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Flashcards in Epilepsy Deck (64):
1

ILAE definitions of epilepsy

1) Two unprovoked seizures 24 hrs apart
OR
2) unprovoked seizure + probability further seizures
OR
3) two seizures in reflex epilepsy

2

Define generalized seizure/ focal:

-generalized: onset is bilateral involving both hemispheres
-focal: one sided, onset consistent

3

EEG important for monitoring what non-epileptic neuro disease?

-herpes encephalitis
-hypoxic anoxic brain injury

4

When should EEG be done in ICU?

-unexplained AMS

5

What seizures may not be recorded at scalp?

frontal

6

When is EEG highest yield?

-sleep deprivation
-w/in 24-48 hours of seizure

7

When should treatment be started after first seizure?

-If eptileptiform activity is seen on EEG

8

Occipital protuberance is aka:

-inion

9

How many leads are on standard EEG?
Which side (left vs right) of head is assigned odd numbered leads?

-21, left leads are odd

10

List the frequencies for standard EEG wave types (a,b,y, d, theta)

-D: 0-4
-T: 4-8
-A: 8-12
-B: 12-40
-Y: 40-100

11

List the wave forms seen in each stage?

-BATS Drink Blood
B-awake
A-eyes shut
T-N1
Sleep spindles, K: N2
D: N3
B: REM

12

What are the types of (focal) seizures?

-simple- conscious
-complex: dyscognitive
-partial w/ secondary generalization (bilateral convulsions)

13

Most classic seizure types (tonic, absence, myoclonic) are what type?

generalized

14

Four seizure etiologies

genetic
structural/metabolic
immune
unknown

15

List two infantile epilepsies

-west
-dravet

16

List two childhood epilepsies

-benign w/ centrotemporal spikes
-absence

17

Infantile spasm triad

-hipsarrythmia
-spasms
-developmental arrest

18

List two adolescent/ adult epilepsies

-JME
-JAE

19

What might MRI localize in epileptic disease?

heterotopia, meseal temporal sclerosis

20

What age group requires repeat MRI 1 year later?

children under two, cortical lesions may not appear early

21

Chances of second seizure following first unprovoked seizure?

-30-50% in 2-5 years

22

What increases the risk of second seizure?

-abnormal EEG
-known etiology
-abnormal exam
-cortical lesion

23

2 MC ADRs of AEDs

Drowziness
Dizziness

24

What are the broad spectrum AEDs?

-Volcanic Lands Love Torturing People
-VPA
-Lamotrigine
-Levitiracetam
-TMX
-Phenobarb

25

Of the broad spectrum AEDs, which effect cyps?

-valproate: inhibitor
-phenobarb: inducer

26

Topiramate special ADRs?

-impaired fluency, cognition ("dopamax")
-weight loss because makes stuff taste nasty

27

levetiracetam special ADR?

-irritable mood

28

3 non-pharm treatments for epilepsy

-vagal nerve stim
-ketogenic diet
-surgery

29

Define catamenial epilepsy:

-assc w/ menstrual cycle

30

Estrogen effect on seizures

lowers seizure threshold

31

Increased risks of what repro conditions are seen in WWE

-PCOS
-infertility
-low libido

32

Which AEDs are assc w/ low bone density?

-EI

33

When may NTDs occur?

within 28 days post conception

34

What increases risk of NTD assc with AEDs?
What decreases?

-increases: polytherapy
-decreases: folic acid supplementation

35

Which AEDs are assc with NTDs? Which is worst?

-Volcanic Lands Love Torturing People (making) Children
-valproate ****
-lamotrigine
-levitiracetam
-topiramate
-phenytoin
-carbamazepine

36

How may seizures effect neonate?

-fetal hypoxia seen in GTCS

37

Rx for SE:

-1: benzo
-2: fosphenytoin
-3: intubation +midazolam/thiopental induced coma

38

When is epilepsy considered no longer present?

-10 year seizure free period off of AEDs

39

Important safety discussions to have with epilepsy patients:

-driving
-pregnancy
-SUDEP
-mood/SI
-daily activity

40

Compared to other neuro conditions, how many years of life are lost from SUDEP?

-2nd only to stroke

41

Describe progression of SUDEP

-usually at night
-GTC/ EEG supression --> rapid breathing --> cardio dysfunction

42

SUDEP is most commonly assc with what seizure types?

-GTCS but can happen in partial or without preceding seizure

43

High risk patients for SUDEP:

-developmental disability
-age 31-40
-ETOH
-symptomatic
-channelopathies
-AEDs w/ cardiac ADRs

44

-List 4 AEDs that cause cardiac abnormalities

-carbamazepine
-phenytoin IV
-rufinamide
-lacosamine

Come play rugby, love.

45

When in WV can epilepsy patients return to driving?

-seizure free 6 months

46

Gold standard for treating depression in epilepsy:

-CBT +SSRI

47

Phenyotin effects metabolism of which HIV drugs?

-must increase dose of ritonavir and lopinavir

48

Valproic acid effects metabolism of which HIV drugs?

-must decrease dose zidovudine

49

Phenytoin is known to interact with what drugs (in addition to antivirals

-phenobarb
-carbam
-warfarin
-digitalis

50

List four drugs that lower seizure threshold

-Wellbutrin
-tramadol
-pseudophedrine
-levaquine

51

When do catamenial seizurs tend to decrease?

Day 4-9 of menstrual cycle

52

Preferred method of contraception in epilepsy?

-dual, IUD #1 choice

53

Levitiracetam requires what changes in HC?

-decrease levonorgestrel + avoid and multiphasic doses

54

What AED decreases levonogestrel by 40%?**

perampanel****
Don't give to women of childbearing age!

55

Emergency contraception for epilepsy patients

double emergency pill dose or get copper IUD within 5 days

56

CBZ, LTM, Barbs are all assc with?

-cardiac defects

57

Which AEDs are dependent on glucuronidation for metabolism? What is the relevance?

-LTM and CBZ
-estrogen increases metabolism

58

Should moms on AEDs continue breast feeding?

yes

59

Which two AEDs may be assc with lower IQ in babies?

-VPA and CBZ

60

In general what increases the risk of AEDs lowering bone density?

-EI
-polytherapy

61

What three AEDs are shown to decrease bone density?

-PB
-PHT
-TPX

62

Three AEDs with high DEXA score?

-lamotrigine
-levetiracetam
-gabapentin

63

Mechanism of decreased bone density w/ AEDs?

-^vitamin D metabolism --> ^^PTH

64

Three concomitant risks for low bone density to remember for WWE?

-tobacco
-alcohol
-agitation