seizures Flashcards
Seizures - types
- partial: affect single area of the brain (and one part of the body)
- generalized: diffuse
- partial that secondary generalize
partial (focal) seizures - types and characteristics
- simple partial - intact consciousnesses
2. complex partial - unconscious
generalized seizures - types
- absence
- myoclonic
- tonic clonic
- tonic
- atonic
generalized tonic-clonic - causes related to electrolyic abnormalites
- hyponatremia
- hypernatremia
- hypocalcemia
- hypomagnesemia (rare)
seizures - when to do Electroencephalogram
not before CT or MRI and exclude metabolic, toxic or anatomic defects
epilepsy - definition
- a disorder a recurrent seizures
- unclear etiology (if there is a clear cause, it is not epilepsy)
status epilepticus?
continuous or recurring seizure(s) that may result in brain that variably defined as >10-30 min
treatment of status epilepticus
- best initial: benzodiazepine (lorazepam or diazepam IV)
- if persistsL phenytoin or fosphenytoin (same efficacy but fosphenytoin has fewer SE)
- if not stopped –> phenobarbital
- if not stopped –> Neuromuscular block to intubate and then general anesthesia (midazolam or propofol)
(the patient must be of ventilator before propofol –> stop breathing)
phytoin vs fosphenytoin
same efficacy but when IV, phenotoin has hypotension and AV block –> so fosphenytoin can be given more rapidly
generally the treatent of status epilepticus in order
- Benzodiazepine
- fosphenytoin
- phenobarbital
- general anesthesia
treatment of seizures for a single seizure?
NO: exceptions
- presentation in status epilepticus or with focal neurological signs
- abnormal EEG or lesions on CT
- family history of seizure
best treatment for epilepsy, most common medications and explain
not clear
levetiracetam, phenytoin, valproicand carbamazepine all have equal efficacy, but lavetiracetam has the fewest SE
alternate treatment is gabapentin, topiramate, lamotrigine, oxcarbazepinem
if seizures are not controlled with a single, try an alternative. if still not contrlled, add a 2nd –> if multiple do not control –> surgical correction of the focus
- 1st line for absence
- 1st line for tonic clonic seizure
- 1st line for status epilepticus prophylaxis
- 1st line for simple seizure
- 1st line for trigeminal neuralgia
- 1st line for complex seizres
- 1st line in neonates
- ethosuximide
- phenytoin or valproic
- phenytoin
- carbamazepine
- carbamazepine
- carbamazepine
- phenobarbital
when to stop medication for epilepsy
- standard of care wait until the patient has been seizure free for 2 years
- a sleep deprivation EEG is the best way to tell if there is the possibility of recurrence (it can elicit abnormal activity, but it lasts high sensitivity)
best initial test for Myasthenia gravis
- acetylcholine recetor antibodies (80-90% sensitivity)
- for patients without those antibodies, get anti-MUSK antibodies (muscle specific antibodies)
Myasthenia gravis - other test for diagnosis
edrophonium: short acting inhbitor of acetylcholinesterase –> improvement lasts for few minutes
Myasthenia gravis - most accurate test
Selectromyography shows decreased strength with repetitive stimulation
Myasthenia gravis - image?
yes –> chest something (chest x-ray, MRI, CT) to look for thymoma or thymuc hyperplasia
CT with contrast is the best
Myasthenia gravis - best initial treatment
Neostigmine or pyridostigmine
Myasthenia gravis - treatment if resistant to best initial
if under 60: thymectomy
if over 60: prednisone (azthioprine, tacrolimus, cyclophosphamide, mucophenolate to get the paitent off of steroids
Myasthenia gravis - management of acute crisis
- severe overwhelming disease with profound weakness or respiratory involvement
- IVIG or plasmapheresis
causes of dementia
- Alzheimer 2. Frontotemporal dementia (Pick disease) 3. Lewy body dementia 4. Creutzfeldt-Jakob disease 5. other causes
other causes of dementia
- Multi-infarct (vascular) 2. Syphilis 3. HIV 4. Wilson disease 5. Normal pressure hydrocephalus
- Vitamins B1, B3 or B12 deficiency
- Chronic substance abuse (neurotoxicity of drugs)
- Huntington
causes of diffuse symmetrical atrophy of the brain on mri
- alzheimer 2. chronic alcoholism 3. untreated HIV
diagnostic tests for dementia
- MRI of the brain
- thyroid function test
- B12 with possible methylmalonuc acid level
- VDRL or RPR to exclude syphilis
Altered proteins - Alzheimer disease
ApoE2 (decreased risk of sporadic)
ApoE4 (increased risk of sporadic) ,
APP (increased risk for early onset (familiar))
presenilin-1 (increased risk for early onset (familiar))
presenilin-2 (increased risk for early onset (familiar))
Alzheimer disease - histology
- loss of ach neurons
- senile plaques in gray matter (extracellular β-amyloid (Aβ) core)
- Neurofibrillary tangles (intracellular, hyperphosphorylated tau protein)
Alzheimer disease - senile plaques CAN CAUSE (how)
amyloid angiopathy –> intracranial haemorrhage
deposition around vessels
Alzheimer drugs (and SE)
Ache inh: Dnepezil, rivastigmine, galantamine (insomnia)
2ND LINE) NMDA receptor antagonists (Hallucinations
Lewy body dementia - manifestation and histology and treatment
- initially dementia + visual distarbances followed by parkinonian features
- intracellular Lewy body: insoluble aggregates a-synuclein in cortex
- levodopa/carbidopa
Frontotemporal dementia - histology / treatment
- silver-staining spherical tau protein aggregates (Pick bodies)
- inclusions of ubiquitinated TDP-43
- no special treatment, ACEi
Frontotemporal dementia - manifestation
- Dementia (later)
- aphasia (early) (primary progressive aphasia)
- movement disorders (eg. parkinsonism, ALS-like UMN/LMN degeneration)
- early change in personality and behaviour
Creutzfeldt-Jakob disease - tests
- normal head MRI or CT
- CSF with 14-3-3 protein
- Biopsy is most accurate
