seizures (and treatment) Flashcards
Seizures?
characterized by synchronized, high-frequency neuronal firing. Variety forms
Seizures - types
- partial (focal)
- generalized
- partial that secondary generalize
partial vs generalized seizures
partial: affect single area of the brain
generalized: diffuse
partial (focal) seizures - most commonly originate in
medial temporal lobe
partial (focal) seizures - often preceded by
seizure aura
partial (focal) seizures - types
- simple partial
2. complex partial
simple partial seizures - characteristics
CONSCIOUSNESS INTACT
motor, sensory, autonomic, psychic
complex partial seizure - characteristics
IMPAIRED CONSCIOUSNESS
simple vs partial seizure according consciousness
simple - intact
complex - impaired
generalized seizures - types
- absence
- myoclonic
- tonic clonic
- tonic
- atonic
absence seizure is also called
petit mal
absence (petit mal) seizure - characteristics
3 hz, no postictal confusion,
blank stare
myoclonic seizure - characteristics
quit, repetitive jerks
tonic-clonic seizure is also called
grand mal
tonic-clonic (grand mal) seizure - characteristics
alternating stiffening and movement
tonic seizure - characteristic
stiffening
atonic seizure - characteristics
drop seizures (falls to floor) commonly mistaken for fainting
epilepsy - definition
a disorder a recurrent seizures
epilepsy with fever?
FEBRILE SEIZURES ARE NOT EPILEPSY
status epilepticus?
continuous or recurring seizure(s) that may result in brain that variably defined as >10-30 min
status epilepticus - duration
> 10-30 min
causes of seizures in children
- genetic
- infection (febrile)
- trauma
- congenital
- metabolic
causes of seizures in adults
- tumor 2. trauma 3. stroke 4. infection
causes of seizures in elderly
- stroke 2. tumor 3. trauma 4. metabolic 5. infection
Generilized seizures - types and characteristics
- absence (petit mal) - 3 hz, no postictal confusion,
blank stare - myoclonic - quick, repetitive jerks
- tonic clonic (grand mal) - alternating stiffening and movement
- tonic - stiffening
- atonic - drop seizures (falls to floor), commonly mistaken for fainting
generalized epilepsy - mistaken for fainting
atonic
seizures - often preceded by aura
partial
epilepsy drugs?
- ethosuximide
- benzodiazepines
- phenyntoin
- carbamazepine
- valproic acid
- gabapentin
- phenobarbital
- topiramate
- lamotrigine
- levetiracetam
- tiagabine
- vigabatrin
ethosuximide - mechanism of action
blocks thalamic T-type Ca2+ channels
ethosuximide blocks ….. T-type Ca2+ channels (area)
thalamic
ethosuximide - clinical use
1st line for absence
ethosuximide - side effects
- GI 2. fatigue 3. headache 4. urticaria
5. Stevens-Johnson
epilepsy - benzodiazepines - drugs
- lorazepam
2. diazepam
epilepsy - benzodiazepines - clinical use
- 1st line for acute status epilepticus
2. also for eclampsia seizure
eclampsia seizure - 1st line
MgS04
epilepsy - benzodiazepines - side effects
- sedation
- respiratory depression
- tolerance
- dependence
phenytoin - mechanism
Na+ channel inactivation
ZERO kinetic order
Fosphenytoin?
phenytoin for parental use
phenytoin for parental use
Fosphenytoin
Phenytoin - side effects
A. Neurologic 1. nystagmus 2. diplopia 3. ataxia 4. sedation 5. peripheral neuropathy
B. Dermatologic 1. gingival hyperplasia 2. hirsutism
3. Stevens-Johnson syndrome 4. DRESS syndrome
C. Musculosceletal: 1. SLE like syndrome 2. osteopenia
D. Hematologic: Megalobl anemia
E. Reproductive: teratogenesis (fetal hydantoin syndrome)
F. Other: c P-450 induction
phenytoin - pharmatokinetic characteristic
zero order kinetics
phenytoin - clinical use
- simple seizure
- complex seizure
- tonic clonic seizure (1st line)
- status epilepticus (1st line for prophylaxis)
carbamazepine - mechanism
Na+ channel inactivation
carbamazepine - clinical use
- simple seizure (1st line)
- complex seizure (1st line)
- tonic clonic
- 1st line for trigeminal neuralgia
Carbamazepine - side effects
- diplopia 2. ataxia 3. blood dyscrasias (agranulocytosis, aplastic anemia) 4. liver toxicity
- teratogenesis 6. induction of P-450 7. SIADH
- Stevens-Johnson syndrome
Valproic acid - mechanism of action
- Na+ channel inactivation
2. increase GABA concentration by inhibiting GABA transaminase
Valproic acid - contraindicated in
pregnancy
Valproic acid - side effects
- GI 2. distress 3. rare but fatal hepatotoxicity (messure LFTs) 4. teratogenesis (neural tube defects) 5. tremor 6. weight gain 7. pancreatitis
Valproic acid - clinical use
- simple
- complex
- tonic-clonic (1st line)
- absence
- myoclonic
- bipolar disorder
- migraine prophylaxis
gabapentin - mechanism
- primarily inhibits high voltage activated Ca2+ channels
2. designed as GABA analogs
gabapentin - clinical use
- simple seizures
- complex
- peripheral neuropathy
- postherpetic neuralgia
Gabapentin - side effects
sedation
ataxia
phenobarbital - clinical use
- simple
- complex
- tonic clonic
- 1st line in neonates
phenobarbital - side effects
1, sedation 2. tolerance 3. dependence 4. induction of P-450 5. cardiorespiratory depression
topiramate - mechanism
- blocks Na+ channels
2. increase GABA action
topiramate - clinical use
- simple
- complex
- tonic - clonic
- migraine prevention
- idiopathic intracranial hypertension (pseudotumor cerebri)
topiramate - side effects
- sedation
- mental dulling
- kidney stones
- weight loss
lamotrigine - mechanism
blocks voltage gated Na+ channels
lamotrigine - side effects
Steven Johnson Syndrome
lamotigine - how to avoid Steven Johnson Syndrome
must be titrated slowly
lamotigine - clinical use
- simple seizure
- complex
- tonic-clonic
- absence
levetiracetam - mechanism of action
unknown. may modulate GABA and glutamine release
levetiracetam - clinical use
- simple seizure
- complex
- tonic-clonic
tiagabin - mechanism of action
increases GABA by inhibiting reuptake
tiagabin - clinical use
- simple seizure
2. complex
vigabatrin - mechanism of action
increase GABA by IRREVERSIBLY inhibiting GABA tranasmaminase
vigabatrin - clinical use
- simple seizure
2. complex
epilepsy drug that induce P-450
- phenytoin
- Carbamazepine
- phenobarbital
trigeminal neuralgia - 1st line treatment
carbamazepine
eplepsy drugs with nystagmus
phenytoin
eplepsy drugs with diplopia
phenytoin and carbamazepine
eplepsy drugs with sedation
- benzodiazepines
- phenytoin
- gabapentin
- topiramate
- phenobarbital
eplepsy drugs with ataxia
gabapentin, phenytoin and carbamazepine
eplepsy drugs that inhibit Na+ channels
- phenytoin
- carbamazepine
- valproic acid
- topiramate
- lamotrigine
eplepsy drugs with Steven Johnson syndrome
- phenytoin
- carbamazepine
- Lamotrigine
- ethosuximide
eplepsy drugs - 1st line for absence
ethosuximide
eplepsy drugs - status epilepticus 1st line
acute - benzodiazepines
prophylaxis - phenytoin
1st line treatment for tonoclonic seizures
- Phenytoin
2. Valproic acid