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Brain Power: First Aid Neurology > Seizures, Epilepsy and Sleep disorders > Flashcards

Seizures, Epilepsy and Sleep disorders Flashcards

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1
Q

What is a seizure?

A

TEMPORARY alteration in
BRAIN FUNCTION due to
EXCESSIVE AND SYNCHRONIZED
neuronal activity

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2
Q

What is epilepsy?

A 
GROUP of d/o
with a TENDENCY TOWARDS
RECURRENT AND UNPROVOKED SEIZURES
typically dx after TWO
UNPROVOKED sz
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3
Q

What idiopathic/genetic epilepsy is characterzied by centrotemporal spikes on EEG and nocturnal sz with salivation? Patients usually outgrow this.

A

Rolandic epilepsy. Peak at age 5-8

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4
Q

What is the treatment for Rasmussen’s encephalitis?

A

Hemispherectomy

IVIG

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5
Q

When is corpus callotomy indicated? How about Vagus nerve stimulator?

A

Drop attacks

Medically intractable epilepsy

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6
Q

What NSS intervention may be done for mesial temporal seizures?

A

Focal resection

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7
Q

What is the treatment for fifth day fits or benign neonatal convulsions?

A

Treat with phenobarbital

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8
Q

What is the treatment of choice for childhood absence epilepsy?

A

Ethosuximide

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9
Q

What is the treatment of choice for Juvenile myoclonic epilepsy?

A

Valproic acid in boys

Lamotrigine in girls (LG ref brand)

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10
Q

What do you call infantile spasms with mental retardation?

A

West syndrome

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11
Q

What is the treatment for infantile spasms?

A

ACTH

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12
Q

What is the EEG finding for infantile spasms VS Lennox gestaut?

A

IS: Hypsarrhythmia, high amplitude sharpa and slow waves
LG: Spike and wave discharge of 1.5-2 Hz MORE ABNORMAL IN SLEEP

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13
Q

Compare the prognosis of lafora dz and baltic myoclonus

A

LD: Chromosome 6 RAPID progression quadriparesis, dementia and death
BM: Chromosome 21 Ataxia and dementia occur late and usually are mild

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14
Q

What is the epilepsy syndrome that involves the progressive aphasia in healthy children with the appearance of paroxysmal EEG changes usually in sleep?

A

Landau-Kleffner syndrome

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15
Q

What common electrolyte abnormality DOES NOT CAUSE sz?

A

Potassium

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16
Q

When is a febrile seizure considered complex?

A

More than 15 minutes

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17
Q

What is the management for alcohol withdrawal?

A 
In order: 
1. Thiamine
2. Glucose
3. Correct fluid and electrolyte abnormalities
4. Magnesium
5. Lorazepam
NO ROLE FOR PHENYTOIN
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18
Q

What should metabolic panel workup target in patients with seizures?

A 
Sodium
Glucose
Thyroid function tests
Calcium
Magnesium
Renal failure
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19
Q

What can be done to increase yield of EEG findings?

A

Sleep deprivation
Photic stimulation
Hyperventilation

20
Q

What is the most common PSYCHIATRIC diagnosis in patients with epilepsy?

A

Depression

21
Q

Almost all anti-sz meds are hepatically metabolized EXCEPT FOR which 3?

A

Gabapentin
Lamotrigine
Vigabatrin
GABi Vanquished Liver

22
Q 
What AE drugs act on:
1 Sodium channel
2 GABA
3 Calcium channel
4. NMDA
A

Na: Carbamazepine, Lamotrigine, Phenytoin
GABA: Tiagabine, Vigabatrin, Barbiturates, Benzos
Ca: Gabapentin, Valproic acid, Ethosuximide
NMDA: Felbamate, Topiramate, Phenobarbital

23
Q

What are the MOA of valproic acid?

A

Val wears CK and GABA NA

24
Q

What are the MOA of phenobarbital and topiramate?

A

TOP BARBIE wears NMDA and GABANA

25
Q

What is the DOC for myoclonic seizures?

A

Valproic acid

26
Q

What are the AE of phenytoin?

A

Gingival hyperlasia
Hirsutism
Peripheral neuropathy
Osteoperosis

27
Q 
What AED has Adverse effects:
Weight gain
Hair loss
Hepatotoxicity
like HOMER SIMPSON!
A

Valproic acid

28
Q

What AEDs cause weight loss?

A

Topiramate and Zonisamide

29
Q

What causes life threatening hepatotoxicity?

A

Valproic acid

30
Q

What are the teratogenic effects of
Valproic acid
Carbamazepine
Phenytoin

A

Valproic acid: Spina bifida
Carbamazepine: Spina bifida with craniofacial
Phenytoin: Hydantoin syndrome: IUGR, microcephaly, craniofacial, extermity defects

31
Q

What is folate supplementation for epileptic women of childbearing age?

A

4mg/day

32
Q

What happens to AED requirement during pregnancy?

A

Usually increases

33
Q

What is the order of management of status epilepticus?

A 
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
34
Q

What is normal EEG during:

  1. Sleep
  2. Drowsiness
  3. Awake
A
  1. Sleep: Delta <4
  2. Drowsy theta 4-7
  3. Alpha with eyes closed and beta with eyes open
35
Q

What are the physical findings during REM sleep?

A

Rapid pulse/ Respiratory rate
Erection
Mental activity increased/ Muscle paralysis
REM!

36
Q

Are wicket waves on EEG suggestive of epileptiform discharges?

A

NO! They are benign! In older adults during light sleep occurring in the temporal region.

37
Q

What is EEG for hepatic encephalopathy?

A

Triphasic waves

38
Q

What is EEG for epeleptiform discharge?

A

Spike <70msec

Sharp wave 70-200msec

39
Q

What is EEG for brain lesion?

A

Focal slowing

40
Q

What is EEG for Anoxia?

A

Burst suppression: sharp waves interrupted by delta wave or no activity

41
Q

What is the minimum duration required for a respiratory event to be called obstructive apnea or hypopnea?

A

10 seconds

42
Q

What triggers cataplexy in narcoleptics?

A

Strong emotion or exercise

43
Q

How to differentiate nightmare from sleep terror?

A

N: Less intense vocalization, Second half of night, Less than 30 minutes, Recall present, REM on EEG

44
Q

What is treatment for Sleepwalking?

A

Benzodiazepenes

45
Q

What is significant in narcolepsy with cataplexy CSF patient?

A

Hypocretin level of less than 110

46
Q

What is treatment for resless legs syndrome?

A

Dopamine agonists, levodopa, opiods, gabapentin, benzos

Brain Power: First Aid Neurology (10 decks)

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