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Epilepsy Flashcards

1
Q

ILAE definitions of epilepsy

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

Define generalized seizure/ focal:

A
  • generalized: onset is bilateral involving both hemispheres
  • focal: one sided, onset consistent
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3
Q

EEG important for monitoring what non-epileptic neuro disease?

A
  • herpes encephalitis

- hypoxic anoxic brain injury

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4
Q

When should EEG be done in ICU?

A

-unexplained AMS

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5
Q

What seizures may not be recorded at scalp?

A

frontal

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6
Q

When is EEG highest yield?

A
  • sleep deprivation

- w/in 24-48 hours of seizure

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7
Q

When should treatment be started after first seizure?

A

-If eptileptiform activity is seen on EEG

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8
Q

Occipital protuberance is aka:

A

-inion

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9
Q 
How many leads are on standard EEG?
Which side (left vs right) of head is assigned odd numbered leads?
A

-21, left leads are odd

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10
Q

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

A
  • D: 0-4
  • T: 4-8
  • A: 8-12
  • B: 12-40
  • Y: 40-100
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11
Q

List the wave forms seen in each stage?

A 
-BATS Drink Blood
B-awake
A-eyes shut 
T-N1
Sleep spindles, K: N2
D: N3
B: REM
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12
Q

What are the types of (focal) seizures?

A
  • simple- conscious
  • complex: dyscognitive
  • partial w/ secondary generalization (bilateral convulsions)
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13
Q

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

A

generalized

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14
Q

Four seizure etiologies

A

genetic
structural/metabolic
immune
unknown

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15
Q

List two infantile epilepsies

A
  • west

- dravet

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16
Q

List two childhood epilepsies

A
  • benign w/ centrotemporal spikes

- absence

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17
Q

Infantile spasm triad

A
  • hipsarrythmia
  • spasms
  • developmental arrest
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18
Q

List two adolescent/ adult epilepsies

A
  • JME

- JAE

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19
Q

What might MRI localize in epileptic disease?

A

heterotopia, meseal temporal sclerosis

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20
Q

What age group requires repeat MRI 1 year later?

A

children under two, cortical lesions may not appear early

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21
Q

Chances of second seizure following first unprovoked seizure?

A

-30-50% in 2-5 years

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22
Q

What increases the risk of second seizure?

A
  • abnormal EEG
  • known etiology
  • abnormal exam
  • cortical lesion
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23
Q

2 MC ADRs of AEDs

A

Drowziness

Dizziness

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24
Q

What are the broad spectrum AEDs?

A
  • Volcanic Lands Love Torturing People
  • VPA
  • Lamotrigine
  • Levitiracetam
  • TMX
  • Phenobarb
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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

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