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DMod3 Pt5 Neurological Disease > DM3 Pt5-1 Seizures > Flashcards

DM3 Pt5-1 Seizures Flashcards

(72 cards)

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1
Q

What are two main categories of causes for seizures in cats?

A

Seizures in cats can be caused by intra-cranial (structural or functional) or extra-cranial diseases (systemic insults).

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2
Q

What clues are often present with extra-cranial causes of seizures?

A

Clues such as weight loss, PU/PD, vomiting, or other signs of systemic or metabolic disease.

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3
Q

Differential diagnosis of seizures can be broken down using what system?

A

DAMNIT V System

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4
Q

What does the D stand for in the DAMNIT V system for diagnosing seizures?

A

D - Degenerative
eg. Lysosomal storage disease

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5
Q

What does the A stand for in the DAMNIT V system for diagnosing seizures?

A

A – Anomalous
* E.g. hydrocephalus – congenital or acquired (e.g. FIP)

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6
Q

What does the M stand for in the DAMNIT V system for diagnosing seizures?

A

M – Metabolic
* Hepatic encephalopathy
* Hypoglycaemia
* Hypocalcaemia
* Hyponatraemia (low blood sodium)
* Hypernatraemia (high blood sodium)

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7
Q

What does the N stand for in the DAMNIT V system for diagnosing seizures?

A

N – Nutritional/Neoplasia
* Thiamine deficiency
* Neoplasia e.g. lymphoma, meningioma

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8
Q

What does the I stand for in the DAMNIT V system for diagnosing seizures?

A

I – Infectious / inflammatory / idiopathic
* FIP, Toxoplasma, FeLV, FIV
* Idiopathic epilepsy

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9
Q

What does the T stand for in the DAMNIT V system for diagnosing seizures?

A

T – Toxic/Trauma
* Permethrin, ethylene glycol
* Drugs e.g. metronidazole
* Trauma

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10
Q

What does the V stand for in the DAMNIT V system for diagnosing seizures?

A

V- Vascular
* Thromboembolism, feline ischaemic encephalopathy, haemorrhage related to hypertension, coagulopathy, trauma, polycythaemia

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11
Q

What degenerative disease can cause seizures in cats?

A

Lysosomal storage disease.

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12
Q

What is an example of an anomalous cause of seizures in cats?

A

Hydrocephalus, which can be congenital or acquired (e.g., FIP).

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13
Q

What metabolic conditions can cause seizures in cats?

A

Hepatic encephalopathy, hypoglycaemia, hypocalcaemia, hyponatraemia, and hypernatraemia.

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14
Q

What is the most common cause of hypoglycaemia-induced seizures in cats?

A

Iatrogenic hypoglycaemia due to excessive insulin administration.

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15
Q

What condition most commonly causes hypocalcaemia in cats?

A

Hypoparathyroidism post-thyroidectomy.

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16
Q

What causes neurological signs due to hyponatraemia?

A

Neurological signs occur when sodium levels drop below 125mmol/l due to water moving into brain cells.

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17
Q

Why must hypernatraemia be corrected slowly in cats with seizures?

A

Rapid correction of hypernatraemia can cause sudden swelling of brain parenchyma, so sodium concentrations should be reduced over 48-72 hours.

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18
Q

What nutritional deficiency can cause seizures in cats?

A

Thiamine deficiency, often due to diets with raw fish, cooked food lacking thiamine, or anorexia.

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19
Q

What types of neoplasia can lead to seizures in cats?

A

Lymphoma and meningioma.

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20
Q

What infectious or inflammatory diseases can cause seizures in cats?

A

FIP, Toxoplasma, FeLV, FIV, and idiopathic epilepsy.

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21
Q

What are some toxic causes of seizures in cats?

A

Permethrin, ethylene glycol, metronidazole, and trauma.

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22
Q

What vascular conditions can cause seizures in cats?

A

Thromboembolism, feline ischaemic encephalopathy, haemorrhage due to hypertension, coagulopathy, trauma, and polycythaemia.

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23
Q

Why is it important to confirm an epileptic seizure?

A

It is essential to distinguish a seizure from other conditions like collapse, syncope, or weakness, which have different causes and treatments.

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24
Q

What features distinguish syncope (fainting) from a seizure in cats?

A

Syncope is often triggered by exercise or excitement, and the cat returns to normal afterward, whereas seizures have a peracute onset and stereotypical motor patterns.

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25
What are some key signs of an epileptic seizure?
Involuntary motor activity, abnormal mentation, and autonomic signs such as salivation, urination, and defaecation.
26
Why is video recording helpful in diagnosing seizures?
Video recordings can help in recognizing the stereotypical pattern of seizures, particularly for partial seizures that may be hard to detect.
27
What information should be gathered from the history during a seizure investigation?
The age of onset, description of episodes, frequency, triggers (e.g., exercise, feeding, sleeping), and the cat’s behavior between seizures.
28
What is the goal of the physical examination in a seizure investigation?
To identify signs of systemic disease that help determine whether the cause of the seizure is inside or outside the skull.
29
When should a cardiac workup be considered in seizure investigations?
If syncope or dysrhythmias are suspected, a cardiac workup may be needed.
30
What neurological signs suggest forebrain disease in cats?
Altered behavior, contralateral proprioceptive deficits, central blindness, reduced mentation, circling, and head pressing.
31
What should be considered if neurological deficits are symmetrical and diffuse?
A metabolic disorder, such as hepatic encephalopathy, should be considered.
32
Why should caution be used when interpreting neurological deficits immediately after a seizure?
Post-ictal neurological deficits may be present but are not necessarily due to underlying structural disease. Seizures can also cause hypoxic injury.
33
What neurological abnormalities are typically seen in metabolic disorders?
Neurological abnormalities in metabolic disorders are usually bilaterally symmetrical and may wax and wane.
34
What can the onset and progression of clinical signs indicate in seizure cases?
A brain tumor usually presents with slowly progressive signs, while traumatic causes have a sudden onset with potential improvement over time.
35
Why are further investigations needed in seizure cases?
To confirm a diagnosis, rule out extra-cranial disease, assess for multi-systemic disease, and provide baseline parameters for treatment and monitoring.
36
What are the key components of further investigations for seizures?
Complete haematology, biochemistry, urinalysis, infectious disease testing, imaging, and CSF analysis.
37
What liver function test is included in the biochemistry panel for seizure investigations?
Dynamic bile acids to assess liver function.
38
Which infectious disease tests are commonly performed in cats with seizures?
FeLV and FIV serology, Toxoplasma serology (IgM and IgG), and possibly Cryptococcus serology depending on geographical location.
39
What is the purpose of thoracic and abdominal imaging in seizure investigations?
To identify underlying systemic disorders (e.g., portosystemic shunt) or complications such as neoplasia.
40
When is advanced imaging like MRI or CT indicated in seizure cases?
MRI or CT is particularly indicated if the neurological examination shows abnormalities.
41
What can CSF analysis help detect in seizure investigations?
CSF analysis helps quantify protein levels, assess cytology, and detect infectious agents such as coronavirus or Toxoplasma.
42
What systemic disorders might be identified through radiographs and ultrasound in seizure investigations?
Disorders such as portosystemic shunt (PSS), neoplasia, or generalised disease.
43
What is the first step in treating seizures in cats?
Treat the underlying cause if identified, such as hypoglycaemia.
44
How should hypoglycaemia be treated in cats with seizures?
Administer 0.5g/kg of 25% dextrose IV as a bolus and continue with 4% dextrose saline, adjusting as needed.
45
What should be monitored closely when treating hypoglycaemia?
Blood glucose should be monitored every hour, and electrolytes should be monitored every 4-6 hours.
46
What additional therapy may be required if hypoglycaemia is caused by insulin overdose?
Administer dexamethasone sodium phosphate, and if needed, initiate a glucagon infusion to maintain euglycaemia.
47
When should glucagon be used in hypoglycaemia treatment?
Glucagon is used when standard dextrose therapy does not maintain normal blood glucose.
48
What are some causes of hypoglycaemia in cats aside from insulin overdose?
Sepsis/SIRS, hepatic disease, neoplasia, polycythaemia, hypoadrenocorticism, or inappetance in very young kittens.
49
Why should seizure treatment be initiated early?
To prevent the "kindling" effect, where repeated seizures cause more brain injury, leading to more seizures.
50
What is a common first treatment for status epilepticus in cats?
Diazepam IV is administered, or rectal diazepam if IV access is not available.
51
What is the bolus dose of diazepam for treating seizures in cats?
0.5 mg/kg IV, repeated up to 3 times if seizures do not stop after 2 minutes.
52
What drug can be used if diazepam is not effective?
Phenobarbitone can be loaded IV if diazepam does not rapidly stop the seizures.
53
What is the dosing protocol for phenobarbitone in status epilepticus?
3 mg/kg boluses every 30 minutes up to a cumulative dose of 20 mg/kg.
54
What alternative treatments can be used if seizures persist despite phenobarbitone?
Continuous rate infusion (CRI) of diazepam or a bolus of propofol followed by CRI.
55
What potential side effect should be monitored with repeated propofol administration in cats?
Heinz body anaemia.
56
What are the key steps in supportive care during a seizure?
Ensure a patent airway, administer oxygen, maintain hydration with 0.9% sodium chloride, monitor vitals, maintain normal body temperature, and monitor for complications.
57
What complications should be monitored for during seizure supportive care?
Hypoglycaemia, neurogenic pulmonary oedema, dysrhythmias, acidosis, hypoxia, and hypotension.
58
How often should a seizing cat be turned to prevent complications?
Every 4 hours, and the bladder should be emptied regularly.
59
When can the neurological status be accurately assessed after stopping anticonvulsants?
Neurological status can be assessed about 48 hours after stopping anticonvulsant infusions or loading doses.
60
What is the first drug of choice for long-term seizure treatment in cats?
Phenobarbitone.
61
When should serum phenobarbitone levels be checked in cats?
10-12 days after starting treatment, after any dose changes, if seizures worsen, if side effects occur, or every 6-12 months.
62
What are the potential side effects of phenobarbitone in cats?
Myelosuppression, severe cutaneous eruptions, lymphadenopathy, initial sedation, PUPD.
63
What is the dose of phenobarbitone for long-term treatment of seizures in cats?
1-3 mg/kg PO every 12 hours.
64
Why is diazepam not ideal for long-term seizure management in cats?
Diazepam can cause fatal idiosyncratic hepatic necrosis in cats.
65
What is the dose of diazepam for seizure maintenance in cats?
0.5-2 mg BID-TID.
66
What drug can be used as an alternative to diazepam?
Clonazepam, at a dose of 0.5 mg PO SID-BID.
67
Why is potassium bromide not recommended in cats?
It can cause severe bronchial disease, leading to coughing and dyspnoea.
68
What is a potential side effect of gabapentin in cats?
Sedation.
69
What is the dose of gabapentin for seizure control in cats?
5-10 mg/kg PO every 24 hours, increasing to twice daily if needed.
70
What newer drug may replace gabapentin in cats for seizure management?
Pregabalin, though information in cats is limited.
71
What is the dose of levetiracetam (Keppra) for seizure control in cats?
20 mg/kg PO every 8 hours.
72
What is an advantage of zonisamide for seizure control in cats?
Its half-life of 33 hours may allow for once-daily dosing, though high doses can cause side effects like GI upset and ataxia.

DMod3 Pt5 Neurological Disease (2 decks)

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