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SBM Neuro > 10-22 Epilepsy > Flashcards

10-22 Epilepsy Flashcards

1
Q

define EPSP, IPSP

A

EPSP = excitatory postsynaptic potential
IPSP = inhibitory postsyn “
When EPSPs&raquo_space; IPSPs —> szs

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2
Q

What neurotransmitter mediates excitation? How so? Drugs that act on it?

A

Glutamate (e.g. via NMDA-Rs) opens Na+ and Ca2+ channels depolarizing cell —> excitation —> sz
—some rxs block glutamate release (lamotrigine)
—others are glutamate receptor antagonists (topiramate)

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3
Q

What neurotrans mediates inhib? Relation to sz/drugs?

A

GABA —> Cl- channel —> hyperpolarize —> inhibiton —> fewer szs

benzos and barbs are GABA—R agonists

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4
Q

What is the etiology behind most heritable epilepsies?

A

ion channelopathies

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5
Q 
Tonic-Clonic/Convulsive/Grand Mal
CATEGORY?
PRESENTATION?
EEG?
NATURAL HX?
FYI?
BEST RX?
A

CATEGORY: GENERALIZED Epilepsy w/ Convulsive Szs

PRESENTATION:
—loss—of—CONSCIOUSness
—muscles become TONIC (rigid) bilaterally
—resp inhib (CYANOSIS)
—CLONIC (rhythmic jerking) bilaterally
—bite tongue/INJURY
—INCONTINENCE of bowel and bladder
—post-ictal CONFUSION

NATURAL HX: Usually starts in childhood; good prognosis; severe sz does NOT mean severe dz

FYI: tonic part is due to firing, clonic jerks are actually brief periods of relaxation

Rx: usually effective (80%); valproate single best; levetiracetam other good one; lamotrigine for preg women

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6
Q

JME-Junvenile Myoclonic Epilepsy

_BRIEF

A

convulsive szs w/ diffuse EEG abnormalities prominently in MOTOR CORTEX
—MUTATED GABA receptor

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7
Q 
Childhood Petit Mal (Absence/ Staring)
CATEGORY?
PRESENTATION?
EEG?
NATURAL HX?
FYI?
BEST RX?
A

CATEGORY: GENERALIZED Epilepsy w/ Non-Convulsive Szs; GENETIC

PRESENTATION:
—presents in school-aged children
—brief LOC/STARING (10-20s)
—subtle MYOCLONUS
—simple AUTOMATISMS*
—NO POSTICTAL period

EEG: diffuse, but not every neuron (e.g. motor cortex thus no convulsions)

NATURAL HX: good prognosis, many grow out, some do develop convulsive szs, though

FYI: *finger rubbing, lip smacking, chewing, or swallowing

RX: Ethosuximide

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8
Q 
Atonic Seizures
CATEGORY?
PRESENTATION?
EEG?
NATURAL HX?
FYI?
BEST RX?
A

CATEGORY: GENERALIZED Epilepsy w/ Non-Convulsive Szs

PRESENTATION:
—Sudden LOSS OF MUSCLE TONE and HEAD DROPS
—go hand in hand WITH TONIC SZS (i.e. some muscle groups stiffen while others lose tone)
—cause FALS/INJURIES

EEG: diffuse FLATTENING (? cortical inhib probs from thal or b.s.)

NATURAL HX: Seen in context of global brain damage; not a good prognosis in terms of response to tx

RX: presuming same as other generaized (valproate best, levetiracetame, too, lamotrigine for preg women)

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9
Q 
Complex Partial Seizure (Temporal Lobe Sz/Psychomotor Sz*)
*prolly best name
CATEGORY?
PRESENTATION?
EEG?
NATURAL HX?
BEST RX?
A

CATEGORY: FOCAL

PRESENTATION:
—IMPAIRED CONSCIOUSness for ~1m
—blank STARE, simple & reactive AUTOMATISMS
—AMENISA of event

EEG: focal abnl; SHARPS over area w/ lesion

NATURAL HX: results from focal brain lesion (e.g. mesial temporal sclerosis)

RX: carbamazepine best (=ly effective to phenytoin w/o SEs); lamotrigine and levetiracetam reasonable options

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10
Q

Trauma and Szs

A

CATEGORY: ?FOCAL

—trauma causes szs acutely and long-term epilepsy thereafter
—blood break-down prods (e.g. hemosiderrin) are eliptogenic

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11
Q

Mesial Temporal Sclerosis

A

CATEGORY: ?FOCAL
—MTS common cause of epilepsy
—caused by: trauma, infx, congen malform, prolonged febrile convulsion
—commonly has AURA

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12
Q

Secondarily Generalized Sz

A

partial seizure that spread to whole body

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13
Q

Auras + location

A 
#Gastric/olfactory/gustatory sensations, déjà vu: Mesial temporal.
#Auditory: Lateral temporal. #Lateralized parasthesias: Frontal, Parietal.
#Visual changes: Occipital.
#Vague feelings in the head: Frontal or Generalized.
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14
Q

Physical Exam findings in epileptic patients?

A

usu neuro exam is nl; may find neurocutaneous lesions or rarely hemi-paresis or hemi-atrophy
—look for clues of DDx’ers: carotid bruit, orthostatic hypoten, murmur, arrythmia

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15
Q

DDX

A
  1. GENERALIZED: Is it a fit or faint?: vasovagal sync, orthostasis, arrythmia and AS can mimic generalized sz
  2. FOCAL/TODD’S PARALY: transient ischemia 2° to carotid dz
  3. AURAS: migraine (usually longer, mins-hrs vs. secs-mins)
  4. pyschogenic szs
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16
Q

Work-Up

A

IMAGING: CT for sure (maybe MRI to r/o tumor); chest film (cardio)
LABS: CHC, chem, LFTs (hepatic encephalopathy? uremia? hyponatremia?)
EKG
I.D.: spinal tap if infx suspected
Neuro: (consider EEG)

17
Q

Acute TX (including status)

A
  1. 3mg lorazepam IV (works just as fast and lasts longer than diazepam)
  2. consider adding long-term drug IV (e.g. 1gm of phenytoin or fosphenytoin; OR 1.5mg valproate or levetiracetame
  3. For status epilepticus (>15mins): phenobarb 500mg; —> intubate midazolam, propofol or pentobarbital
18
Q

midazolam trade name

A

Versed

19
Q

Principles of Chronic Tx

A
  1. First seizures are often not treated, because only 50% recur.
  2. Provoked seizures, e.g. with trauma, high fever, or alcohol withdrawal, are acutely treated for a few days but not long term.
  3. Recurrent seizures are treated on a long term basis. Medications can be successfully withdrawn after several years in about 50% of patients
20
Q

lamotrigine vs. carbamazepine

A

—equal efficacy
—LTg has fewer med interactions b/c not a liver enzyme inducer and fewer SEs in geriatrics
—wayy pricerier though, so stick

21
Q

Vagus Nerve Stim

A

L vagus n. b/c less arrythmias than R
—hard to detect early sz with portable EEG inside, so shocks given for 30s q5m
—also approved for refractory depression (and many intractable sz pts depressed)

22
Q

Cerebral Stim

A

—cortex or into parenchyma

23
Q

surgery

A

—good for mesial temporal sclerosis (remove scarred area) which is usually refractory to RX

24
Q

SPECT Scanning

A

—inject w/in seconds of sz onset (can scan later)

—sz foci are HYPO perfused inter- and post-ictally, and hyperperfused ictal period

25
Q

Callosotomy

A

palliative
prevents 2° generaization
stop drop-attack szs
qqf decr sz freq

SBM Neuro (29 decks)

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