Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

M2 Neurology > 10. Epilepsy > Flashcards

10. Epilepsy Flashcards

1
Q

define epilepsy

A

tendency to have seizures in absence of provocations that would cause the normal brain to have a seizure. due to electrically irritable brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

besides epilepsy, what else can cause seizures?

A

acute brain injury, tramua, anoxia, fever.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what causes a seizure at the neuronal level?

A

excitation that substantially exceeds inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the action of glutamate?

A

binds to receptors that open Na and Ca channels depol cell, make neuronal firing and seizures more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

in regards to glutamate, what is the action of some anti-epileptic drugs?

A

block release of glutamate (lamotrigine), or are glut receptor antagonists (topiramate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the action of GABA?

A

inhibitory. opens a chloride channel that hyperpolarizes the cell. makes neuronal firing less likely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

in regards to GABA, what is the action of some anti-epileptic drugs?

A

imitate GABA/ agonists at GABA receptors (benzodiazepines, barbituates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

a specific gene that causes epilepsy?

A

mutation in gene 19 –> mutation in VG sodium channel. leaves your neurons excitable. causes generalized epilepsy with febrile seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are generalized epilepsies associated with in terms of brain activity and presentations?

A

diffuse electrographic changes in the whole brain. may be tonic-clonic (grand mal), staring (absence/petit mal), tonic (stiffening), atonic (loss of muscle tone), myoclonic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are focal epilepsies associated with in terms of brain activity and presentations?

A

starts at one area, spreads to some extent. may start due to focal structural lesions, focal electrical abnormalities. may have confusion, aura, tonic-clonic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a secondarily generalized seizure?

A

starts focal, spreads to become generalized.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

define a primary generalized seizure?

A
  • seiz activity visible in all areas of cortex simultaneously
  • no warning/aura
  • may be genetic or due to metabolic upset
  • some primary epilepsies of childhood may be outgrown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

primary generalized seizure due to metabolic upset: what are some of the upsets that can cause seizures?

A

electrolyte disturbance, organ failure, hypoglycemia, hypoxia, withdrawal from alc or drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

epilepsy with generalized convulsive seizures but no other brain problems: what is the prognosis?

A

good prognosis. may be idiopathic or genetic. usually begins in childhood or adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

general tonic-clonic seizures (grand mal): what does it look like?

A 
bilateral tonic extension followed by clonic activity. 
autonomic upset (pupils large, hyperthermia, tachy, salivation, bladder emptying)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is clonic activity?

A

alternating jerks of activity of flexors and extensors, grunting respirations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

general tonic-clonic seizures (grand mal): what will terminate the activity?

A

inhibitory transmitters that result in postictal period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a petit mal seizure?

A

type of generalized seizure. brief, no movement (except maybe eye blink or lip movement), no loss of tone, no memory, no postictal period.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

petit mal: onset? prognosis?

A

begins with staring spells around school age. good prognosis, may outgrow. some develop convulsive seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is juvenile myoclonic epilepsy?

A

type of generalized seizure. brief, prominent motor cortex involvement. may result in myoclonic jerks. may be due to mutated GABA receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a myoclonic seizure?

A

brief, generalized seizure often resulting in myoclonic jerks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is tonic activity?

A

stiffening due to rapid repetitive neuronal firing

23
Q

petit mal: appearance on EEG?

A

diffuse abnormalities, characteristic = 3 waves/sec.

24
Q

petit mal: what neurons are involved?

A

diffuse involvement but not all neurons are involved. if every neuron were involved, pt would convulse. instead, this is like hitting the gas pedal while in neutral.

25
Q

petit mal: genetic component?

A

in some families there is a mutated GABA or glutamate receptor

26
Q

generalized epilepsy with non-convulsive seizures (atonic seizure): what are the characteristics?

A

atonic seizures: loss of muscle tone, head-drops or falls
EEG shows diffuse flattening, reflecting cortical inhibition
often seen in context of diffuse brain damage. poor prognosis.

27
Q

how is a petit mal seizure different from an atonic generalized seizure?

A

petit mal is more absence, staring, no movement but no loss of tone
atonic generalized is characterized by a drop or fall due to loss of tone.

28
Q

what distingishes a complex partial seizure from a simple partial seizure?

A

complex = consciousness is affected. simple = consciousness not affected.

29
Q

partial v focal: terminology?

A

they are the same thing

30
Q

what does a partial seizure look like?

A

blank stare, focal muscle jerks, simple automatisms, reactive automatisms

31
Q

partial seizure: aura?

A

may have aura if it does not spread too quickly

32
Q

how can a hemorrhage cause a seizure?

A

acute trauma –> hemorrhage -> degradation product of hemoglobin = hemosiderin and it is a brain irritant/ epileptogenic.

33
Q

how is mesial temporal sclerosis associated with epipelsy?

A

common cause. may be due to trauma, infection, malformation, or febrile convulsion

34
Q

temporal lobe epilepsy on EEG?

A

focal sharp activity on bottom leads associated with temporal lobe.

35
Q

Clinical approach to epilepsy: what to consider about the history?

A

family history, trauma, meningitis?
frequency? more than one type?
aura? may give clue to location if focal

36
Q

Clinical approach to epilepsy: what to consider about the physical exam?

A

often the neuro exam is normal
look for neuro-cutaneous disorders
occasional hemi-pareisis or hemi-atrophy

37
Q

how does an epileptic aura compare to a migraine aura?

A

much shorter: seconds to minutes

38
Q

what is Todd’s paralysis?

A

focal weakness in a part of the body after a seizure

39
Q

Clinical approach to epilepsy: what to consider if evaluating in ER?

A

Get a CT scan. (tumor, stroke, hemorrhage)
check CBC, chemistry, liver profiles (infections, ionic imbalance)
EKG and chest xray
spinal tap (infections)
elective EEG (focal v partial)

40
Q

what is status epilepticus?

A

emergency, continuous or recurrent seizures over 30 min without waking up in between.

41
Q

what might cause status epilepticus?

A

sedative withdrawal, discontinuation of anticonvulsants

42
Q

what an result from status epilepticus?

A

resp failure, lactic acidosis, aspiration, changes in BP, hyperthermia

43
Q

acute treatment of a seizure?

A
  • IV lorazepam. lasts longer than diazepam. short half-life
  • longer term therapy: IV phentoni or fosphenytoin
  • status epilepticus: IV phenobarbital. intubation.
44
Q

chronic treatment of seizures?

A
  • first seizures usually untreated. only 50% recur
  • provoked seizures are treated acutely but not long-term
  • recurrent seiz are treated chronically. may withdraw meds eventually in 50% of pts
45
Q

what meds are best for child-bearing women?

A

lamotrigine and levetiracetam

46
Q

which is easier to control: generalized or focal epilepsy?

A

generalized.

47
Q

overall, what is the most effective drug for generalized?

A

valproate

48
Q

which is more common: generalized or focal epil?

A

focal.

49
Q

overall, what is the most effective drug for focal?

A

carbamazepine. can also use lamotrigine and levetiracetam

50
Q

what is the patient response to drugs for focal epil?

A

50% do well on first drug, 20% do well on next drug

51
Q

what is a treatment if drugs have failed?

A

vagus nerve stimulation. like a pacemaker. intermittent/regular stimulation

52
Q

when drugs, vagus nerve stimulation, cerebral stim fail?

A

open the head and remove some brain.

53
Q

for what type of epilepsy is surgical treatment particularly effective?

A

mesial temporal sclerosis. often refractory to meds, lesion removal is effective

M2 Neurology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions