Seizures, HA, Sleep Flashcards
List 2 Focal onset seizures (involves a single cerebral hemisphere at onset)
Aware
Impaired awareness
List 4 drugs used for focal onset seizures
Carbamazepine
Levetiracetam
Lamotrigine
Phenytoin
(CLLaP)
List 3 General onset seizures (involves both cerebral hemisphere at onset)
Tonic-Clonic (grand mal)
Myoclonic
Absence (petite mal)
How are
Tonic-Clonic & Myoclonic
seizures treated?
Valproic Acid
Levetiracetam
How is an Absence seizure treated?
Ethosuxamide (1st line)
Valproic Acid
Seizure is characterized by: No loss of consciousness No postictal state \+/– automatisms – motor symptoms Autonomic, Sensory or Cognitive symptoms
Aware (Focal)
Seizure is characterized by:
looks Awake, but consciousness is altered (blank stare).
Has a postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)
Impaired awareness (Focal)
Seizure is characterized by: Loss of consciousness Has a postictal state Diffuse muscle contractions of limbs (Tonic) followed by Rhythmic jerking (clonic)
Tonic-clonic
Generalized
Seizure is characterized by:
No loss of consciousness
No postictal state
Brief jerking movements
Myoclonic (Generalized)
Seizure is characterized by:
Brief episodes of altered consciousness (blank stare)
Usually no postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)
Absence (Generalized)
Sudden impaired consciousness (staring spells)
Preserved muscle tone
Unresponsive to tactile/verbal stimuli
Short < 20 sec
+/- Automatism
Easily provoked by hyperventilation
Absence (Generalized)
EEG: 3Hz spike waves during seizure
*Electroencephalogram
Absence (Generalized)
Patients are awake and interactive, but have symptoms corresponding to the involved area of the brain
Face & limb Twitching/ jerking = Frontal lobe motor cortex
Auditory/ Olfactory hallucinations = Temporal lobe
Visual phenomena = Occipital lobe
Focal Aware seizures
simple partial
Patients are awake, but not interactive and engage in frequent repetitive automatisms (lip smacking, hand wringing, repeating words)
Focal impaired awareness
complex partial
The most common
recurrent seizure disorder is
Focal impaired awareness
Focal seizures with impaired awareness are the typical manifestation of ____ epilepsy
temporal lobe
Seizures are often preceded by a distinctive aura (uneasy epigastric sensation, unpleasant olfactory hallucinations) that localizes the origin of the epileptiform discharges to the
mesial temporal lobe (eg, hippocampus, amygdala, parahippocampal gyrus).
Focal seizures with impaired awareness is usually due to underlying _____ which is associated with childhood febrile seizures.
hippocampal sclerosis
(mesial temporal sclerosis)
most common etiology
Focal seizures with impaired awareness is usually due to underlying hippocampal sclerosis which is associated with childhood ____.
febrile seizures
The ____ lobe plays a role in nonverbal spatial mapping and orientation.
A seizure affecting this part of the brain can cause:
distortions in a patient’s sense of position (a feeling of floating, changes in posture) or
visual interpretation (the size of objects).
nondominant parietal
Seizures that originate in the ____ lobe characteristically have visual auras
(flashing lights, visual distortions, complex hallucinations).
occipital
High fevers due to viral infection in infants can precipitate
febrile seizures
febrile seizures are caused by _____ induced neuronal dysfunction.
hypethermia
Temporal lobe epilepsy can also be caused by
congenital malformations, Strokes, Tumors (structural abnormalities)
EEG: epileptiform waves
Temporal lobe epilepsy (Impaired aware focal)
Temporal lobe seizures can evolve into secondary
generalized seizures
a neuropathic disorder that typically presents with episodic, severe, unilateral, electric shock-like or stabbing-like pain in the distribution of CN V of the face.
trigeminal neuralgia (tic douloureux)
carbamazepine, a neuroleptic medication that inhibits neuronal high-frequency firing by reducing the ability of ____ channels to recover from inactivation.
sodium
Carbamazepine can cause _____ suppression; therefore, complete ____ should be monitored periodically
bone marrow
CBC (complete blood cell counts)
*may lead to anemia, agranulocytosis, thrombocytopenia
The first-line treatment for trigeminal neuralgia is
carbamazepine
Ethosuximide blocks T-type Ca2+ channels and decreases calcium current in thalamic neurons.
Major side effects include (2)
gastrointestinal symptoms
drowsiness
Carbamazepine can cause
SIADH
Gingival hyperplasia is a common side effect of
phenytoin
an anticonvulsant effective in the treatment of grand mal (tonic-clonic) seizures, partial seizures, and status epilepticus.
Phenytoin
Treatment for narcolepsy includes ____ for daytime sleepiness.
psychostimulants (Modafinil)
Narcolepsy is characterized by episodes of irresistible sleep during the day and usually one or more REM sleep–related phenomena such as
cataplexy (sudden weakness/sleep triggered by strong emotions)
hypnagogic/hypnopompic hallucinations (hallucinations while falling asleep or awakening, respectively)
& _____
sleep paralysis
(physiologic sleep paralysis that persists on awakening/falling asleep).
Carbamazepine is used to treat (3)
seizures
bipolar disorder
trigeminal neuralgia
This young man with throbbing, UNILATERAL l periorbital headache associated with conjunctival injection, lacrimation and miosis has
cluster headaches
Can present with Ipsilateral autonomic symptoms (lacrimation, rhinorrhea, flushing, diaphoresis) due to
parasympathetic hyperactivity and include nasal congestion, ptosis, miosis, and conjuntival injection.
The headaches typically last 15-180 minutes and tend to occur in clusters over a period of several weeks.
cluster headaches
- most prevalent in MEN
Typically presents with severe, pulsatile, unilateral headache often associated with photophobia, phonophobia, nausea, and vomiting.
Migraine
with/without aura
Typically occurs in patients with thrombophilia (malignancy, antithrombin deficiency) or as a septic thrombosis related to a sinus infection or facial cellulitis.
Periorbital swelling, fever, and proptosis. Orbital pain is worsened with eye movement.
Cavernous sinus thrombosis
Headache lasts 4 to 72 hours and is most prevalent in women
Migraine
Dull, tight & persistent pain
Band-like distribution around the head (bilateral)
Muscle tenderness in the head, neck, or shoulders
Precipitated possibly by stress
Can last 30 minutes to months
Affects women slightly more
Tension headache
Patients typically develop fever, generalized lymphadenopathy, facial swelling/edema, diffuse/confluent skin rash, EOSINOPHILIA, and internal organ dysfunction after starting a new medication
DRESS
drug reaction with eosinophilia and systemic symptoms
*can have liver (ALTs), Kidney (creatine), and lung (dyspnea) failure
DRESS syndrome typically occurs 2-8 weeks after exposure to high-risk drugs such as:
Sulfonamides (sulfasalazine)
Anticonvulsants (phenytoin, carbamazepine)
Antibiotics (minocycline, vancomycin)
Allopurinol
DRESS SAAA
Act as antiemetics and pain relievers for severe migraine headache associated with nausea and vomiting.
Dopamine (D2) receptor blockers
metoclopramide, prochlorperazine
Dopamine blockade treatment for migraines can result in excess cholinergic activity.
____ can be co-administered to prevent these reactions due to its anticholinergic activity.
diphenhydramine
patient with a normal neurologic examination has unilateral headache associated with nausea and vomiting, and photophobia features that are consistent with
migraine headache
Severe migraine headache with nausea and vomiting is typically treated with ___ & ___ to abort the migraine and treat associated n/v.
serotonin 1B/1D AGONIST
(– triptans)
Dopamine (D2) receptor blocker
(metoclopramide, prochlorperazine)
List 4 medications for ABORTIVE migraine treatment
Serotonin 1B/1D AGONIST (– triptans)
(D2) receptor blocker (antiemetics)
NSAIDs/ Acetaminophen
Ergotamine (vasoconstrictor)
List 4 medications for Preventative migraine treatment
Anticonvulsants (Topiramate, Valproate)
Beta Blockers
Antidepressants (–TCAs, venlafaxine)
Characteristic histopathologic findings of atrophy of the hippocampal neurons with marked reactive gliosis (astrocyte proliferation in response to injury).
Temporal lobe epilepsy
Hemosiderin-laden microglial cells are associated with prior
intracerebral hemorrhage
Form when cells of microglia surround a neuron and phagocytize it.
Are most commonly seen in viral CNS infection (particularly HIV).
Microglial nodules
Electroencephalography reveals periodic sharp-wave complexes
Spongiform changes in the brain
Cruetzfeldt-Jacob
Kuru
The pathogenesis of migraines involves a GENETIC predisposition to increased cerebral EXCITABILITY (cortical spreading depression), which leads to release of Trigeminal nerve afferent ______, a neuropeptide involved in pain transmission.
calcitonin gene-related peptide (CGRP)
- CGRP also causes local vasodilation and increased neurogenic inflammation
causes headache and decreased vision associated with elevated intraocular pressures. Patients are typically older (age >60), and have severe eye pain and conjunctival erythema are common.
Acute angle-closure glaucoma
a demyelinating disorder that causes unilateral vision loss, that progresses over a period of weeks.
Eye pain (worse with movement) color vision is often affected afferent pupillary defect is present.
Optic neuritis
Orexin receptor antagonism is the mechanism of action for this insomnia medication
suvorexant
Serotonin receptor agonism is the mechanism of action of ____ used to treat migraine headaches and of psychedelics (LSD)
–Triptans
Are GABAa receptor agonist used for insomnia
They are primarily hypnotics and do not produce the anxiolytic, muscle relaxant, or anticonvulsant effects associated with benzodiazepines.
Nonbenzodiazepine medications (zolpidem, zaleplon, eszopiclone)
Older children with absence seizures may also develop generalized _____ seizures.
Although Ethosuximide is effective against ISOLATED absence seizures,
_______ is a broad-spectrum antiepileptic that treats both types of seizures.
tonic-clonic OR myoclonic
Valproic acid
Patient develops involuntary, rhythmic jerking of her right upper extremity that lasts for about a minute. She remains fully alert during and after the event.
Diagnosis?
Focal seizure with retained awareness
*originating in the contralateral motor cortex one hemisphere
β-hydroxybutyrate is a
ketone
made from/ can make Acetoacetate
patient with abdominal pain, vomiting, HYPERGLYCEMIA, anion gap metabolic acidosis, and
elevated beta-hydroxybutyrate (KETONE) has
diabetic ketoacidosis
Metabolic derangements (hyperglycemia, acidosis) in patients may cause neurologic dysfunction manifesting as:
altered mental status,
FOCAL neurologic deficits,
and/or
seizures
This patient’s initial right arm numbness and paresthesia was likely caused by a focal onset seizure originating in the left
primary somatosensory cortex
postcentral gyrus
The frontal eye field is the region of the cerebral cortex that controls _____ eye movement.
horizontal
*It is located superiorly to Broca motor speech
Activation of the LEFT _____ during a seizure would cause the eyes to deviate horizontally to the RIGHT
frontal eye field
*After the seizure, eyes may temporarily deviate to the LEFT due to postictal neuroinhibition (aka TOWARDS the “lesion”)
A seizure originating from the LEFT primary visual cortex would likely result in visual hallucinations affecting the RIGHT _____ visual fields.
homonymous
Normal changes in Elderly sleep patterns include decreased total sleep time, increased \_\_\_\_\_\_, sleepiness earlier in the evening earlier morning awakening, Decreased \_\_\_\_\_ sleep increased daytime napping. Increased sleep \_\_\_\_\_\_
nighttime awakenings
REM
Latency
Nightmares occur during ____ sleep and are more frequent in the final third of the night when their periods become longer
rapid eye movement (REM)
REM sleep is characterized by the defining feature of rapid eye movements, vivid dreaming, and ____ due to inhibition of motor neurons.
voluntary muscle atonia
a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content.
sleep terrors
Intravenous ______ are the initial drug of choice for status epilepticus.
benzodiazepines (eg, lorazepam)
a GABA-B agonist that can treat chronic muscle spasticity (ex: cerebral palsy).
Baclofen
a dopamine depletion agent that can treat Tourette syndrome, a disorder characterized by motor and phonic tics that persist for >1 year.
Tetrabenazine
chlorpheniramine is a
1st generation antihistamine
The clinical diagnosis of narcolepsy can be confirmed by low cerebrospinal fluid levels of ____ or shortened REM sleep latency on polysomnography.
hypocretin-1 (orexin A)
made in Lateral Thalamus
Abortive Migraine therapy can be induced via stimulation of trigeminovascular seretonin receptors using which drug?
–Triptans
Sleepwalking and Sleep Terrors occur during _____ which is more prominent during the first half of the night
Deep, slow-wave sleep
NR Stage 3
Delta waves
EEG pattern during
Non-REM stage 1 (N1)
Theta waves (4-7.9 Hz)
Wakefulness-sleep transition
Easy to wake
EEG pattern during
Non-REM stage 2 (N2)
Theta waves (4-7.9 Hz)
Sleep spindles
K-complexes
*Largest percentage of sleep
EEG pattern during
Non-REM stage 3 (N3)
Delta waves (<4 Hz)
Prominent 1st half of night
Difficult to wake
Sleep walking & night terrors
EEG pattern during
REM sleep
EEG resembles wakefulness
Occasional sawtooth waves
Prominent 2nd half of night
DREAMS, REMs, muscle atonia
REM sleep behavior disorder & NIGHTMARES
Lamotrigine, used to treat Focal seizures, has what concerning adverse reaction
Stevens-Johnson syndrome (Toxic epidermal necrolysis)
Flu-like symptoms
Rash
Widespread mucocutaneous epidermal necrosis.
a single seizure lasting >5 minutes or the occurrence of multiple discrete seizures with incomplete recovery of consciousness between episodes.
Status epilepticus
To treat status epilepticus administer IV Lorazapam (Benzodiazepine) & IV _____ to prevent the recurrence of seizure activity, regardless of patient responsiveness to lorazepam
Phenytoin (or fosphenytoin)
