
Metabolic disease

34
Q

Why use an EEG in seizure diagnosis?

A

Can confirm diagnosis and discriminate between general and partial seizures
Can help identify a suspected seizure focus

35
Q

What are indications for starting an animal on anticonvulsant drug therapy?

A

Frequency and severity..

  • seizures more than once every6-8weeks
  • clusters of seizures (several in a day)
  • prolonged seizures than might cause neuronal damage
  • status epilepticus
  • symptomatic epilepsy caused by CNS disease
36
Q

Only _________% of animals will be free of seizures on anticonvulsant therapy, and only _____% will have a reduction in the number of their seizures?

A

30-40; 50

—> therapy is generally lifelong

37
Q

When can withdrawal of seizure medication be considered?

A

If animal has been seizure free for more than one year..
withdrawal is gradual over 6-12months
Sudden discontinuation can result in severe seizures
Remission rate only 15%

38
Q

Antiseizure drugs often have long half lives, what implications does this have on monitoring and dosages?

A

Loading doses should be given for animals with severe seizures

Blood levels should be taken when

  • steady state levels have been reached or after loading dose
  • if seizure is not controlled
  • dose related toxicity signs
  • when autoinduciton occurs
  • every 6-12months
39
Q

What is the drug of choice for treating seizures and what is its MOA?

A

Phenobarbital

enhance GABA action —> elevate seizure threshold

40
Q

When is use of phenobarbital contraindicated?

A

Liver disease

41
Q

What are the adverse effects of phenobarbital ?

A

Sedation and ataxia - usually disappear in the first few weeks

PP/PU/PD
Liver enzyme induction
Lipidemia —> predispose to pancreatitis

42
Q

What laboratory abnormalities would you see on a patient treated with phenobarbital ?

A

Increase ALP and ALT

Due to enzyme induction, cannot asses hepatotoxicity with these values

43
Q

Because of phenobarbital’s effect on liver enzymes, how must you dose it over time?

A

Phenobarbital is an enzyme inducer—> enhances its own metabolism —> must gradually increase dose over time (autoindution may continue for up to 6 months)

44
Q

What are signs of liver failure, what can help you determine if liver failure is present on lab work of a patient that is on phenobarbital ?

A

Sedation, ataxia, anorexia, jaundice, acities, and encephalopathy

Increase in bile acids and bilirubin
Proportionally large increase in ALT over ALP

Can see increased phenobarbital levels —> lack of metabolism in liver (causes the ataxia and sedation)

45
Q

T/F: hepatotoxicity caused by phenobarbital is reversible if drug is withdrawn early in disese

A

True

-> this is why we do 6-12months bloodwork

46
Q

T/F: dogs on phenobarbital will have similar clinical and laboratory signs to dogs with hyperadrenocortisim

A

True

—> adrenal function tests are normal

47
Q

You initiate treatment with phenobarbital, what is your follow up procedure?

A

Measure [PB] for the first time a 3weeks and adjust dose accordingly
Remeasure at 6weeks and then at 3 and 6 months after —> detecting liver enz induction
CBC at 3 or 6 weeks —> detect idiosyncratic blood cell disturbances
Long term—> [PB], liver function, and CBC every 6-12months

48
Q

T/F: Doses of phenobarbital are much smaller in puppies than adults

A

False

Puppies have increased doses (up to 50%) because they have increased distribution volume/clearance, and decreased half-life

49
Q

What is the MOA of bromide??

A

Moves through Cl- channels and hyperpolarizes membranes

—> mimic inhibitory affect of GABA making depolarization more difficult

50
Q

When is bromide used?

A

As refractory drug to phenobarbital

-can help control up to 70% of seizures that are not controlled by phenobarbital

51
Q

For patients on bromide therapy, how should diet be changed?

A

Low salt / consistent salt intake diet
—> chloride competes with bromide for reabsorption, with high levels of chloride, bromide excretion increases and concentration falls

—> low salt intake —> decreased excretion and a rise in bromide concentration

52
Q

Can bromide be given to dogs with renal insufficiency?

A

Yes but should only receive 50% of the recommended dose and be monitored very closely

53
Q

How can you treat dogs with bromism toxicity?

A

Given high chloride diet/furosemide to hasten excretion

54
Q

What are adverse effects of bromide?

A

PP/PU/PD

Personality change- Irritability, attention seeking, and aimless pacing
Sedation for first few weeks of therapy is common

55
Q

T/F: unlike phenobarbital, bromide does not cause changes in ALP, ALT, or thyroid levels and is not hepatotoxic

A

True

56
Q

When is bromide contraindicated?

A

Renal insufficiency

Cats —> feline asthma or renal insufficiency

57
Q

Refractory epilepsy occurs in 10-20% of dogs despite appropriate treatment with phenobarbital and bromide. What treatment methods can you use in these patients?

A

Phenytoin - short half life
Primidone - only about as useful of phenobarbital and expensive
Benzodiazepines - short halflife and rapid tolerance (5-7days)
Imepitoin - partial benzodiazepines agonsit (GABA) about as effective as PB

58
Q

What are side effects of imepitoin?

A 
PP/PU/PD 
Hyperactivity 
Apathy/Somnolence 
Hypersalivation 
Emesis /diarrhea
Ataxia
Decreased sight and sensitivity to sound

—> usually not severe and only temporary

59
Q

T/F: blood monitoring of imepitoin is not required

A

True

There is no correlation between dose and reduction in seizure frequency

60
Q

What drug has been shown to reduce seizures when given as a “pulse treatment” when pre-ictal signs occurred?

A

Levetricetam (Keppra)

61
Q

What are common reasons for inadequate decrease in seizure frequency and or seizure severity ??

A 
Owner non-compliance
Incorrect dosage of anti epileptic drug 
Failure to monitor drug levels 
Generic factors 
Incorrect diagnosis 
Wrong drug 
Concurrent disease (liver/kidney) 
Tolerance to drug 
Monotherapy is insufficient 
Hepatic enzyme induction
62
Q

What are non-drug therapies for seizures?

A 
Surgery (resect focus or separate corpus callosum) 
Vagus nerve stimulation 
Acupuncture  
Ketogenic diets 
Hypoallergenic diets
63
Q

What is juvenile epilepsy??

A

Generalized tonic-clonic seizures that begin in clinically normal puppies up to 4 months of age, often littermates

Phenobarbital is often effective and prognosis is good once seizures are under control and puppies develop into normal dogs, not requiring treatment

64
Q

About ___% of cats have non-convulsive seizures that are mild, generalized seizures/ partial seizures/ complex focal seizures

A

50

65
Q

T/F: symptomatic epilepsy is more common in cats than it is in dogs

A

True

About 50% of epilepsy cases in cats is symptomatic, only about 20% in dogs

66
Q

What are common diagnostics run in cats with seizures?

A 
CBC
Chem profile 
Bile acids 
Serum T4
FeLV/FIV testing
67
Q

What is a feline audio genie reflex seizures??

A

Focal or generalized seizures in response to high-pitched sounds, like crinkling tin foil, or metal spoon, tapping glass

68
Q

How are Feline audiogenic reflex seizures controlled?

A

Levetricetam (70%) better than with phenobarbital (25%)

69
Q

When should anticonvulsant therapy be started in cats?

A

Seizures becoming more frequent
Status epilepticus / clusters
Seizures more often than every 12weeks

70
Q

What is the drug of choice for treatment of seizures in cats?

A

Phenobarbital

-contraindicated in liver disease

71
Q

T/F: diazepam can be used to treat seizures in cats

A

True

However contraindicated in.. liver disease, oral can cause hepatotoxicity

72
Q

T/F: imepitoin is well tolerated by cats and can prevent seizures

A

True

73
Q

What can cause status epilepticus ??

A 
Cerebral trauma 
Intracranial space occupying lesions 
CNS infections 
Acute metabolic disturbances 
Idiopathic epilepsy
74
Q

What changes occur in the body during the early stages of status epilepticus ?

A

Autoregulatory mechanisms in the brain increase blood flow to meet metabolic demand for oxygen or glucose

Vasodilation and increased blood flow to muscles to correct hypoglycemia, hyperkalemia, and lactacidosis.

Increased cardiac output by SNS

75
Q

What occurs in the body if status epilepticus is maintain longer than 30mins?

A

Cardiac output is no longer sufficient to provide for metabolic demands of tissue
—> metabolic acidosis, hypoxia, hypercapnia, hypoglycemia, hyperpyrexia, electrolyte disturbances, myoglobinuria, renal failure, respiratory failure, and arrhythmias
—> ischemia and neuronal cell death

76
Q

What is the treatment of status epilepticus?

A

First, stop seizures.. then maintain..

Airway, oxygen 
IV line 
Temperature 
Glucose 
ECG 
Blood gases and pH
77
Q

How can you stop a status epilepticus seizure when the animal is convulsing?

A

Diazepam- IV bolus/rectally/intranasally
Lorazepam -IV(longer acting)/IM/ intranasally
Midazolam -IM/ intranasally

When seizing has decreased, place IV line and administer another bolus of diazepam if seizure has not completely stopped
Being maintenance phenobarbital

78
Q

If the animal is not longer seizing on presentation from a status epilepticus seizure, how would you treat?

A

Sample for lab analysis

Administer phenobarbital loading dose

79
Q

What do you do if seizures cannot be controlled with diazepam or phenobarbital ?

A

Induce general anesthesia with IV pentobarbital

Propofol can be used to induce anesthesia and maintained CRI

80
Q

What supportive therapy should accompany treatment of status epilepticus once seizures are under control?

A

Brain edema —> mannitol/ dexamethasone/methylprednisone succinate
Treat any lab abnormalities —> glucose/calcium
Body temp—> cooling
Turn stuporous animals to avoid lung congestion and clean to avoid dermatitis, eye lubricaiton, express bladder, fluid therapy

RUSVM SAM 1 (26 decks)

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