Epilepsy,seizure ,status Epilepticus And Covid-19 Flashcards
(44 cards)
What are seizures and epilepsy
Seizures are sudden abnormal electric discharges from the brain that result in changes in the sensation,behavior ,movement ,perception or consciousness
Epilepsy is derived from the Greek word epilepsia meaning seizure.
It is the chronic disorder of recurrent seizures
What is Coronavirus(what family does it belong,what characteristic do the members show),coronavirus disease 2019,where does the virus infect?
Coronavirus is an enveloped, positive single-strand RNA virus. It belongs to the Orthocorovirinae subfamily, as the name suggests, whose members show characteristic ‘crown-like’ spikes on their surfaces.
•Coronavirus disease 2019 (COVID-19) is a contagious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This kind of virus infects the nose, sinuses or upper throat. The first known case was identified in Wuhan, China, in December 2019. It was initially reported to the WHO on December 31st, 2019 and that was how WHO derived the acronym COVID-19 meaning Coronavirus disease 2019.
On January 30, 2020, the WHO declared Covid-19 outbreak a global health emergency and on March 11, 2020, the WHO declared Covid-19 a global pandemic.
•Global cases of COVID-19 continue to rise, causing havoc to several economies. As of January 22nd, 2022, confirmed COVID-19 infections numbered over 359 million individuals worldwide and have resulted in over 5.62 million deaths. In Ghana COVID-19 infections numbered over 156,392 and have resulted in 1,384 deaths. All 16 administrative regions had recorded cases of COVID-19 by June 30, 2020 due to internal migration between the hotspots and other regions.
•From observation of patients presenting to health centres around the world suggests that, over 80% of symptomatic individuals with COVID-19 develop mild or uncomplicated illness, and approximately 14% develop severe disease requiring hospitalization and oxygen support, while 5% may have very severe illness requiring admissdion to an Intensive Care Unit (ICU) with ventilators for care
True or false
True
What is the Cause of CoVid disease,the virus was first isolated from three people with what ?
What is the mode of transmission
Although the virus is widely believed to have originated from animals, there is insufficient scientific evidence to identify the specific animal reservoir or the original mode of transmission of the disease to humans.
•However, SARS CoV-2 was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.
The spread of the disease in humans, however, is currently known to be from person to person, mainly through droplets arising from people sneezing, coughing, speaking or exhaling, which deposit on surfaces.
•The virus may be transferred from contaminated surfaces to mucosal surfaces (eyes, nose, mouth), via the hands.
•Aerosol transmission is also possible when people have prolonged exposure to high concentrations of droplets in relatively closed spaces.
Which four people are at risk of COVID -19
Individuals who have had close contact with a person with known or suspected COVID-19 ( at least, last 14 days)
•International travelers (high at risk countries of infection)
•Aged people
•People with chronic underlying medical conditions such as cardiovascular disease,diabetes, chronic respiratory disease, hypertension and immunosuppression.
What is the pathophysiology of CoVId-19
Inflammation of the lungs will cause what ?
SARS-CoV-2 virus can infect a wide range of cells and systems of the body. COVID‑19 is most known for affecting the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs).
•The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the receptor for the enzyme Angiotensin-Converting Enzyme-2 (ACE-2), which is most abundant on the surface of type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a “spike” to connect to the ACE-2 receptor and enter the host cell.
- ACE-2 receptors are also expressed in myocardial cells, renal epithelial cells, enterocytes, and endothelial cells in multiple organs, which may explain the extrapulmonary manifestations associated with the disease.
- Inflammation of the lungs will cause fever, shortness of breath and cough
What are the most common symptoms ,less common symptoms,serious symptoms of this Covid-19 disease
State four of each
Most common symptoms:
●Fever
●Cough
●Tiredness
●Loss of taste or smell
Less common symptoms:
●Sore throat ●Headache ●Diarrhea ●Rashes on skin, or discoloration of fingers or toes ●Red or irritated eyes
Serious symptoms:
●Difficulty breathing
●Loss of speech or mobility, or confusion
●Chest pain
●Loss of appetite,
When the Coronavirus disease affects the lungs ,the heart,the brain,spleen,pancreas,liver,kidney,GIT system state theee symptoms of each that show
Lungs:dyspnea
Chest pain
Cough
Pancreas:pancreatitis
Pancreatic injury
Heart: Chest pain Myocardial inflammation Palpitations T serum troponin
Brain: Brain fog Delirium Fatigue Sleep disturbances Depression/anxiety/PTSD/OCS
Spleen:
Decreased T and B lymphocytes
Atrophy of lymphocyte follicles
Liver:
Liver injury
Increased Aspartate aminotransferase
Increased Alanine aminotransferase
Renal:
Renal impairment
Acute kidney injury
GIT:
Diarrhea
Nausea
Sore throat
Blood vessels: Inflammation Vessel damage Coagulopathy Microangiopathy
State six signs of coronavirus disease
Fever (body temperature ≥ 37.5oC) •Tachypnea •Tachycardia •Cyanosis •Flaring of nostrils •Signs of consolidation on chest examination
- Use of accessory muscles of respiration (plus intercostal in-drawing etc.)
- Restricted chest wall movement (unilateral or bilateral)
- Drowsiness
- Restlessness or confusion
- Low blood oxygen saturation by pulse oximeter (SPO2 < 93%)
What are the four main investigations for COVID and four supportive ones
DIAGNOSTIC
•Polymerase chain reaction assay for SARS-COV-2 by nasal swabs
•Chest X-Ray (Patchy consolidation)
•Chest Computed Tomography: Ground glass changes
•Antibody testing
SUPPORTIVE •Full Blood Count (FBC): Raised leukocytes but lymphocytopenia •Liver Function Test •Electrocardiogram (ECG/EKG) •Blood Film for Malaria Parasites •Renal Function Test
State five ddx of coronavirus disease
What is the coMplication of this disease
Pneumonia •Tuberculosis •Asthma •Pleural effusion •Chronic Obstructive Pulmonary Disease •Congestive Cardiac Failure •Lung collapse
Complication
Acute Respiratory Distress Syndrome (ARDS)
How is coronavirus disease prevented
State the vaccines available
Wear a mask in public, especially when physical distancing is not possible
•Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
•Maintain a safe distance from others (at least 1 metre), even if they do not appear to be sick
•Clean your hands often. Use soap and water, or an alcohol-based hand rub
Stay home if you feel unwell. •Monitor your health daily •Get vaccinated; Vaccines available include; oPfizer vaccine oJohnson and Johnson oModerna vaccine oAstraZeneca vaccine oSputnik V vaccine
How is coronavirus disease treated
(Treatment objectives,non pharmacological treatment for kids,for all age groups) state five of the treatments for each
Treatment objectives;
•To prevent person to person transmission
• To alleviate symptoms of the disease
•To prevent and/or manage complications of the disease
• To treat secondary bacterial or other infections
• To eradicate the COVID-19 infection
Non Pharmacological;
●For children
•Tepid sponging to control fever i.e. children < 5 years
•Adequate fluids e.g. breast milk, porridge, coconut water
•Feed as can be tolerated during the episode. Give an extra meal per day for two weeks after recovery
Non Pharmacological
●For all age groups
•Early quarantine of suspected cases and self-quarantine of all contacts of confirmed cases with follow up
•Mechanical ventilation for respiratory distressed patients
•Cessation of smoking
• Physical exercise and Rest
•Lukewarm salt solution gargle 3 to 4 times daily
•Psycho-social support by counselling patients and contacts
What is the pharmacological management of coronavirus disease
State the drugs and how they work
●Pharmacological
•Anti-Viral Drugs
•. Remdesivir was the first drug approved by the FDA. The broad-spectrum antiviral is a nucleotide analog prodrug
Use of Corticisteroids as Supportive Care
•Use of corticosteroids improve survival in hospitalized patients with severe COVID-19 disease requiring supplemental oxygen.
•In other words, patient who requires mechanical ventilation needs it for bronchodilation and anti-inflammatory
ANTITHROMBOTICS
•A review of COVID-19 hypercoagulopathy describes both microangiopathy and local thrombus formation.
• Systemic coagulation defect leading to large vessel thrombosis and major thromboembolic complications, including pulmonary embolism, in critically ill patients.
•While sepsis is recognized to activate the coagulation system, the precise mechanism by which COVID-19 inflammation affects coagulopathy is not fully understood.
What is the pharmacological treatment of confirmed asymptomatic cases
State the first line and second line treatment
1st line treatment
Hydroxychloroquine, Oral
2nd line treatment
Chloroquine, Oral
What is the TREATMENT(Confirmed cases with Mild/Moderate symptoms) for COVID disease
First line and second line
TREATMENT(Confirmed cases with Mild/Moderate symptoms)
•1st Line Treatment
•Hydroxychloroquine, Oral
And
•Azithromycin or Doxycycline
•2nd Line Treatment
•Chloroquine, Oral
And
•Azithromycin or Doxycycline
What are the four drugs used to treat confirmed cases of COVID disease with severe disease
TREATMENT(Confirmed cases with severe diseases) •Hydroxychloroquine, Oral •Azithromycin or Doxycycline •Convalescent plasma •Methylprednisolone, IV
What are the nine major causes or triggers of seizures (remember VITAMIN DE) and give four examples of such causes under each cause
About (60-70 ) % of all cases have unknown origin
• -Vascular causes( common in focal types of seizures)
-acute ischemic strokes
-intra-cerebral hemorrhage
-subarachnoid hemorrhage
-anoxia( anoxic brain injury) (absence or supply of oxygen), extreme hypoxia
Specifically, anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues although there is adequate blood flow to the tissue. Hypoxia is a condition in which there is a decrease of oxygen to the tissue in spite of adequate blood flow to the tissue.
- -Infectious causes
- meningitis
- encephalitis
- Brain abscess- traumatic causes
- traumatic brain injury leading to
- epidural hematoma
- subdural hematoma - autoimmune causes
- systemic lupus erythematosus
- traumatic causes
Quick way to remember : VITAMIN D,E
- metabolic causes
- hypoglycemia
- hyponatremia
- hypocalcemia
- increased in metabolic waste ( urea , ammonia)
- hyperthyroidism
- idiopathic causes
- epilepsy
- Neoplastic causes
- brain tumor
- meningioma
- etc
- drugs causes
- opiods
- TCA’s
- cocaine
- ampitamines
- metronidazole
- alcohol withdrawal
- etc
- degenerative diseases like Alzheimer’s disease and demyelinating diseases like multiple sclerosis
- everything else
- eclampsia
- fever
- genetic causes
What are the causes of epilepsy
What are the causes of seizures in newborns and infants and kids before the age of 20yrs,people after the age of 20yrs,people older than 65 years
Can be caused by any process that disrupts the stability of the neuronal cell membrane
It’s idiopathic
Newborns:
Congenital brain defects ,birth injuries,metabolic problems such as anoxia,hypoglycemia,hypocalcemia,périnatal seizures
After 20:
Traumatic brain injury
Brain tumour
Infection
Older than 65: CVA Tumor Delirium Alzheimer’s disease Infection Brain trauma Chronic alcoholism
Why do seizures develop?
Hat protects the brain
The brain is dived into four structural parts name them
The cerebral hemisphere accounts for how much of total Brain mass and how many lobes does it have
Mention em
What are the functions of the brain
Seizures develop due to an imbalance between inhibitory and excitatory signals in the brain.
The brain is a sensitive organ protected by the rigid bone of the skull . The brain is divided into four structural parts: cerebrum, diencephalon, brainstem and cerebellum. The cerebral hemisphere accounts for about 83% of the total brain mass and it has five lobes: frontal, parietal, occipital, temporal and insular lobes.The brain coordinates the functions of the body by controlling the activities of the neurons which are specialized nerves that conduct electrical impulses throughout the central nervous and peripheral systems. To fulfil their functions of controlling cognitive activities, sensory perception and skeletal muscle contractions, the nerve cells (neurons) of the brain must work in harmony.
What is the pathophysiology of seizures
Seizure occurs basically due to excessive firing of the neurons and fast spread of these impulses over the brain.
-that is , there are two phenomenons in the pathophysiology of a seizure:
•Hyper excitability of a neuron
•hyper synchronization
- Hyper synchronization means that a hyper-excitable neuron leads to excessive excitability of a large group of surrounding neurons. This means that when a large electrical impulse is generated in one part of the brain from a focus of tissues millions of neurons in the brain fire excessively in addition bringing on a seizure.
•In summary the hyperexcitable state associated with epilepsy results from excessive excitatory transmission, reduced inhibitory neurotransmission, or both. If abnormal, excessive electrical activity spreads over an area large enough, then a seizure may develop.
What is the pathophysiology of epilepsy(state the abnormal first)
State the abnormal neuronal activity
Excitatory and Inhibitory Synaptic Signaling
- Neurons talk to each other by passing chemical signals called neurotransmitters across small gaps known as synapses. Presynaptic neurons release neurotransmitters which then diffuse across the synapse before binding to the receptor on the postsynaptic neuron. This process is called synaptic transmission. - The binding of a neurotransmitter to its corresponding receptor exerts specific effects on the postsynaptic cell, for example by influencing its membrane potential. Accordingly, we can broadly divide neurotransmitters into excitatory and inhibitory.
Excitatory and Inhibitory Synaptic Signaling
-brief on synaptic transmission
• Synthesis of acetylcholine occurs in the presynaptic neuron
•Acetylcholine is stored in vesicles within the presynaptic neuron
•The influx of calcium ions following the depolarization of the presynaptic terminal initiates the fusion of vesicles with the presynaptic membrane
•Neurotransmitter is released into the synaptic cleft by a process known as exocytosis
•Neurotransmitter diffuses across the synaptic cleft and binds to nicotinic acetylcholine receptors on the postsynaptic membrane
•Acetylcholine is broken down by acetylcholinesterase into choline and acetate
•Choline is taken up the presynaptic neuron for further production of acetylcholine
Excitatory and Inhibitory Synaptic Signaling
-Neurotransmitters can be broadly divided into excitatory and inhibitory:
•Excitatory neurotransmitters increase the likelihood of postsynaptic neuron depolarization and generation of an action potential
•Inhibitory neurotransmitters reduce the likelihood of postsynaptic neuron depolarization and generation of an action potential.
•An example of the excitatory neurotransmitter is glutamate, whereas GABA is an inhibitory neurotransmitter. Some neurotransmitters, including dopamine, may exert both excitatory and inhibitory effects by binding to different receptors.
Excitatory Synaptic Signaling
-Glutamate is the most abundant neurotransmitter in the vertebrate nervous system. It exerts its effects via ionotropic receptors such as kainate, AMPA or NMDA receptors as well as metabotropic receptors – mGlu1-mGlu8.
-Upon binding of glutamate molecules to a receptor such as AMPA receptor(The α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (also known as AMPA receptor, AMPAR, or quisqualate receptor) is an ionotropic transmembrane receptor for glutamate (iGluR) that mediates fast synaptic transmission in the central nervous system (CNS).), its integral ion channel opens and ions( sodium and potassium ) flow across the postsynaptic neuronal membrane.
Inhibitory Synaptic Signaling
- GABA is the major inhibitory neurotransmitter in the mammalian nervous system. Similarly to glutamate, it acts via ionotropic receptors – GABAA receptors– as well as metabotropic receptors – GABAB receptors. - the binding of GABA to GABAA receptors induces the opening of ion channels that are selectively permeable to chloride ions. Consequently, GABA causes chloride ions to flow across the postsynaptic membrane. As chloride ions are more abundant extracellularly, they will flow down their concentration gradient into the cell, producing a hyperpolarising current and hence generating a hyperpolarising inhibitory postsynaptic potential. - This takes the postsynaptic membrane away from the action potential threshold, thus inhibiting the postsynaptic cell.
Abnormal neuronal activity:
Abnormal neuronal activity
-Normally brain tissues prevent hyper excitability by several inhibitory mechanisms involving negative ions like chloride ions.
-Disturbance in this normal excitability leads to hyper-excitability
- In this state there is increases excitatory transmission of impulses and decreases inhibitory transmission
•Mechanism of seizure formation
• Excitation of a group of nerves. This is caused by inward currents of Na, Ca and involvement of excitatory neurotransmitters like Glutamate and Aspartate.
- Too little inhibition.
- Epileptogenesis, hyperexcitability and hyper synchronization of neurons that facilitates spread. There has to be abnormal synchronization – a property of a population of neurons to discharge together independently. Alone, a hyperexcitable neuron cannot generate a seizure.
What are the two major types of seizures and the groups under them and explain each of them
Focal seizures:they result from abnormal electrical activity in one area of your brain .
They can occur with or without loss of consciousness
a.Focal seizures with impaired awareness:these seizures involve a change or loss of consciousness or awareness. They stare into space and not respond normally to the environment or they perform repetitive movements such as hand rubbing,chewing,swallowing,or walking in circles
b.Focal seizures with consciousness:These seizures may alter emotions or change the way things look,smell ,feel,taste or sound, but they don’t lose consciousness
They may result in involuntary jerking of a body part such as an arm or a leg, and spontaneous sensory symptoms such as dizziness,tingling and flashing lights
Generalized seizures :seizures that appear to involve all parts of the brain.
a.Absence seizures:previously known as petit mal seizure often occurs in kids and is characterized by staring into space or subtle body movements such as eye blinking or lip smacking . These seizures may occur in clusters and cause a brief loss of awareness
Episodes last less than 15secs
Tonic seizures:Tonic seizures cause stiffening of your muscles . They usually affect muscles in your back ,arms and legs and may cause you to fall to the ground
Atonic seizures:also knows as drop seizures cause a loss of muscle control which may cause sudden collapse or fall down
Clonic seizures:they’re associated with repeated or rhythmic jerking muscle movements. They usually affect the neck,face and arms
Myclonic seizures:usually appear as sudden brief jerks or twitches of arms and legs
Tonic-clonic seizures:previously known as grand mal seizures are the most dramatic type of epileptic seizures and can cause an abrupt loss of consciousness,body stiffening,shaking,and sometimes loss of bladder control,biting of tongue
Name five clinical manifestations of seizures
Can range from mild to severe and vary depending on the type of seizure
Temporary confusion A staring spell Uncontrollable jerking movements of the arms and the legs Loss of consciousness and awareness Cognitive or emotional symptoms such as fear,anxiety or deja vu Loss or alteration of basic senses Trembling or shaking Incontinence Numb and prickling sensation
