11: Epilepsy Flashcards Preview

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Flashcards in 11: Epilepsy Deck (15):
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Epilepsy- info Ddx: seizure

Seizure: abnormal excessive excitation of neurons in brain
Epilepsy: 2 or more episodes of seizure

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Epilepsy- cc

Endogenous factor- neurological defect. esp in ion gated channels
Epileptogenic factor- space occupying lesion, metabolic conditions, alzheimers, trauma, alcohol withdrawal, injury from birth to a neonate
Precipitating factor- flashing lights (used as dx), sleep deprivation, loud sounds

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Epilepsy- path

excess or lack of glutamate
EEG: spike and wave morphology at an episode

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Epilepsy- types

Partial- one part of brain: no loss of consciousness*
-Simple: pt is aware. can be motor, sensory, visual, psychogenic, etc
-Complex: impaired consciousness, cannot respond stimulus

Generalized- whole brain: loss of consciousness*
-Tonic clonic (Gran mal)
-Absence (Petit mal)
-Myotonic
Atonic
Secondary generalization*- start as partial and progress to generalized

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Epilepsy- simple partial- motor features

Motor**
-Jacksonian march (episode starts with one part and moves around the body)
-Epilepsia partialis continua (partial types epilepsy that continues. Ddx: status epilepsy: loss of consciousness)
-Todd's palsy (temporary loss of sensation/paralysis)

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Epilepsy- partial complex- features

Starts with Aura
Does not respond to verbal command- disconnect from the environment-> motionless and stare into a space
Then the episode can be variable- lipsmacking, dishwashing etc

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Epilepsy- Complex- Tonic clonic features

Loss of consciousness
Tonus phase- sustained contraction of muscles, impaired respiration (cyanosis), tongue biting, cry/ moan, secretion
Clonic phase- contraction/relaxation, foaming (churned saliva)
Flaccid phase- urinate/defecate, strider, limp
Recovery of consciousness- confusion, body-ache
EEG: Tonus: multiple full waves, Clonus: hard waves and mild waves

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Generalized- Absence

Common in children
Outgrow as they grow
200-300 episodes a day for few seconds (stare in a space, blinking)
Hx: Day dreamer, Grades suddenly goes down
EEG: 3 spikes in 1 second

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Generalized- Atonic

Drop attack

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Generalized- Myoclonic

Loss of consciousness followed by jerky movements

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Secondary generalization

Complex partial-> Generalized
Aura** followed by Tonic clonic
Tx is different so needs to dx*

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Investigation

CBC
Electrolytes
EEG* (diagnostic)

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tx*

Partial: carbamezepine
2dary generalized: carbamazepine
Generalized: valproic acid
Absence: ethosuximide

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Status epilepticus

Epileptic attack anything above 15mins*
EEG: crazy polyspikes
Medical emergency due to complicatons;
Hyperthermia
Lactic acidosis
Hypoxia/Hypercapnia
Hyperkalemia/ Hyponatremia
Rhabdomyalysis-> acute renal failure

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Status epilepticus- tx

In this order as long as pt is under episode
1: Diazepam/ Lorazepam-> 2: second dose
3: Phenytoin-> 4: Phenytoin
5: Phenobarbital
6: Phenytoin
7: Anesthesia

Pregnant woman: increase folate to the above (minimum dose with one dose)
Mother of neonate: concentration of drug is low enough in breast milk so feeding to the baby is okay