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CSI > epilepsy > Flashcards

epilepsy Flashcards

1
Q

questions to ask

A 
prodrome?
loss of urine/BM?
tongue biting?
describe seizure (witnesses?)
occupation?
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2
Q

seizure old def

A

paroxysmal event due to abnormal, excessive, hypersynchronous discharges from aggregate of CNS neurons

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3
Q

seizure new def

A

transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain

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4
Q

epiplepsy

prevalence?

causes??

A

Recurrent seizure due to genetically or acquired brain disorder

0.5 to 1 % of pop

50% have a cause:
Head trauma, brain tumor, stroke, infection in brain, congenital

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5
Q

what is NOT considered epilepsy

A

etOH, metabolic derangements (PROVOKED)

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6
Q

seizure initiation phase

A

High frequency APs and hypersynchronization (all at same time)
Long lasting depol. of membrane due to influx of calcium which opens voltage dependent sodium channels–>repetitive action potentials
(abnormal e- activity)

location of activity determines type

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7
Q

if gets better w. prednisone

A

reduces vasogenic edema from brain mass

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8
Q

seizure propagation phase

A

can go all over from initial location

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9
Q

??? can lower seizure threshold by inhibiting (antagonizing) the effects of ??? at the receptors

A

PCN (dangerous!)

GABA

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10
Q

structural/metabolic causes

A

Pediatric – congenital
Metabolic – withdrawal alcohol, drugs, hypoglycemia
Trauma – post trauma, may not imply future seizure
Tumors – all patients > age 30 with seizure must have head imaging, focal seizures
Vascular – usually advanced age, >60
Infectious – AIDS, meningitis, encephalitis, syphilis, cysticercosis

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11
Q

hypoglycemic seizures are

A

reversible, give sucrose

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12
Q

assess for meningitis

A

nuchal rigidity
Kernig: flex knee and hip
Bruzinski: flex neck
stretching meninges

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13
Q

partial seizure: simple

A

motor, sensory, autonomic, or psychic signs
-preservation of consciousness
Jacksonian march: spread over larger regions of motor cortex
Todd’s paralysis: loc. paresis after seizure

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14
Q

partial seizure: complex

A

loss of consciousness
Frequently begins with aura

Automatisms:
Chewing, lip smacking, picking

EEG will be abnormal during seizure

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15
Q

partial with secondary generalization

A

Focal onset may not be clinically evident, but EEG would capture spikes/waves
Difficult to distinguish from generalized tonic clonic seizure

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16
Q

primarily generalized seizures: absence (petit mal)

A

“staring off into space”
Brief lapse of consciousness without loss of postural control

Frequently lasts seconds
Usually begins in childhood, ages 4-8
Can occur hundreds of times a day
Decline in school performance? Daydreaming?

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17
Q

primarily generalized seizures: tonic clonic (grand mal)

A

~10% of patients with epilepsy have this type

Most frequent type from metabolic derangements

Tonic contraction of muscles of expiration and larynx cause “ictal cry”

EEG will be abnormal during seizure

what worry about: airway, aspiration, most dangerous

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18
Q

other primarily generalized seizures:

A

tonic: stiffening
atonic: limp
myoclonic: shaking

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19
Q

unclassified:

A

neonatal

infantile

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20
Q

simple partial seizure symptoms

A

paresthesia, flashing lights, vertigo, flushing, altered smell/hearing

EEG will be abnormal during seizure, but hard to classify unless actually having seizure- use 24 hr EEG
how to provoke? sleep deprivation

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21
Q

generalized seizure arise from..

A

both hemispheres simultaneously

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22
Q

Juvenile Myoclonic Epilepsy

A

Bilateral myoclonic jerks single or repetitive

Most frequent in AM, worse with sleep deprivation

Respond well to anti convulsive therapy
-roll on side
hypoglycemic?

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23
Q

Lennox-Gastaut Syndrome (triad)

A

1) multiple seizure types (ie: generalized tonic clonic, atonic, atypical)
2) an EEG showing slow spike and wave discharges
3) impaired cognitive function

24
Q

a normal brain is…

A

capable of having a seizure, there are differences in the threshold or susceptibility
i.e. 2 kids w/ fevers, 1 gets seizure, other doesn’t

25
Q

a variety of conditions have high chance of chronic seizure disorder

A

i. e. penetrating brain trauma, 50% chance of epilepsy

- ppx anticonvulsants

26
Q

seizures are ??

A

episodic

May go months to years between episodes

27
Q

things to exclude

A 
syncope
TIA (stroke-like, resolves w.in 24 hrs)
migraine
acute psychosis (pseudo seizure)
other causes of episodic cerebral dysfunction
28
Q

how to dx pseudoseizure??

A

dx of exclusion
24 hr EEG
HAVE episode, NORMAL EEG
trick: “hand drop” doesn’t fall on face

29
Q

ddx syncope from seizure

A 
(convulsant syncope
can pass out and shake
gray vision, lightheaded)
see slide 21
seizures longer
biting of tongue
30
Q

hit ground fast with no prodrome

A

cardiac arrhythmia

31
Q

if hx of epilepsy

A 
consider tx, SEs, serum levels
e-lytes (hypoNa)
CBC (leukocytosis)
L/RFTs
tox screen (ecstasy: hypothermic, thirsty-->hypoNa)
32
Q

no hx epilepsy

A

same labs + serum glucose, Ca, Mg, UA

33
Q

do what first?

A

head CT w. w.out contrast
contrast better for masses
no contrast better for bleeds

34
Q

+ metab. screen

A

metab/inf disorder

35
Q

no hx epilepsy, neg metab. screen

A 
MRI scan or EEG ?
if neg: idiopathic seizure
if pos: mass, stroke, etc-tx underlying disorder
for both:
controversial: antiepileptic meds
36
Q

ddx seizure

A

TIA
Panic Attack
Syncope

Psychogenic Nonepileptic Seizure (PNES):
Check prolactin, which can be high 15-30 minutes after a tonic-clonic seizure in most patients
CK may also be high post convulsion

37
Q

check ?? level after seizure

why ??

A 
CK 
rhabdomyalgia (tightened musc.)
38
Q

chance my child will have it again?

A

It is possible, but unlikely

39
Q

childhood febrile seizure

A

Simple febrile – brief, symmetric

Complex febrile - >15 minutes, focal features

1/3-1/2 of children will have another seizure, but

40
Q

evaluation

A 
ABCs
Hx/exam (neuro focus)
lab studies 
EEG
brain imaging
psychogenic seizure
prolactin level (rises in seizure)
41
Q

lab studies

A

CMP, Magnesium, UDS
LP if meningeal signs on exam
HIV patient? Must do LP.

42
Q

EEG

A

Recording electrodes on scalp, potential differences recorded

Normal awake, 8-13Hz alpha rhythm, variable faster >13Hz beta waves

Sleep deprivation helps induce seizure, consider 24 hour continuous EEG; may be normal 60% of the time

43
Q

brain imaging

A

Almost all patients, except children may not need this

*MRI better than CT to detect any anatomical abnormalities

44
Q

status epilepticus

how does it wreak havoc?

A

Repeated seizures without recovery between them; a fixed and enduring epileptic condition lasting > or = 30 minutes

Medical Emergency: can “fry” brain, airway issues
May lead to irreversible neuronal injury

45
Q

seizure tx

A

Treat underlying cause if metabolic
Avoid alcohol if alcoholic
Single seizure, started AED is controversial

46
Q

status epilepticus tx

A

Typically intubation, lorazepam (ativan), and AED (anti-epileptic drugs)
all together

If no IV, can give rectal diazepam (valium)

resp. depression is issue with lots of benzos-intubate–>ventilator

47
Q

first line tx: tonic-clonic

A

valproic acid

lamotrigine

48
Q

FLD: partial

A

carbamazepine
phenytoin (dilantin)
lamotrigine
valproic acid

49
Q

FLD: absence

A

valproic acid
ethosuximide
“sucks to have an absence seizure”

50
Q

FLD: atypical absence, myoclonic, atonic

A

valproic acid

51
Q

phenytoin (dilantin) OD SEs

A

diplopia, skin rashes (SJS), ataxia, nystagmus, gingival hyperplasia

52
Q

carbamazepine (tegretol, carbatrol) OD SEs

A

leukopenia, aplastic anemia

53
Q

valproic acid OD SEs

A

thrombocytopenia, hepatic toxicity

54
Q

can you ever stop the medicine?

A

it depends

after 2 yrs seizure free

55
Q

Lamictal SEs OD

A

SJS, skin rash

CSI (75 decks)

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