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PAT401 > w4: Seizure Disorders & Epilepsy > Flashcards

w4: Seizure Disorders & Epilepsy Flashcards

1
Q

Definition of Seizure

A

sudden disruption in the electrical function of brain

D/T: abnormal excessive discharges of corticol neurons

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2
Q

Definition of Epilepsy

A

2+ unprovoked seizures more than 24+ hours apart

one unprovoked seizure w/ 60% chance of reoccurence after two unprovoked seizures, within 10 years

Dx of epilepsy syndrome

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3
Q

Epilepsy Syndrome Definition

A

sizure + abnormal ECG & MRI in a recognizible pattern

age, time of day, triggers, and type of seizure taken into account

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4
Q

Convulsions

A

involuntary violent spasms of large skeletal muscles of face, arms, neck, legs

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5
Q

Are all convulsions seizures?

A

Yes

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6
Q

Are all seizures convulsions?

A

No

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7
Q

Drugs used for seizures should be called ___ and not _____

A

antiseizure, anticonvulsants

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8
Q

Seizures are caused by the dysregulation of what neurotransmitter?

A

GABAA

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9
Q

Mechanisms that cause a seizure

A
  1. stimulation of CNS excitatory pathways
  2. inhabition of inhibatory pathways with the CNS
  3. withdrawal of LT CNS depressants
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10
Q

Which meds need to be tapered due to risk of seizures?

A

antidepressants

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11
Q

Which medications can cause seizures?

A

antipsychotic
chloropramzine
clozapine

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12
Q

Causes of Recurrent Seizures in YA

A

alcohol/drug w/d
brain tumor
idiopathic
illicit drug use
P-TBI
Perinatal insults

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13
Q

Causes of Recurrent Seizures in OA

A

alcohol/drug withdrawal
brain tumor
cerebrovascular disease (stroke, aneurysm)
CNS degenerative diseases (alzhimers, MS)
MDD
Idiopathic
metabolic d/o
P-TBI

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14
Q

3 Phases of Seizure

A

preictal
ictus
postictal

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15
Q

Preictal Phase of Seizure

A

Prodoma

Aura

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16
Q

Prodoma

A

early clinical manifestations

hours to days before

insomnia, headache, irritability, ill-temper, increased agitation and depression

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17
Q

Aura

A

focal sizure than generalized tonic-clonic sizure or complex partial seizure

abnormal sensations (taste, smell, visual, auditory experiences), dizziness/numbness, funny feeling

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18
Q

ictus

A

seizure epiosde

tonic-clonic activity (muscle twitches)
incontinence

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19
Q

Postictal

A

period following cessation of seizure activity

h/a , confusion, aphasia, memory loss, deep sleep, PARALYSIS

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20
Q

priority during ictus

A

maintain airway

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21
Q

how long does postictal phase last?

A

1-2 days

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22
Q

4 Consequences of Seizures

A
  1. inc cerebral blood flow
  2. cerebral oxygen consump inc 60%
  3. glucose depletion
  4. accmulation of lactate in brain tissue
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23
Q

Irrversible brian damage occurs after how much time?

A

after 5 minutes there is irreversible hypoxic brain injury

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24
Q

How are seizures classified?

A

origin of seizure in the brain (focal/generalized onsent)

degree of awareness during seizure (self, environment)

level of body movement (motor, nonmotor)

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25
Q

Focal Seizures

A

previously called partial seizures

neurons unilaterally (limited to one part of either L/R hemisphere, but can spread)

with OR w/o of loss of conciousness

aura is common

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26
Q

Focal Sizure Motor Terms: stiffening of body muscles with falling/rigidity + loss of conciousness. fall backwards.

A

tonic

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27
Q

Focal Sizure Motor Terms: sudden brief loss of muscle tone w/ falling. no loss of conciousness. fall forward.

A

atonic

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28
Q

Focal Sizure Motor Terms: sudden brief shock like jerks/twitches of arms & legs. may drop things. no loss of conciousness.

A

myoclonic

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29
Q

Focal Sizure Motor Terms: abrupt loss of conciousness, body stiffening then shaking. sudden cry, loss of bladder control, biting of tongue. 2 mins.

A

tonic-clonic

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30
Q

Focal Sizure Motor Terms: bimanual or bipedal motor activity. kicking, thrashing, and rubbing hands. hugging. autonomic changes w/o awareness.

A

hyperkinetic

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31
Q

Focal Sizure Nonmotor: sensory

A

sensorynumbness, tingling, burning, flashing lights, auditory experiences

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32
Q

Focal Sizure Nonmotor: cognitive

A

aphasia, hallucination, memory, or attention impairment

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33
Q

Focal Sizure Nonmotor: emotional or affective

A

fear, agitation, anger, crying, laughing, paranoia

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34
Q

Focal Sizure Nonmotor: autonomic

A

blushing, pallor, in./dec. HR, hyperventilation, hypoventilation, nausea

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35
Q

Focal Seizure: w/o loss of awareness

A

recall
responsiveness
conciousness intact

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36
Q

What are focal seizures w/ impared awareness called?

A

complex focal seizure

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37
Q

Traits of complex focal seizure?

A

loss of conciousness/awareness
vague/ dream like state

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38
Q

Is the onset and awareness known for focal seizures?

A

no

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39
Q

FS: Focal to Bilateral Tonic-Clonic Seizure

A

begins in one part of the brain –> spreads to both sides –> tonic-clonic seizure

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40
Q

is there loss of conciousness in a Focal to Bilateral Tonic-Clonic Seizure?

A

Yes

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41
Q

Generalized Seizure:

A

neurons bilaterally
seizure orginate in both sides simultaneously
loss of conciousness

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42
Q

Generalized Seizure: Motor responses

A

tonic-clonic, tonic, atonic, clonic, myoclonic, myoclonic atonic, clonic-tonic-clonic

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43
Q

Generalized Seizure: Non-Motor responses (absence seizures)

A

typical
atypical myoclonic
eyelid myoclonia (eyelid twitch)

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44
Q

Generalized Seizures: Epileptic Spasms Overview

A

episode of sudden flexion/extension of neck/trunk/extremeties

increases in intensity and severity overtime (miss developmental milestones & disability)

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45
Q

Generalized Seizures: Epileptic Spasms Onset

A

1-12 months

can occur after infancy

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46
Q

Generalized Seizures: Epileptic Spasms, frequency

A

occurs in clusters of 5-150 per day
worse when infant waking/sleeping
EEG abnormalities

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47
Q

Generalized Seizures: Epileptic Spasms Cause

A

idiopathic
genetic
metabolic disease
CNS insult

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48
Q

Treatment of Epileptic Spasms

A

ST adrenicorticotrophic hormone- vigabatrin, corticosteriods, prednisone

surgery when pharmacological tx has failed

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49
Q

What is Epilepsy? (detailed)

A

complex genetic mutations + environmental effects

abnormalities in synaptic transmissions

imbalance in brain’s neurotransmitters

alterations of receptors and iron channels

development of abnormal nerve connections OR loss of nerves after injury

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50
Q

Epileptogenic Focus: How epilepsy works

A
  1. group of hyperexcitable neurons
  2. corticol excitation spreads
51
Q

Epileptogenic Focus: How epilepsy works- Tonic Phase

A

excitatory neurons react to corticol stimulation
fire more frequently and with greater amplitude

52
Q

Epileptogenic Focus: How epilepsy works- Clonic Phase

A

inhibatory neurons react to corticol stimulation
Seizure discharge interrupted

53
Q

What can cause epilepsy? (ILAE proposal)

A

genetic
structural
metabolic
immune
infections
unkown

54
Q

How are epilepsies classified?

A

types of seizures
epilepsy syndromes

55
Q

Epilepsy Seizure Types

A

Focal
Generalized
Focal + Generalized
Unknown

56
Q

Epilepsy Syndromes

A

Childhood Absence Epilepsy Syndrome
Lennox-Gastaut Syndrome
Juvenile myoclonic epilepsy
Unclassified epileptic seizure
Psuedoseizures

57
Q

Status Epilepticus

A

abrupt discontinuation of antiseizure drugs
untreated/inadequately treated persons w/ seizure d/o

faliure of mechanisms in place to stop seizures = abnormally long seizures

rapidly recurring seizure before person has fully regained conciousness from previous seizure

58
Q

Status Epilepticus: How long are seizures?

A

tonic-clonic for 5+ minutes
OR
Single seizure for 30+ mins

59
Q

Why is Status Epilepticus a medical emergency?

A

high risk for aspiration
cerebral hypoxia

60
Q

What are the LT consequences of Status Epilepticus?

A

neuronal death
neuronal injury
alternation in neuronal networks

61
Q

What is your number 1 prioriy for Status Epilepticus?

A

administer high flow oxygen

62
Q

What can you do during Status Epilepticus to help?

A

put pt on their left side (help secretions come out)
do not suction

63
Q

Childhood Absence Epilepsy Syndrome: Overview

A

abnormal actvity occuring many times a day: eye moevements, chewing, blank stare, lack of awarness, swimming movements

child may not aware that seizure activity occured

64
Q

Childhood Absence Epilepsy Syndrome: onset

A

4-8 yrs
may disappear during adolescence

65
Q

Childhood Absence Epilepsy Syndrome: duration

A

10-20 secs

sudden end –> normal activity

66
Q

Childhood Absence Epilepsy Syndrome: Tx

A

antiepileptic drug

67
Q

Lennox-Gastaut Syndrome:

A

various generalized seizures (tonic-clonic, atonic, akenetic, absenc, and myoclinic)

EEG - slow spike and wave

results in intellectual disablity and delated psychomotor development

68
Q

Lennox-Gastaut Syndrome: onset

A

early childhood, 1-5 yrs of age

69
Q

Lennox-Gastaut Syndrome: Tx

A

difficult

drugs, ketogenic diet, vagal nerve stimulator

70
Q

Juvenile Myoclinic Epilepsy:

A

myoclinic jerks (neck, shoulders, arms) + generalized tonic-clonic seizures- SINGLE OR REPETITIVE

Aggravated by lack of sleep, excessive alcohol intake

onset in adolescence

71
Q

Juvenile Myoclinic Epilepsy: when do they occur?

A

early in the morning

72
Q

Juvenile Myoclinic Epilepsy: tx

A

drugs 4L

73
Q

Unclassified Epileptic Seizures

A

etiology unknown
seizures do not have distinct clinical and EEG features

74
Q

Psuedoseizures

A

nonepileptic phenomena but look like epileptic seizures

dx requires video EEG monitoring to capture spells, determine EEG is normal during clinical events

75
Q

Simple Febrile Seizure: Unique feature

A

presents as generalized seizure
temperature >38C
no hypoglycemia
no electrolyte d/o
no CNS infection

76
Q

Simple Febrile Seizure: Onset

A

Onset: 3mo - 5yrs

77
Q

Simple Febrile Seizure: Duration

A

<5 minutes
without reccurance

78
Q

Simple Fberile Seizure: MOA

A

systemic infection w/ release of inflammatory cytokines that cross BBB
stimulate neuronal hyperexcitability trigerring seizure

79
Q

Complex Febrile Seizure: duration

A

> 15 mins

80
Q

Complex Febrile Seizure: frequency

A

1+ 24 hour period

81
Q

Complex Febrile Seizure: tx

A

antipyretic and/or antiepileptic drugs

82
Q

Complex febrile seizure: overview

A

have focal characteristics
considered risk factor for development of epilepsy

83
Q
A
84
Q

Dx of Epilepsy in children

A

more than 2 unprovoked seizures more than 24 hours apart

85
Q

Barbituates tx?

A

phenobarbital

86
Q

benzodiapines tx?

A

diazepam

87
Q

hydantoins tx?

A

phenytoin

88
Q

Phenytoin-like/Carboxylic acid derivatives tx?

A

valproic acid

89
Q

succinimides tx?

A

ethosuximide

90
Q

Goal of antiseizure drugs?

A

suppress neuronal activity to prevent abnormal and reptitive firing w/o intolerable side effects or drug resistance

91
Q

Seizure D/O Drug Therapy Approach

A

placed on initial low dose
gradually increased until seizure control acheived

if seizure continue- different drug in small dose increments is added while reducing dosage of initial drug

92
Q

Antiseizure drug withdrawal period?

A

6-12 weeks

93
Q

How antiseizure drugs work: MOA

A

control movement of electrolytes across neuronal membrrades or affect neurotransmitter balance

resting state: neurons surrounded by inc. electrolyte concentration

influx of Na and Cl enhances neuronal activity

influx of Cl surpresses neuronal activity

94
Q

Antiseizure MOA: 3 general mechanisms

A
  1. stimulate influx of Cl ions –> activates GABA
  2. delay inflex of sodium ions (red. neuronal excitability)
  3. delay influx of calcium ions (delay neurotransmitter release)
95
Q

What drugs potentiate GABA?

A

phenobarbital
diazepam

96
Q

Which drugs increase GABA production in nerve terminal?

A

valproic acid

97
Q

Phenobarbital : MOA

A

enhances and potentiates action of GABA

98
Q

Phenobarbital: Indications for Use

A

mgt of variety of seizures including tonic-clinic and febrile seizures

99
Q

Phenobarbital: Desired Effects

A

surpresses abnormal neuronal d/c that can cause epilepsy

100
Q

Phenobarbital: Adverse Effects

A

barbie is breathtaking (resp dep, laryngospasm)

barbie makes you sleepy (drowsy, coma, death)

barbie has fanss everyone (dependence, tolerance), your love for her is longlasting

barbie can deplete you (Vit D/B12, folate)

going out with barbie can give you rash (steven-johnson syndrome)

thrombophlembitis from standing to long

barbie goes out at night- take it at night
once you get hooked you cant stop seeing barbie

barbie withdrawal symptoms (nightmares, insomnia, tremors, hallucination, nausea, vomiting)

101
Q

Diazepam: MOA

A

binds to GABA receptor-chloride channels intensifies GABA action

102
Q

Diazepam: Indications for use

A

ST seizure control
status epilepticus
anxiety

103
Q

Diazepam: Adverse effects

A

VALIUM

V- very low BP
A- accelerated HR
L- low and slow respirations (resp dep)
I- increased alcohol and CNS depressant effects (blurred vision, dizzy, constipation)
U-uknown if oral contraceptives work
M- muscle Weakness

104
Q

Diazepam: Desired Effects

A

suppression of abnormal neuronal activity
calming w/o sedation
skeletal muscle relaxation
reduce seizure activity

105
Q

Drugs that suppress sodium influx

A

phenytoin & valproic acid

106
Q

Phenytoins: MOA

A

delays sodium influx into enurons

107
Q

Phenytoins: Indications for use

A

most types fo seizures/epilepsy BUT absence

108
Q

Phenytoins: desired effects

A

prevent spread of disruptive electical charges in brain that produce seizures

109
Q

Phenytoins: AE

A

PHENYTOINS

bradycardia
v-fib
severe hypotension
hypeglycemia
blood dyscrasias
severe skin and connective tissue reactions
HA
confusion
nervousness, twitching insomnia
peripheral neuropathy (LT use)

110
Q

Valproic Acid: MOA

A

delays sodium influx into neurons
aslso effects calcium channels and increases GABA

111
Q

Valproic Acid: Indications for use

A

wide range of seizures (absence + mixed)
prevention of migrane HA
tx of BPD

112
Q

Valproic acid: desired effects

A

prevents spread of disruptive electrical charges that produce seizures

113
Q

Valproic Acid: AE

A

sedation, drowsy, GI upset, prolonged bleeding

114
Q

Drugs that suppress Calcium Influx

A

ethosuximide

115
Q

ethosuximide: indications for use

A

absence (petit mal) seizures

116
Q

ethosuximide: MOA

A

depressed acivity of neurons in motor cortex
- delays calcium influx into neurons by blocking
- raises seizure threshold

117
Q

ethosuximide: DE

A

reduced likelyhood that action potential will be generated, keeps neurons from firing to quickly

118
Q

ethosuximide: AE

A

psychosis or extreme mood swings, depression with suicidal intent

119
Q

Ketogenic Diet: indications

A

when seizures are uncontrollable by medication or extreme AE.

primary treatment for epilepsy before drugs

120
Q

Ketogenic Edit: MOA

A

increased ketone bodies and metabolic changes enhance GABA and inhibatory neurotransmitters

121
Q

Ketogenic diet: benefits

A

alzhiemers, parkinsons, + degenrative diseases
high efficacy rates in controllign seizure w/ rapid improvement

122
Q

Ketogenic diet: diet composition

A

high fat, low carb and protein
stringent water and caloric intake control
3-4g of fat - 1g protein

123
Q

complications of ketogenic diet

A

hyperlipedemia
hepatotoxicity
LT monitoring

124
Q

Keotgenic diet: AE

A

vomiting
fatigue
constipation
diarrhea
hunger

PAT401 (6 decks)

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