What is epilepsy caused by?
excessive electrical activity of neurons in cerebral cortex
What is a seizure?
brief episode of abnormal electrical activity in nerve cells of brain -> may/may not lead to convulsion
What is a convulsion?
more severe seizure involuntary spasmodic contractions of any/all voluntary muscles in body, including skeletal, facial, and ocular
What is epilepsy?
chronic, recurrent pattern of seizures
Primary Epilepsy Another name and what cause
Idiopathic Epilepsy Cause cannot be determined more than 50% of cases
Secondary Epilepsy Another name and what cause
Symptomatic Epilepsy Distinct cause identified: trauma, infection, cerebrovascular disorder Infants/children: r/t developmental defects, metabolic disease/injury at birth Adults: acquired brain disorder is major cause
What are grand mal seizures now known as?
Generalized onset seizures
What is happening in generalized-onset seizures?
neuronal activity originating simultaneously in both hemispheres
What are the subtypes of generalized onset seizures?
4. atonic (drop attacks)
6. absence and infantile spasms
Who is generalized onset seizures most often seen in?
How will a generalized onset seizure present itself to you?
1. loss of consciousness
2. no postical confusion
3. may have rhythmic movements
4. no convulsion
What are the 3 types of partial-onset seizures?
1. Simple (used to be "petit mal seizures")
3. secondary generalized tonic-clonic seizure
Characteristics of Simple Partial-onset seizures
brief loss of awareness (blank stare), no LOC
autonomic nervous system responses
motor symptoms are commonly at face, arms, and leg
What are the classifications of seizures?
1. Partial seizures
2. Generalized seizures
3. Unclassified seizures
Characteristics of Complex Partial-onset Seizures
aura, chewing, swallowing, unreal feelings
tonic, clonic, or tonic-clonic seizures
Characteristics of Secondary Generalized Tonic-Clonic Seizure
Partial onset seizures that progress
Occurs in up to 40% of pts
What is an Unclassified Seizure?
Seizures that do not fit into any other category
What can status epilepticus lead to?
hypotension, hypoxia, and cardiac dysrhythmias
which can all lead to brain damage and death
What is status epilepticus?
multiple seizures occurring without recovery between
What can febrile seizures progress to?
What drugs are used to treat status epilepticus?
3. lorazepam (off label use)
Page 221, Table 14-3 has all the doses, onsets, etc.
What are Antiepileptic Drugs (AEDs) also known as?
What are the goals of therapy using AEDs?
control/prevent seizures while maintaining reasonable quality of life
minimize adverse effects/drug-induced toxicity
How long does AED therapy last? When can the pt discontinue?
therapy is usually lifelong
Pts who are seizure-free for 1-2 years may be able to discontinue
_______ drug therapy started before _______ drug therapy
single drug therapy started before multiple drug therapy
Titrate antiepileptic drugs to the lowest effective level. True or false?
MOA of AEDs
Exact MOA is unknown.
AEDs are thought to alter movement of Na, K, and Ca ions across nerve cells in the brain
1. Increase the threshold of activity (reduce nerve's ability to be stimulated)
2. Limit the spread: suppress transmission of impulses from one nerve to the next
3. Decrease the speed of nerve conduction within a neuron
Overall effect of MOA and AEDs
Neuron hyperexcitability decreased
Excessive nerve impulse spread decreased
Indications of AEDs
prevention/control of seizure activity
long-term maintenance therapy for chronic, recurring seizures
acute treatment of convulsions and status epilepticus
Adverse effects of AEDs
Numerous - vary per drug
often necessitate change in meds
Phenytoin: long-term may cause gingival hyperplasia, acne, hirsutism, and dilantin facies
black box warning (2008): suicidal thoughts/behavior is twice the risk