5: Seizure Disorders

Question 1

Recurrent, uncontrolled cerebral excitation

Answer 1

seizure

Question 2

How are seizures initated?

Answer 2

neurons

Question 3

Where are seizure activities?

Answer 3

adjecent areas of brain; can stay local or spread

Question 4

cause of seizure disorders

Answer 4

often unknown in younger people; in adults it’s often secondary to a specific even (CVA, tumor, trauma, etc)

Question 5

classify seizures according to…

Answer 5

1) extent of cerebral involvement
2) EEG activity
3) symptoms
4) etc.

Question 6

subdivisions of seizures

Answer 6

1) focal (partial) seizures

2) generalized seizures

Question 7

focal seizures

Answer 7

simple, complex

Question 8

generalized seizures

Answer 8

absence; tonic-clonic; others

Question 9

can focal become generalized?

Answer 9

yes

Question 10

which primary subdivision affects both cerebral hemispheres?

Answer 10

generalized

Question 11

most common seiures

Answer 11

1) complex partial

2) generalized tonic clonic

Question 12

goal of antiseizure medications

Answer 12

SELECTIVE effect on hyperexcitable neurons

Question 13

primary antiseizure agents- “front line”

Answer 13

1) phynytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Ethosuximide (Zarontin)
4) Valproates (Depakene, Divalproex, others)

Question 14

other primary antisizure agents

Answer 14

benzos, barbiturates

Question 15

most common antizeizure agent worldwide

Answer 15

barbitol

Question 16

“second generation” antiseizure drugs

Answer 16

1) Gabapentin (Neurontin)
2) Lamotrigine (Lamictal)
3) Levetiracetam (Keppra)
4) pregabalin (lyrica)
5) Tiagabine(Gabitril)
6) Topiramate (Topamax)

Question 17

“second generation” antiseizure drugs: are they more effective than traditional agents?

Answer 17

not necessarily but they tend to have milder side effects; more predictable profile

Question 18

“second generation” antiseizure drug benefits: all more ( ) to tx seizures

Answer 18

drug combos

Question 19

“second generation” antiseizure drug benefits: used to tx what?

Answer 19

neuropathic pain (esp. Neurontin)

Question 20

primary antiseizure mechanisms: Dilantin, Tegretol, and Depakene decrease what entry into rapidly firing neurons?

Answer 20

Na+

Question 21

primary antiseizure mechanisms: Zarontin decreases what entry into thalamic neurons?

Answer 21

Ca++

Question 22

primary antiseizure mechanisms: barbs, BZDS, several newer drugs increase what inhibition?

Answer 22

GABA

Question 23

primary antiseizure mechanisms: several newer drugs decrease the release or effects of what?

Answer 23

excitatory amino acids

Question 24

antiseizure med side effects: relatively minor

Answer 24

1) sedation
2) headache
3) dizziness
4) incoordination
5) GI problems

Question 25

antiseizure med side effects: more serious

Answer 25

1) liver toxicity 2) blood dyscrasias (aplastic anemia, agranulocytosis) 3) increased risk of birth defects

Question 26

( ) % can remain seizure-free after meds are withdrawn

Answer 26

60-70%

Question 27

success in no meds are associated with: bein free of seizure for at least ( ) while on meds

Answer 27

2 years

Question 28

success in no meds are associated with: having good seizure control withing ( ) after seizures being

Answer 28

1 year

Question 29

success in no meds are associated with: having a normal ( ) prior to withdrawal

Answer 29

neurologic exam

Question 30

success in no meds are associated with: having intial seizure onset in ( )

Answer 30

childhood

Question 31

PTs should document ( ). what does this help? what population is this especially true in?

Answer 31

seizure activity; helps assess efficacy of meds; children