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Clin Med III - Neuro > Seizures and Epilepsy > Flashcards

Seizures and Epilepsy Flashcards

1
Q

Define generalized seizure

A

Distributes bilaterally from basal ganglia

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2
Q

Define focal seizure

A

Occurs in 1 hemisphere

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3
Q

Define tonic seizure

A

Muscle stiffening frequently in a decerebrate posture

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4
Q

Define clonic seizure

A

Rhythmic synchronous limb movements

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5
Q

Define status epilepticus

A
  • 5 or more mins of seizures OR

- Multiple seizures over 5 mins without return to awareness (baseline)

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6
Q

How many patients with seizures achieve control with meds?

A

About 2/3

1/3 of pts have drug resistant seizures

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7
Q

What is neurostimulation and what is it FDA approved for?

A
  • Vagal nerve stimulator

- Refractory epilepsy

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8
Q

What is FDA approved for refractory epilepsy?

A

Neurostimulation

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9
Q

Define SUDEP

A
  • Sudden unexpected death in epilepsy
  • No identifiable cause of death in an epileptic pt
  • Higher risk in refractory epileptics
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10
Q

Who is at higher risk for SUDEP?

A

Refractory epileptics

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11
Q

Etiology of epilepsy

A
  • 70% idiopathic

- 30% have secondary causes (meds, alcohol, trauma, stroke, cancer)

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12
Q

How are seizures classified with regards to mode of onset?

A
  • Focal onset

- Generalized onset

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13
Q

Types of focal onset seizures

A
  1. Simple (w/o impaired consciousness)
  2. Complex (w/impaired consciousness)
  3. Secondarily generalized
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14
Q

Types of generalized onset seizures

A
  1. Absence
  2. Tonic
  3. Clonic
  4. Tonic Clonic
  5. Atonic
  6. Myoclonic
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15
Q

Which types of seizures do NOT have a warning?

A

Generalized onset

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16
Q

Describe absence seizures

A
  • Brief episodes (seconds) of impaired consciousness
  • NO aura or postictal confusion
  • Can happen many times per day
  • May or may not have repetitive blinking
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17
Q

EEG hallmark of absence seizures

A

3 Hz generalized spike and slow wave complexes

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18
Q

What type of seizures are MC secondary to metabolic issues (electrolytes, renal, glucose)?

A

Tonic-Clonic (grand mal)

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19
Q

Describe tonic-clonic seizures

A
  • Begins abruptly
  • Usually secondary to metabolic issues
  • Periods of muscle relaxation on muscle contractions
20
Q

What type of seizures are brief and arrhythmic?

A

Myoclonic

21
Q

Describe myoclonic seizures

A
  • Brief (less than 1 sec), arrhythmic jerking motor movements
  • May progress to tonic-clonic
  • Myoclonus may occur normally when falling asleep
22
Q

Which seizures cause rhythmic motor jerking?

A

Clonic (rhythmic)

arrhythmic = myoclonic

23
Q

Describe tonic seizures

A
  • Sudden flexion or extension of head, trunk, extremities
  • Usually occur w/drowsiness
  • “Beta buzz” on EEG
24
Q

Describe atonic seizures

A
  • Loss of postural tone for 1-2 secs

- Consciousness briefly impaired

25
Q

Describe juvenile myoclonic epilepsy

A
  • Bilat myoclonus jerks
  • Provoked by sleep deprivation
  • Fam hx
  • Responds well to meds
26
Q

Describe Lennox-Gastaut Syndrome

A
  • Severe form of epilepsy in children
  • Triad of: multiple seizure types, 3 Hz spike and wave on EEG, impaired cognitive function
  • Does NOT respond well to meds
27
Q

What is the MC epileptic syndrome?

A

Mesial Temporal Lobe Epilepsy Syndrome

28
Q

Describe Mesial Temporal Lobe Epilepsy Syndrome

A
  • Focal seizures
  • EEG and MRI specific changes
  • If does not respond to meds, surgery
29
Q

What are seizures caused by?

A

Abnormal electrical currents in neurons (gray matter)

30
Q

Define epileptogenesis

A

CNS becomes chronically hyperexcitable from an insult or injury

31
Q

What is tuberous sclerosis?

A
  • Genetic disorder which has harmartoma lesions in any organ system
  • 60% pts have refractory epilepsy
32
Q

What are adenoma sebaceum and what are they associated with?

A

Small raised tumors on face - a/w Tuberous Sclerosis

33
Q

Describe Sturge-Weber

A
  • Genetic syndrome

- Port Wine stain on face

34
Q

Fragile X affects who MC?

A

Males more than females

35
Q

Who does Retts Syndrome affect?

A

Females

36
Q

Hallmark of seizure activity on EEG?

A

Spike and wave discharge which is paroxysmal

37
Q

Where in the brain do lesions cause higher incidence of epilepsy?

A

Frontal and temporal lobes

38
Q

Examples of enzyme altering drugs to treat seizures

A
  • Phenytoin (Dilantin)

- Carbamazepine

39
Q

Describe enzyme altering drugs

A
  • Seizure control

- Increase their own metabolism

40
Q

Describe non-enzyme altering meds

A
  • Seizure control

- No metabolism issues

41
Q

Examples of non-enzyme altering meds

A
  • Levatriacetam (Keppra)

- Gabapentin (Neurontin)

42
Q

MC treatment of focal seizures

A

Carbamazepine

43
Q

MC treatment of generalized epilepsy

A

Valproic acid (Depakote)

44
Q

Treatment of status epilepticus

A
  • ABCs
  • IV access
  • Labs (CMP, gluc, lytes, CBC, etc)
  • EKG
  • CT brain (w/and w/o dye)
  • Give THIAMINE before glucose
  • Lorazepam
45
Q

In status epilepticus, what should be given prior to administering glucose?

A

THIAMINE (to avoid Wernicke’s)

46
Q

MC causes of status epilepticus

A
  • Antiepileptic drug withdrawal/noncompliance
  • Drug toxicity
  • CNS infection, tumors
  • Head trauma

Clin Med III - Neuro (11 decks)

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