Flashcards in Epilepsy Deck (64):
ILAE definitions of epilepsy
1) Two unprovoked seizures 24 hrs apart
2) unprovoked seizure + probability further seizures
3) two seizures in reflex epilepsy
Define generalized seizure/ focal:
-generalized: onset is bilateral involving both hemispheres
-focal: one sided, onset consistent
EEG important for monitoring what non-epileptic neuro disease?
-hypoxic anoxic brain injury
When should EEG be done in ICU?
What seizures may not be recorded at scalp?
When is EEG highest yield?
-w/in 24-48 hours of seizure
When should treatment be started after first seizure?
-If eptileptiform activity is seen on EEG
Occipital protuberance is aka:
How many leads are on standard EEG?
Which side (left vs right) of head is assigned odd numbered leads?
-21, left leads are odd
List the frequencies for standard EEG wave types (a,b,y, d, theta)
List the wave forms seen in each stage?
-BATS Drink Blood
Sleep spindles, K: N2
What are the types of (focal) seizures?
-partial w/ secondary generalization (bilateral convulsions)
Most classic seizure types (tonic, absence, myoclonic) are what type?
Four seizure etiologies
List two infantile epilepsies
List two childhood epilepsies
-benign w/ centrotemporal spikes
Infantile spasm triad
List two adolescent/ adult epilepsies
What might MRI localize in epileptic disease?
heterotopia, meseal temporal sclerosis
What age group requires repeat MRI 1 year later?
children under two, cortical lesions may not appear early
Chances of second seizure following first unprovoked seizure?
-30-50% in 2-5 years
What increases the risk of second seizure?
2 MC ADRs of AEDs
What are the broad spectrum AEDs?
-Volcanic Lands Love Torturing People
Of the broad spectrum AEDs, which effect cyps?
Topiramate special ADRs?
-impaired fluency, cognition ("dopamax")
-weight loss because makes stuff taste nasty
levetiracetam special ADR?
3 non-pharm treatments for epilepsy
-vagal nerve stim
Define catamenial epilepsy:
-assc w/ menstrual cycle
Estrogen effect on seizures
lowers seizure threshold
Increased risks of what repro conditions are seen in WWE
Which AEDs are assc w/ low bone density?
When may NTDs occur?
within 28 days post conception
What increases risk of NTD assc with AEDs?
-decreases: folic acid supplementation
Which AEDs are assc with NTDs? Which is worst?
-Volcanic Lands Love Torturing People (making) Children
How may seizures effect neonate?
-fetal hypoxia seen in GTCS
Rx for SE:
-3: intubation +midazolam/thiopental induced coma
When is epilepsy considered no longer present?
-10 year seizure free period off of AEDs
Important safety discussions to have with epilepsy patients:
Compared to other neuro conditions, how many years of life are lost from SUDEP?
-2nd only to stroke
Describe progression of SUDEP
-usually at night
-GTC/ EEG supression --> rapid breathing --> cardio dysfunction
SUDEP is most commonly assc with what seizure types?
-GTCS but can happen in partial or without preceding seizure
High risk patients for SUDEP:
-AEDs w/ cardiac ADRs
-List 4 AEDs that cause cardiac abnormalities
Come play rugby, love.
When in WV can epilepsy patients return to driving?
-seizure free 6 months
Gold standard for treating depression in epilepsy:
Phenyotin effects metabolism of which HIV drugs?
-must increase dose of ritonavir and lopinavir
Valproic acid effects metabolism of which HIV drugs?
-must decrease dose zidovudine
Phenytoin is known to interact with what drugs (in addition to antivirals
List four drugs that lower seizure threshold
When do catamenial seizurs tend to decrease?
Day 4-9 of menstrual cycle
Preferred method of contraception in epilepsy?
-dual, IUD #1 choice
Levitiracetam requires what changes in HC?
-decrease levonorgestrel + avoid and multiphasic doses
What AED decreases levonogestrel by 40%?**
Don't give to women of childbearing age!
Emergency contraception for epilepsy patients
double emergency pill dose or get copper IUD within 5 days
CBZ, LTM, Barbs are all assc with?
Which AEDs are dependent on glucuronidation for metabolism? What is the relevance?
-LTM and CBZ
-estrogen increases metabolism
Should moms on AEDs continue breast feeding?
Which two AEDs may be assc with lower IQ in babies?
-VPA and CBZ
In general what increases the risk of AEDs lowering bone density?
What three AEDs are shown to decrease bone density?
Three AEDs with high DEXA score?
Mechanism of decreased bone density w/ AEDs?
-^vitamin D metabolism --> ^^PTH