Seizures, Epilepsy and Sleep disorders Flashcards
What is a seizure?
TEMPORARY alteration in
BRAIN FUNCTION due to
EXCESSIVE AND SYNCHRONIZED
neuronal activity
What is epilepsy?
GROUP of d/o with a TENDENCY TOWARDS RECURRENT AND UNPROVOKED SEIZURES typically dx after TWO UNPROVOKED sz
What idiopathic/genetic epilepsy is characterzied by centrotemporal spikes on EEG and nocturnal sz with salivation? Patients usually outgrow this.
Rolandic epilepsy. Peak at age 5-8
What is the treatment for Rasmussen’s encephalitis?
Hemispherectomy
IVIG
When is corpus callotomy indicated? How about Vagus nerve stimulator?
Drop attacks
Medically intractable epilepsy
What NSS intervention may be done for mesial temporal seizures?
Focal resection
What is the treatment for fifth day fits or benign neonatal convulsions?
Treat with phenobarbital
What is the treatment of choice for childhood absence epilepsy?
Ethosuximide
What is the treatment of choice for Juvenile myoclonic epilepsy?
Valproic acid in boys
Lamotrigine in girls (LG ref brand)
What do you call infantile spasms with mental retardation?
West syndrome
What is the treatment for infantile spasms?
ACTH
What is the EEG finding for infantile spasms VS Lennox gestaut?
IS: Hypsarrhythmia, high amplitude sharpa and slow waves
LG: Spike and wave discharge of 1.5-2 Hz MORE ABNORMAL IN SLEEP
Compare the prognosis of lafora dz and baltic myoclonus
LD: Chromosome 6 RAPID progression quadriparesis, dementia and death
BM: Chromosome 21 Ataxia and dementia occur late and usually are mild
What is the epilepsy syndrome that involves the progressive aphasia in healthy children with the appearance of paroxysmal EEG changes usually in sleep?
Landau-Kleffner syndrome
What common electrolyte abnormality DOES NOT CAUSE sz?
Potassium
When is a febrile seizure considered complex?
More than 15 minutes
What is the management for alcohol withdrawal?
In order: 1. Thiamine 2. Glucose 3. Correct fluid and electrolyte abnormalities 4. Magnesium 5. Lorazepam NO ROLE FOR PHENYTOIN
What should metabolic panel workup target in patients with seizures?
Sodium Glucose Thyroid function tests Calcium Magnesium Renal failure
What can be done to increase yield of EEG findings?
Sleep deprivation
Photic stimulation
Hyperventilation
What is the most common PSYCHIATRIC diagnosis in patients with epilepsy?
Depression
Almost all anti-sz meds are hepatically metabolized EXCEPT FOR which 3?
Gabapentin
Lamotrigine
Vigabatrin
GABi Vanquished Liver
What AE drugs act on: 1 Sodium channel 2 GABA 3 Calcium channel 4. NMDA
Na: Carbamazepine, Lamotrigine, Phenytoin
GABA: Tiagabine, Vigabatrin, Barbiturates, Benzos
Ca: Gabapentin, Valproic acid, Ethosuximide
NMDA: Felbamate, Topiramate, Phenobarbital
What are the MOA of valproic acid?
Val wears CK and GABA NA
What are the MOA of phenobarbital and topiramate?
TOP BARBIE wears NMDA and GABANA
What is the DOC for myoclonic seizures?
Valproic acid
What are the AE of phenytoin?
Gingival hyperlasia
Hirsutism
Peripheral neuropathy
Osteoperosis
What AED has Adverse effects: Weight gain Hair loss Hepatotoxicity like HOMER SIMPSON!
Valproic acid
What AEDs cause weight loss?
Topiramate and Zonisamide
What causes life threatening hepatotoxicity?
Valproic acid
What are the teratogenic effects of
Valproic acid
Carbamazepine
Phenytoin
Valproic acid: Spina bifida
Carbamazepine: Spina bifida with craniofacial
Phenytoin: Hydantoin syndrome: IUGR, microcephaly, craniofacial, extermity defects
What is folate supplementation for epileptic women of childbearing age?
4mg/day
What happens to AED requirement during pregnancy?
Usually increases
What is the order of management of status epilepticus?
Airway Breathing Circulation Thiamine 100mg IV Glucose 50ml of 50% dextrose Lorazepam 2mg IV Repeat every minute up to 0.1mg/kg IF NO RESPONSE TRY THE FF: 1. Phenytoin 20mg/kg IV 2. Phenobarbital 15mg/kg IV 3. Valproate 20mg/kg IV IF NO RESPONSE TRY THE FF: 1. Propofol 2. Pentobarbital 3. Midazolam
What is normal EEG during:
- Sleep
- Drowsiness
- Awake
- Sleep: Delta <4
- Drowsy theta 4-7
- Alpha with eyes closed and beta with eyes open
What are the physical findings during REM sleep?
Rapid pulse/ Respiratory rate
Erection
Mental activity increased/ Muscle paralysis
REM!
Are wicket waves on EEG suggestive of epileptiform discharges?
NO! They are benign! In older adults during light sleep occurring in the temporal region.
What is EEG for hepatic encephalopathy?
Triphasic waves
What is EEG for epeleptiform discharge?
Spike <70msec
Sharp wave 70-200msec
What is EEG for brain lesion?
Focal slowing
What is EEG for Anoxia?
Burst suppression: sharp waves interrupted by delta wave or no activity
What is the minimum duration required for a respiratory event to be called obstructive apnea or hypopnea?
10 seconds
What triggers cataplexy in narcoleptics?
Strong emotion or exercise
How to differentiate nightmare from sleep terror?
N: Less intense vocalization, Second half of night, Less than 30 minutes, Recall present, REM on EEG
What is treatment for Sleepwalking?
Benzodiazepenes
What is significant in narcolepsy with cataplexy CSF patient?
Hypocretin level of less than 110
What is treatment for resless legs syndrome?
Dopamine agonists, levodopa, opiods, gabapentin, benzos
