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2nd shift lecs > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

A sudden, disorganized electrical discharge in one or
more parts of the brain that interrupts normal brain
signals and disrupts the normal balance of inhibitory and
excitatory input

A

Seizure

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2
Q

Multiple neurons misfire simultaneously and depending on location and severity

A

seizure

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3
Q

single occurrence only

A

seizure

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4
Q

_________ seizures may lead to chronic neurologic disorder = epilepsy

A

Recurrent

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5
Q

A CNS disorder in which nerve cell activity in the brain
becomes disrupted, causing seizures or periods of
unusual behavior, sensations and sometimes loss of
consciousness

A

Epilepsy

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6
Q

Defined by the occurrence of at least two unprovoked seizures, with or without convulsions (voluntary muscles violently contract and relax causing uncontrolled shaking), separated by at least 24 hours

A

Epilepsy

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7
Q

Defined by the occurrence of at least _____unprovoked seizures, with or without convulsions (voluntary muscles violently contract and relax causing uncontrolled shaking), separated by at least ________ hours

A

two; 24

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8
Q

Chronic neurological disorder

A

epilepsy

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9
Q

characterized by recurrent seizures

A

epilepsy

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10
Q

seizure are due to ________________ in the electrical functions of the brain

A

brief disturbances

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11
Q

Epilepsy is contagious (t or f)

A

F

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12
Q

Clinical manifestation of epilepsy

A

seizures

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13
Q

Anything that disrupts the normal homeostasis or stability of neurons can trigger __________ and
seizures

A

hyperexcitability

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14
Q

occurs when a hyperexcitable neuron leads to excessive excitability of the large group of surrounding neurons

A

Hyperexcitability and Hyper-synchronization

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15
Q

Hyperexcitation occurs due to the inward
current of _______ and _________ions and ________ such as glutamate and aspartate.

A

Na; Ca; NT

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16
Q

Principal excitatory neurotransmitter

A

Glutamate

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17
Q

Principal Inhibitory neurotransmitter

A

GABA

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18
Q

Causes or Triggers

A
  • Infections
  • Acquired brain injuries
  • High fever
  • Lack of sleep
  • Electrolyte Imbalance, Hypoglycemia
  • Sudden alcohol, smoking or drug withdrawal
  • Flashing lights
  • Medications
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19
Q

seizures can start in any of the lobes (t or f)

A

T

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20
Q

Lobes of the brain

A
  • occipital
  • parietal
  • frontal
  • temporal
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21
Q

Behind frontal lobes

A

parietal lobe

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22
Q

behind the forehead

A

frontal lobe

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23
Q

back of the head

A

occipital lobe

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24
Q

either side of the head

A

temporal lobe

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25
Q

For processing visual information

A

occipital

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26
Q

For processing sensory information (touch, pain, taste)

A

parietal

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27
Q

For movement, planning, decision-making, emotion regulation, solve problems, maintain behavior

A

frontal

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28
Q

For memory, learning, emotions, and auditory information

A

temporal

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29
Q

Symptoms: visual disturbances (flashing lights, hallucination) temporary blindness, headache and difficulty with spatial orientation

A

occipital

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30
Q

Symptoms: tingling or numbness, difficulty understanding spatial relationships or distances, dizziness, vertigo, difficulty reading and writing, pain sensations

A

parietal

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31
Q

Symptoms: jerking movements (typically one side of the body), difficulty speaking or slurred speech, abnormal sensations, out-of-body experience, impaired
awareness, confusion, changes in mood or behavior

A

Frontal

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32
Q

Symptoms: auras (strange smells, tastes or déjà vu), altered awareness or confusion, automatisms (repetitive
movement), auditory hallucinations, difficulty speaking or understanding speech

A

temporal

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33
Q

warning sensations experienced before a seizure

A

auras

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34
Q

Classifying seizures

A
  • The onset or beginning of a seizure
  • A person’s level of awareness during seizure
  • Whether movements happen during a seizure
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35
Q

types of seizures

A
  • generalized
  • focal
  • unknown
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36
Q

Affect both sides of the brain or groups of cells on both sides of the brain at the same time

A

GENERALIZED ONSET SEIZURES

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37
Q

subclassifications of generalized onset seizures

A
  • tonic-clonic (grand mal)
  • absence (petit mal)
  • atonic epilepsy
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38
Q
  • Most dramatic type of generalized seizure
  • May start as a focal seizure first, then generalized when spread to other brain areas
A

Tonic-Clonic (Grand Mal)

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39
Q

muscle stiffening of the entire body

A

tonic

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40
Q

rhythmic jerking of the limbs and
face

A

clonic

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41
Q

Tonic-Clonic (Grand Mal) lasts for _________________

A

seconds to several minutes

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42
Q

patients lose consciousness in grand mal seizures (t or f)

A

T

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43
Q

period of confusion or drowsiness

A

post-ictal phase

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44
Q

“daydreaming” or “spacing
out”

A

Absence (Petit Mal)

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45
Q

”staring spell” - unresponsive while awake

A

Absence (Petit Mal)

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46
Q

Absence (Petit Mal)
Brief lapses or impaired
consciousness lasting from
_____________

A

five to ten seconds

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47
Q

Often occurs in children

A

Absence (Petit Mal)

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48
Q

Absence (Petit Mal) stops on its own after adolescence (t or f)

A

T

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49
Q
  • Patient may stare blankly,
    blink rapidly, or appear
    fidgety
  • Usually, no jerking movements or other physical manifestations, lip smacking
A

Absence (Petit Mal)

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50
Q

non-convulsive seizure

A

Absence (Petit Mal)

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51
Q

“Akinetic” or “Drop seizures”

A

Atonic Epilepsy

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52
Q

Sudden loss of muscle tone, strength or control, causing the person to fall

A

Atonic Epilepsy

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53
Q
  • May involve the entire body or just certain muscle groups
  • usually lasts for a few second
  • Brief loss of consciousness may occur
A

Atonic Epilepsy

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54
Q
  • previously known as partial seizure
  • Can start in one area or group of cells in one side of the brain
A

Focal onset seizures

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55
Q

Types of focal onset based on awareness

A
  • focal onset aware seizures
  • focal onset impaired awareness
56
Q
  • Simple partial seizures (previous name)
  • Individuals remain fully aware of their surroundings
  • May experience unusual sensations, movements, or other changes related to the affected brain area
  • No lost of consciousness
A

Aware Seizures

57
Q
  • Complex partial seizures (previous name)
  • Involves a degree of altered awareness or confusion
  • Individual may appear dazed, (daydreaming) unresponsive, or engage in automatic behaviors like hand
    rubbing, lip smacking or fidgeting without full control or awareness
A

Impaired Awareness Seizures

58
Q
  • When the beginning of a seizure is not known
  • If it’s not witnessed or seen by anyone
  • May later be diagnosed as a generalized or focal seizure
A

Unknown onset seizures

59
Q

Separates epilepsy simply into groups that involve movement

A

new classification of seizures

60
Q

Generalized onset seizures
Motor symptoms (affects muscle movements)

A
  • clonic
  • atonic
  • tonic
  • myoclonus
  • epileptic spasms
61
Q

sustained rhythmic jerking

A

clonic

62
Q

sudden loss of muscle tone, strength,
control

A

atonic

63
Q

muscle stiffening

A

tonic

64
Q

brief and sudden muscle jerking

A

myoclonus

65
Q

sudden abnormal repetitive
body flexion

A

epileptic spasms

66
Q

Usually called absence seizure (generalized onset seizures)

A

non-motor symptoms

67
Q
  • Typical or atypical absence seizures
  • no involvement of movement; affects other brain function — sensory, autonomic, cognitive, emotional changes
A

Non-motor symptoms Generalized onset seizures

68
Q

affects one area of the brain

A

focal onset

69
Q

Both sides of the brain are affected

A

generalized

70
Q

Symptoms of epilepsy depend on ____________

A

seizure type

71
Q

The more areas in the brain affected, the more symptoms can be manifested (t or f)

A

T

72
Q

There are no diagnostic laboratory tests for epilepsy (t or f)

A

T

73
Q

following GTC seizures, serum
_____________ can be transiently elevated due to the possible release of ________ from the pituitary gland

A

prolactin levels

74
Q

Seizures and stress may stimulate the ___________ which regulates hormones by triggering prolactin release
from the pituitary gland

A

hypothalamus

75
Q
  • very useful in the diagnosis of various seizure disorders
  • measure electrical activity of the brain
  • cannot definitively diagnose epilepsy or specific seizure type on its own
A

Electroencephalogram (EEG)

76
Q

abnormal EEG findings can occur without epilepsy (t or f)

A

T

77
Q
  • Imaging of temporal lobes
    > Structural abnormalities or lesions
  • not a definitive test for epilepsy
  • expensive
A

Magnetic Resonance Imaging (MRI)

78
Q

typically not helpful except in the initial evaluation for a brain tumor or cerebral bleeding

A

Computed Tomography (CT Scan)

79
Q
  • May be performed in the presence of suspected infection
  • cerebrospinal fluid for culture test
A

Lumbar puncture

80
Q
  • Not a first-line diagnostic tool for seizures
  • Supportive role in diagnosing seizures when other tests are inconclusive
A

Positron emission tomography (PET) scan and Single-photon emission computed tomography (SPECT)

81
Q

Factors favoring successful withdrawal of AEDs

A
  • Seizure-free period of two to four years
  • Complete seizure control within one year of onset
  • An onset of seizures after age two, but before age 35
  • A normal neurologic examination and EEG
82
Q

most common type of generalized epilepsy occurring in children

A

Juvenile myoclonic epilepsy

83
Q

Sudden withdrawal may result to _____________

A

status epilecticus

84
Q

a seizure that last longer than 5 mins or has >1 seizure within 5 mins without returning to normal level of consciousness between episodes

A

status epilepticus

85
Q

Implanted medical device that is
FDA-approved for use as adjunctive
therapy in reducing the frequency of seizures in adults and adolescents older than 12 years of age with partial-onset seizures that are
refractory to AEDs

A

Vagus Nerve Stimulation

86
Q

Placing a spoon in a person’s mouth during a seizure to protect the tongue is RECOMMENDED (t or f)

A

F

87
Q
  • No AEDs are recommended unless there is presence of risk factors for recurrence
  • Avoid alcohol and sleep deprivation
A

For single unprovoked seizures

88
Q

Recurrent unprovoked seizures or more than one episode of seizure, sleep-deprived individuals and patients with abnormal EEG results may also benefit with AED therapy

A

Special situations requiring treatment

89
Q

Partial seizures (refractory monotherapy)

A
  • Lamotrigine
  • Oxcarbazepine
  • Topiramate
90
Q

Partial seizures (newly diagnosed) Adults and Adolescents - First Line Drugs

A
  • Carbamazepine
  • Gabapentin
  • Oxcarbazepine
  • Phenobarbital
  • Topiramate
  • Valproic Acid
91
Q

Partial seizures (newly diagnosed) Adults and Adolescents - Alt drugs

A
  • Carbamazepine*
  • Lacosamide
  • Phenobarbital
  • Phenytoin*
  • Topiramate*
92
Q

Partial seizures (Refractory adjunct) - adults

A
  • Gabapentin
  • Lamotrigine
  • Levetiracetam
  • Oxcarbazepine
  • Tiagabine
  • Topiramate
  • Zonisamide
93
Q

Partial seizures (Refractory adjunct) - children

A
  • Gabapentin
  • Lamotrigine
  • Oxcarbazepine
  • Topiramate
94
Q
  • Cause fewer cognitive impairments
  • Memory, language, thinking and judgment skills
A

Gabapentin and Lamotrigine

95
Q
  • May cause substantial cognitive impairments
  • When given in high doses or rapid dose escalation
A

Topimarate

96
Q

Most widely used AEDs
`

A

Carbamazepine, Phenobarbital, Phenytoin, Valproic Acid

97
Q

Superior to valproic acid for efficacy in the treatment of partial seizures

A

Carbamazepine

98
Q
  • NEW generation agents
  • Received FDA approval for use as monotherapy in
    patients with partial seizures
A

Lamotrigine, Oxcarbazepine, Topiramate

99
Q

Tonic-Clonic Seizures - traditional treatment

A

Phenytoin

100
Q
  • increasingly used due to lower incidences of side effects
  • With equal efficacy compared to phenytoin
A

Carbamazepine and Valproic acid

101
Q

Generally considered the drug of first choice for atonic seizures and for juvenile myoclonic epilepsy (JME)

A

valproic acid

102
Q

Alternative agents

A

Lamotrigine, Topiramate, Zonisamide

103
Q

FDA-approved as adjunctive treatment of myoclonic
seizures in patients with JME

A

Levetiracetam

104
Q

First-line therapy for patients with
- newly diagnosed partial seizures and for patients with
- primary generalized convulsive seizures

Associated with a 1% risk of spina bifida when ingested during
first trimester

A

carbamazepine

105
Q

Second-line agent for patients with partial seizures who have
failed initial treatment

useful for chronic pain and other non-epileptic

Beneficial for less severe seizures in the elderly

A

Gabapentin

106
Q

Both monotherapy and adjunctive treatment in patients with
partial seizures

Alternative for primary generalized seizure types

Adjunctive therapy for primary GTC seizures

A

Lamotrigine

107
Q

Indicated for patients with partial seizures who have failed
initial therapy

Approved for adjunctive treatment of myoclonic seizures in
patients with JME

Adjunctive treatment of primarily generalized seizures in

patients with idiopathic generalized epilepsy

A

Levetiracetam

108
Q

Monotherapy

Adjunctive therapy in treatment of partial seizures in adults and children as young as four years of age

first-line drug for patients with primary generalized convulsive seizures

May also be effective in patients not demonstrating a response
to carbamazepine

A

Oxcarbazepine

109
Q

Drug of choice for neonatal seizures
- Reserved for patients who have failed therapy with other AEDs
- May be useful given IV in refractory status epilepticus
- Multiple dosage forms available (oral solid, oral liquid, IM,
IV)
- Most inexpensive AED

A

Phenobarbital

110
Q

First-line AED for primary generalized convulsive and partial
seizures

A

Phenytoin

111
Q
  • Second-line agent for patients with partial seizures who have
    failed initial treatment
  • Useful for chronic neuropathic pain and generalized anxiety
    disorder
A

Pregablin

112
Q
  • First-line AED for partial seizures as an adjunct and/or monotherapy
  • Approved for the treatment of tonic-clonic seizures in
    primary generalized epilepsy
A

Topiramate

113
Q

First-line therapy for primary generalized seizures including
myoclonic, atonic, and absence seizures
- Used as both monotherapy and adjunctive therapy for partial
seizures
- Useful in patients with mixed seizure disorders

A

Valproic acid

114
Q

Adjunctive treatment of partial seizures

A

Zonisamide

115
Q

Neurosensory side effects
- Diplopia
- Blurred visions
- Nystagmus
- Ataxia
- Unsteadiness
- Dizziness
- Headache
Hematologic side effect (leukopenia)

A

Carbamazepine

116
Q

Minimal CNS adverse effects and few drug interactions due
to broad therapeutic index

Aggressive behavior in children

A

Gabapentin

117
Q

diplopia, drowsiness, ataxia,
headaches

A

Lamotrigine

118
Q

sedation, fatigue, and coordination
difficulties

A

Levetiracetam

119
Q

dizziness, nausea, headache, diarrhea, vomiting, URTI, constipation, dyspepsia,
ataxia, and nervousness

A

Oxcarbazepine

120
Q
  • CNS side effects: primary factors limiting the use of phenobarbital
  • Hyperactivity in children
  • May also cause porphyria and rashes as serious as SJS
A

Phenobarbital

121
Q

CNS depressant effects (lethargy, fatigue, incoordination,
blurred vision, higher cortical dysfunction,
and drowsiness)
- Usually transient, can be minimized by slow dosage titration

A

Phenytoin

122
Q

Most frequently reported: dizziness, ataxia,
blurred vision and weight gain

A

Pregablin

123
Q
  • Slow dosage titration and increments
  • Main: ataxia, impaired concentration, memory difficulties,
    attentional deficits, fatigue, paresthesia, somnolence, and
    “thinking abnormally” which rarely has included psychosis
  • Cognitive dysfunctions in concomitant therapy with
    topiramate, valproic acid, or phenobarbital
A

Topiramate

124
Q
  • Most frequently reported: Gastrointestinal symptoms
    (nausea, vomiting, anorexia and weight gain)
  • Minimize GI complaints: enteric-coated formulation or by
    giving the drug with food
  • Alopecia and hair changes (temporary)
  • Most serious side effect: hepatotoxicity
A

Valproic acid

125
Q

Most common: somnolence, dizziness, anorexia, headache, nausea, agitation, wordfinding difficulties, irritability

A

Zonisamide

126
Q

Drug interaction:

Very significant
Drugs that inhibit CYP3A4 potentially may increase carbamazepine serum
concentrations

A

Carbamazepine

127
Q

Drug interaction:

Not likely to occur
- Do not induce or inhibit liver enzymes

A

Gabapentin

128
Q

Drug interaction:

  • Low potential for pharmacokinetic drug interactions
  • Do not induce or inhibit liver enzymes
A

Lamotrigine

129
Q

Drug interaction:

  • Do not induce or inhibit liver enzymes
  • Do not appear to interact with other AEDs, warfarin, digoxin,
    or oral contraceptive drugs
A

Levetiracetam

130
Q

Drug interaction:

  • Decreases the bioavailability of ethinyl estradiol and levonorgestrel
A

Oxcarbazepine

131
Q

Drug interaction:

Potent enzyme inducer (increases elimination of any drug
metabolized by CYP450)

A

Phenobarbital

132
Q

Drug interaction:

Associated with numerous drug interaction
- Involves altered absorption, metabolism, protein binding
- May enhance or reduce its effects

Dosing
- Must be in mg phenytoin
equivalents or PE
- Example: 75 mg fosphenytoin to 50 mg phenytoin sodium

A

Phenytoin

133
Q

Drug interaction:

Unlikely to happen, predominantly
excreted unchanged in the urine and undergoes negligible metabolism

A

Pregabalin

134
Q

Drug interaction:

Highly protein-bound, can be displaced by other drugs

A

Valproic acid

135
Q

Drug interaction:

  • Do not induce or inhibit liver
    enzymes
  • Should be avoided in patients
    allergic to sulfa drugs
A

Zonisamide

2nd shift lecs (21 decks)

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