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Flashcards in epilepsy Deck (47):
1

def. epileptic seizure

- transient occurance of signs and Sx
- due to abnormal excessive syncronous neuronal brain activity

2

def.epilepsy

- disorder of the brain with an enduring predisposition to seizures
- patient has had at least one seizure

3

def. focal seizure

originating within networks limited to one hemisphere
- can be discretely localized or more widely distributed

4

def. generalized seizures

originating at some point in the brain and rapidly engaging bilaterally distributed networks

5

*** 3 types of focal seizures

1. no impairment of consciousness
- simple partial
- subjective Sx only, or observable motor features only
2. with impairment of consciousness or awarness
- complex partial
3. eveolving to bilateral convulsive seizure
- secondary generalized

6

6 types of generalized

1. tonic-clonic
2. abscence
3. clonic - full body
4. tonic - seize up
5. atonic
6. myoclonic - very short

7

what does 3Hz spike and slow wave indicate

absence epilepsy

8

DDx for a "spell" (7)

1. seizure
2. cardiac
3. migraine
4. stroke/TIA
5. decerebration
6. movement disorder
7. psychogenic non-epileptic event

9

3 patient Hx questions

1. warning with siezure
2. preciptating factors
3. health at seizure onset

10

what to ask for to see if there is a previous seizure

many PTs unaware
- positive phenomenology
- flashin lights
- aura
- post-ictal confusion
- tonguq biting
-bed wetting

11

5 possible predisposing factors

1. birth insult
2. febrile seizures
3. meningitis
4. traumatic brain injury
5. fam Hx of epi

12

why is close questioning important

50% of "1st" seizures will have had one before

13

what are acute precipitants

1. drugs
2. withdrawal
3. metabolic
4. meninggitis
5. brain abscess
6. vascular

14

5 investigations

1. general and neuro exam
2. labs
3. EKG - long QT, brugada
4. EEG
5. neuroimaging

15

why EEG? 2

1. helps diagnose - tells if consistent with Sx
2. help prognosticate - if +ve, 50% chance risk of seizure in next 5 years

16

what is sens of interictal epiletiform changes

intial EEG - seen in 20-55%
repeat - seen in 80-90%
negative EEg doesn't rule out

17

use of imaging

- significant problem in 10%
- should always do unless known primary epilepsy

18

5 predictors of recurrent sizure

1. epiletiform on EEg
2. know etiology is symptomatic
3. post-ictal todd's paralysis
4. prior seizure
5. multiple seizure in first 24 hours NOT predictove

19

what to be cautious about with meds

triggering a seizure

20

what are cautions for GTC, partial, myclonic, absence, atonic/clonic

GTC - ETX
partial - ETX
myclonic - ETX, PHT, CBZ, OXC, LTG
absence - PHT, CBZ, OXC

21

what are good drug for fast dosing

- pheytoin
- valproate
- gabapentin
- levetircetem

22

what is phenytoin use for

emerg. and maintance

23

AE of phenytoin

CNS - mystagmus, cognition, encephalopathy, movement disorders
GI - give with meals
chronic - cerebellar, peripheral neuopathy, cosmetic

24

when to use and not use carbemazepine

good - partial onset, generalized tonic/clonic
bad - JME

25

carbemazepine SE

nausea, GI
neuro - dizzy, sedation, HA, ataxia

26

how to give valproic acid

emergency loads, then gradually titrate loads up

27

main caution in valpoate

teratogenticity

28

SE of levetiracetam

- somnolence, dizzyness
- behav. mood distubances
- hypersensitivity

29

what is best drug for seizure control

vaproic acid

30

what is Juv. myoclon epi

triad of absence, generalized convulsions, and myoclinc seizures
- high rate of remission with AED
- life long therapy
- traditionally valproate

31

what is caution with valproate

teratogenicity
- can give folic acid

32

6 meds that are high risk for contraceptive failure

1. phenobarbital
2. primidone
3. phenytoin
4. carbamazpine
5. oxcarbazepine
6. topriamate

33

def. status epilepticus

- 5 mins or longer of continuous seizure
- or 2 or more discrete seizures without complete recovery of consciousness

34

4 types of status

1. generalized tonic-clonic
2. nonconvulsive - absence, partial
3. focal motor status
4. myoclonic

35

what is mort. of SE

17-23%

36

what does mort depend on (4)

1. etiology - alc. better
2. duration (best predictor)
3. age - worse older
4. treatment adequacy

37

morbidity of SE

-neuro delay in kids
- speech deficits
- 10-23% of pts with SE are left disabled

38

what is important with timing in SE

need to treat ASAP

39

mgmt step in SE (4)

1. ABCs
2. check glucose, thiamine if giving glucose
3. anticonvulsants
4. diagnose and treat underlying cause

40

what are anticonvulsants for sE

1st line - benzos
2nd line - if fail - phenytoin
3rd line - ICU for general anasthetic

41

etiology of SE in order

1. stroke
2. med change/non-compliance
3. EtOH/ drugs

42

def. refractory epilepsy

- not well controlled after 2 trials of drugs
- 20-40%
- after 2, send for speciality care

43

def. psychogenic non-epiletic seizures

- form of conversion disorder
- most commonly masquerade as medically refactory epi

44

features of psedo seizures

- multiple ill defined and illdescribed
- tongue bite on tip, not sides
- paradoxical response to drugs
- other Psych
- tearing/crying during seizure

45

what is concept of surgery

- remove the zones that begin the seizure
- epileptogenic zone

46

what is rate of cure for surg

70-80%
- mortality ration of 2-5%

47

when to refer

when there has not been appropriate seizure control by neurologist in 9 months
- takes average of 20 years

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