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3. Cat & Dog 3 > Seizures & Epilepsy > Flashcards

Seizures & Epilepsy Flashcards

1
Q

Terminology
Seizure:
epilepsy:
- neurolocalization?

A
  • Seizure: A transient occurrence of signs due to abnormal excessive or synchronous neuronal activity in the thalamocortex
  • Epilepsy: A condition of recurrent seizures due to a chronic brain disorder
    <><><><>
    Neurolocalization: Thalamocortex
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2
Q

Seizure Stages

A

Prodrome: Period prior to seizure, with change in sensorium exhibited in behaviour; ~ hrs – days
<><>
Aura: Initial motor / sensory signs (early ictus); ~ seconds
<><>
Ictus: Seizure itself
<><>
Post-ictus: Recovery period with transient abnormalities, e.g. mentation, menace, gait; ~ minutes – days

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3
Q

what is a cluster of seizures, vs status epilepticus?

A
  • cluster >= 2 in 24h
  • Status epilepticus: Continuous
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4
Q

Generalized Seizure
- origin
- localization?
- signs?

A
  • Originates at some point within & rapidly engaging bilateral networks
  • Location & lateralization not necessarily consistent
  • Usually symmetric (may be asymmetric)
  • Impaired consciousness
    > Impaired awareness
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5
Q

Focal Seizure
- origin, localization

A
  • Originate w/in networks limited to 1 hemisphere (unilateral)
  • Ictal onset consistent between seizures
  • Preferential propagation patterns may include other hemisphere
    > focal to bilateral (“secondarily generalized”)
    ± impaired awareness
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6
Q

Generalized Seizures - descriptors

A
  • Tonic-clonic
  • Absence
  • Myoclonic
  • Clonic
  • Tonic
  • Atonic
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7
Q

Focal Seizures descriptors

A
  • Sensory
  • Altered consciousness
  • Motor / autonomic signs
  • Focal to bilateral tonic-clonic
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8
Q

Things Mistaken For Seizures

A
  • Syncope: Transitory loss of consciousness, short, no pre-/post- ictus; cardiac vs respiratory
  • Cataplexy/narcolepsy
  • Neck Pain
  • Vestibular dysfunction
  • Metabolic encephalopathy
  • Generalized tremor syndromes
  • Exercise-induced weakness
  • Compulsive disorders
  • Stereotypy
  • Feline estrus behaviours
  • Myoclonus
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9
Q

Epilepsy Etiologies

A
  • Idiopathic (Genetic)
  • Structural (Metabolic)
  • Unknown
    <><>
    Intracranial vs Extracranial
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10
Q

Idiopathic Genetic Epilepsy
- origin?
- signs?
- who gets it?
- timing?
- tests
- prognosis

A
  • Direct result of a known or presumed genetic defect
  • Intracranial cause
  • Generalized tonic-clonic seizures
  • Dogs > > cats / horses
    > australian and belgian shepherds
  • First seizure: 1-5 years of age
  • Normal interictal neurologic exam & diagnostic tests (normal between seizures)
  • Prognosis (efficacy of therapy) > breed related, Border Collies & Australian Shepherds worse
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11
Q

Progressive Myoclonic Epilepsy
- signs and progression?
- inheritance?

A
  • Progressive, abnormal interictal NE
  • Autosomal recessive genetic syndromes
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12
Q

Structural Epilepsy
- what is this?
- diagnostics?

A
  • Signalment does not fit genetic epilepsy
    > Breed, Age of seizure onset
  • Interictal abnormalities found on diagnostic tests, including NE
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13
Q

Structural Epilepsy
- extracranial toxic ddx

A

Lead
Organophosphates
Ethylene glycol
Chocolate
Xylitol

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14
Q

Structural Epilepsy Extracranial metabolic DDx

A

Hypoglycemia: iatrogenic, young/toy, insulinoma
Organ failure: hepatic/uremic encephalopathy Electrolyte abnormalities: Na+, H2O, K+, Ca2+ Hypoxemia
Hyperlipidemia
Hyperthermia

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15
Q

Structural Epilepsy Intracranial DDx
- vascular
- inflammatory/infectious
- truma
- anomaly

A
  • Vascular: hypertension, hyper/hypoT4
  • Inflammatory/Infectious: encephalitis: MUE, FIP, (bacterial, viral, fungal, protozoal, Rickettsial, larval migrans)
  • Trauma: brain injury (old or new)
  • Anomaly: hydrocephalus, cortical dysplasia (e.g., lissencephaly, porencephaly)
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16
Q

Structural Epilepsy Intracranial DDx
- neoplasia
- degenerative

A
  • Neoplasia: Primary: meningioma, Secondary: HSA, LSA
  • Degenerative: Mitochondrial encephalopathies / storage diseases / organic acidurias, thiamine deficiency (polioencephalomalacia)
17
Q

Unknown Epilepsy
- etiology
- what is it?

A
  • Truly idiopathic (but we all agree not to use this term… we already use the term ‘idiopathic’ for genetic…)
  • Signalment does not fit genetic epilepsy
  • No cause identified on diagnostic tests
    <><>
    How?
  • Lesion is beyond the level of detection by current technology
  • Genetic, just don’t know it yet
  • Old injury (Birth? Previous encephalitis? Previous stroke?)
18
Q

Cats - epilepsy etiology

A
  • Idiopathic (genetic?) epilepsy: ~40%
    <><><><>
    Not idiopathic if:
  • Status epilepticus
  • > 7 years of age
  • Abnormal interictal neurologic exam
    <><>
    Hippocampal necrosis: ~11%
  • dont know if necrosis is cause or effect of seizures
  • Orofacial signs & “absences”
  • Acute cluster
19
Q

epilepsy diagnostis - neuro exam: what does it tell us?

A

NAF:
- genetic (idiopathic) epilepsy
- (early neoplasia)
<><>
Deficits:
- postictal
- drugs (therpapy)
- structural/metabolic epilepsy
<><><><>
For thalamocortex:
- Mentation
- Menace response
- Nasal septum response
- Postural reactions

20
Q

age of seizre patient - what origins might we suspect based on age?

A

<1y
* Congenital anomaly
* Hypoglycemia, PSS
* Infectious (distemper, FIP)
<><><><>
1–5y
* Idiopathic (genetic) epilepsy
<><><><>
>5y
* Neoplasia (primary&raquo_space; secondary)

21
Q

epilepsy diagnostics - minimum database

A
  1. CBC
  2. Serum biochem (5 tests of liver function)
    - Glucose
    - Albumin
    - BUN
    - Bilirubin
    - Cholesterol
    <>
    - electrolytes
  3. UA
22
Q

Epilepsy diagnosis: Discretionary Database

A
  • Thyroid panel: TT4, TSH, fT4
  • Blood pressure (note machine, cuff, limb, recumbency, x3)
  • Ocular exam
  • Ammonia & pre/post-prandial BAs
  • Fructosamine & glucose curve
  • Glucose:insulin
  • Toxicology
  • Titres / PCR
  • Met check: Thoracic rads + Abd US
23
Q

Epilepsy Diagnosis: Advanced Database

A
  • Only if previous tests are normal
  • EEG: if not sure seizure
  • MRI vs CT
  • CSF analysis (“spinal tap”)
  • Biopsy?
24
Q

when to perform an MRI for seizure diagnostics

A
  • Epileptic seizure onset < 6 m or > 6 y
  • Abnormal interictal NE
  • status epilepticus or cluster seizures
  • presumptive IE but refractory to 1 ASD at highest tolerable dose
25
Q

when might we require high-field MRI for seizure diagnotics

A
  • Congenital/developmental: cortical dysplasia
  • Infectious: distemper, rabies
  • Metabolic: hepatic, thiamine
26
Q

Idiopathic epilepsy diagnostic confidence criteria: (tiers)

A
  • Tier I: normal minimum + discretionary database
  • Tier II: normal BAs + advanced database
  • Tier III: as above + ECG (ictal or interictal abnormalities)
27
Q

When to start ASDs? why is it important?

A
  1. structural epilepsy (treat cause), prior brain pathology
  2. status epilepticus (>5 min) or >=3 seizures / 24h
  3. > =2 seizures / 6m
  4. prolonged, severe, unusual post-ictal periods
    <><><><><>
    Seizures beget seizures!
    - seizures get entrenched in the brain by repetition > the more you control, the less they will seize in the future
28
Q

Treatment: Client Education
- what are our goals?
- what else they need to know
- commitment, cost, monitoring

A
  • Practical goals of therapy: not seizure eradication
    > decreased frequency & severity
  • Expected adverse effects
  • Commitment
    > Lifestyle: Dosing requirements
    > Cost: Drugs + routine monitoring bloodwork
    > Organization: Seizure diary to monitor efficacy
29
Q

seizure Treatment: Drug Choices

A

Phenobarbital
Potassium Bromide
Levetiracetam
Gabapentin/Pregabalin
Zonisamide

30
Q

why not use diazepam for long-term seizure control?

A

Diazepam: too short-acting, tolerance builds up, emergency only

31
Q

When to monitor [ASD]serum?

A
  1. @ steady-state after starting Tx or dose Δ
  2. Uncontrolled seizures despite apparently adequate dose
  3. @ signs of dose-related toxicity
  4. to check for pharmacokinetic change causing drift and compliance
32
Q

Risks of seizure Tx? by type

A
  • Type I: predictable, directly related to pharmacokinetics in dose-dependent fashion
  • Type II: Idiosyncratic, potentially life-threatening
  • Type III: Cumulative, potentially life-threatening
  • Type IV: Delayed (carcinogenic/teratogenic), life-threatening
    > these are not seen in any of our commonly used medications, but types 1-3 are

3. Cat & Dog 3 (26 decks)

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