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PR3153 > IC6&7: Seizures and Epilepsy > Flashcards

IC6&7: Seizures and Epilepsy Flashcards

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1
Q

What is seizures?

A

Transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in brain

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2
Q

What is epilepsy?

A

It is a conditions that is affected by
1. Min. 2 unprovoked seizures > 24 hours apart
2. 1 unprovoked and probability of further seizures similar to general recurrence risk after 2 unprovoked seizures for next 10 years
3. Diagnosis of epilepsy syndrome

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3
Q

What causes an acute seizure?

A

Recognizable stimulus such as metabolic disorders, toxic substance, infection, inflammation or structural issues

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4
Q

What is a remote seizure?

A

Seizure that occur longer than 1week following disorder known to increase the risk of epilepsy

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5
Q

What is an non-epileptic seizure?

A

Seizures that have s/s similar to that of epilepsy but there is no abnormal discharge

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6
Q

What is an unprovoked seizure?

A

Seizure not caused by anything clinical condition or beyond interval estimated for occurrence of acute symptomatic seizures

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7
Q

What are the 2 types of non-epileptic seizures?

A
  1. Psychogenic non-epileptic seizures
  2. Psychological non-epileptic events
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8
Q

What are the common drugs that are related to lowering of seizures threshold?

A
  1. Antimicrobial - beta-lactam (high doses)
  2. Analgesics - Opioids, tramadol
  3. Antipsychotics - Clozapine
  4. Antidepressant - Bupropion
  5. Immunosuppressants - cyclosporine
  6. Simulants - Dextroamphetamine, metylphenidate
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9
Q

Describe the pathophysiology of seizures and epilepsy.

A
  1. Hyperexcitability: Increase depolarization due to imbalance of neurotransmitter, abnormal intra and extracellular substances, and ion channels
  2. Hypersynchronization: Hippocampal sclerosis (reorganization of local circuits, contribute to synchronization + promotion of epileptiform activity generation)
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10
Q

What are the key features of ILAE classifciation?

A
  1. Location of seizure in brain
  2. Awareness level
  3. Other features of seizure
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11
Q

What are the clinical presentation of focal onset seizures?

A
  1. Motor symptoms: Clonic twitching, speech arrest
  2. Sensory: GI discomfort, numbness, tingling, visual
  3. Autonomic: BP, pallor, HR
  4. Psychic: flashback, hallucinations, mood changes
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12
Q

What are the clinical presentation in generalized tonic clonic seizures?

A
  1. Limbs stiffening, jerking of face and limbs
  2. Breathing issues - labored, heavy
  3. Cyanosis
  4. Possible incontinences, biting of tongue and inner mouth
  5. Headaches, lethargic, confused, sleepy - After seizures
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13
Q

Generalized clonic seizures are ______ and ______ in naure and often occurs in _______.

A
  1. Asymmetrical
  2. Irregular
  3. Neonates, infants, young children
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14
Q

What are the clinical presentation of generalized tonic seizures?

A

Sudden loss of consciousness and rigid posture of entire body lasting 10 to 20 seconds

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15
Q

Generalized tonic seizures are common in ______.

A

Lennox-Gastaut syndrome

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16
Q

Generalized myoclonic seizures involves _______.

A

rapid, brief contractions of bodily muscles on both side

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17
Q

List the clinical presentation of absence sizeures.

A
  1. Basic lapse in awareness for a few seconds
  2. EEG pattern “3 Hz spike wave”
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18
Q

What is the characteristic presentation of atonic seizures?

A

Collapse like “paper doll”

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19
Q

What is the scalp electroencephalography used for?

A

Diagnosis and seizures classification

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20
Q

What are the limitation of scalp electroencephalography?

A
  1. Not all patients will have abnormal EEG
  2. Normal EEG does not exclude possibility of epilepsy
  3. Unable to sense if seizures from deep down the brain
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21
Q

What is the use of a video EEG?

A

To assist in diagnosis of issues that cannot be solved by normal EEG

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22
Q

MRI with gadolinium helps to identify _____.

A

focal lesions

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23
Q

What are the biochemical and toxicology test used for?

A
  1. Rule out electrolytes abnormalities
  2. Measure serum prolactin
  3. Creatine kinase
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24
Q

List 4 psychosocial issues that seizures patients face?

A
  1. Social stigma
  2. Employment
  3. Driving prohibition
  4. Caregiver burden
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25
Describe the first aid measurements that should be done when someone is having seizures.
1. Lay person on floor with something soft under head, facing one side. 2. Remove sharp objects, glasses and potential objects that can obstruct breathing 3. Time seizure. If > 5mins, call 911
26
List 4 things that should not be done when someone is having a seizure.
1. Restrict movement 2. CPR 3. Put anything in mouth 4. Offer food/ water till alert
27
List 4 non-pharmacological methods used for seizures.
1. Ketogenic diet 2. Vagus nerve stimulator 3. Responsive neurostimulator system 4. Epilepsy surgery
28
Ketogenic diet is mainly used for seizure prevention in ______.
children
29
Vagus nerve stimulator is used only for _____ seizures.
intractable focal
30
Responsive neurostimulator system helps decrease _______ seizures.
partial onset
31
When is responsive neurostimulator used?
1. PT with localized ≤ 2 epileptogenic foci 2. Refractory to ≥ 2 antiepileptic medication 3. Freq and disabling symptoms
32
What are the first generation ASM drugs indicated for focal onset epliepsy?
Carbamazepine Phenobarbital Phenytoin Sodium Valproate
33
What are the second generation drugs indicated for focal onset epilepsy?
Lamotrigine Levetiracetam Topiramate
34
What are the medications indicated for generalised tonic clonic seizures?
Carbamazepine Sodium Valproate Lamotrigine Topiramate
35
1st generation ASM have _____ protein binding and ____ water solubility.
high, poor
36
How are 1st generation ASM cleared?
Hepatically
37
1st generation ASM have _____ DDIs.
multiple
38
How are first generation ASM administrated?
Oral (Good F)
39
Newer generation ASM have _____ water solubility due to ____ protein binding
better, poorer
40
Which of the newer generation is not renally cleared?
Lamotrigine
41
Which of the newer ASM have multiple DDIs?
Lamotrigine, Topiramate
42
______ is both an inducer and inhibitor.
Topiramate
43
Which of the ASM are not inducers nor inhibitors?
Gabapentin, pregabalin
44
Most of the drugs are inducers except _____.
sodium valproate
45
List the 5 drugs classes that have interaction with ASM.
1. Antidepressants 2. Antipsychotics 3. Immunosuppressive therapy 4. Chemotherapeutics 5. Antiretroviral
46
What are some DDI effects associated with ASM?
1. Women: reproductive hormones, sexual functions, OC 2. Men: Sexual function, fertility 3. Bone health 4. Vascular risk
47
When is correction need for phenytoin?
Albumin < 40g/L
48
What happens when a patient is give more than 400mg of phenytoin?
Bioavailability decreases
49
Phenytoin follows ____ order kinetics.
zero
50
What happens when phenytoin concentration is increased?
Clearance decreases
51
Valproate can be displaced by ______ compounds
Endogenous compounds (Uremia, hyperbilirubinemia)
52
Valproate exhibits _______ protein binding with therapeutic range.
saturable
53
When valproate concentration is increased, protein binding ______.
decreases
54
Carbamazepine undergoes _____ metabolism.
autoinduction
55
List the dose and plasma concentrated side effects of ASM.
CNS GI (N/V - carbamazepine, valproate) Psychiatric (behavioral disturbance - levetiracetam) Cognition (speech - topiramate)
56
What are some idiopathic and hypersensitvity related adverse effect
Blood dyscrasia Hepatotoxicity (1st gen except phenobarbital) Pancreatitis (sodium valproate) Lupus like reaction Exfoliative Dermatitis TEN/SJS
57
Which of the ASM should be avoided in patients are tested positive for HLB-B*1502?
Carbamazepine
58
What is a chronic adverse effect of phenytoin?
Gingival hyperplasia Hirsutism Peripheral neuropathy (at high dose) Osteomalacia
59
Which ASM drugs will have osteomalacia as a chronic side effect?
1. Phenytoin 2. Phenobarbital 3. Carbamazepine
60
What is a chronic adverse effect of sodium valproate?
Alopecia
61
What is one chronic adverse effect present in all ASM?
Suicidal ideation
62
Topiramate may cause _____ and ______ as chronic side effects.
anorexia, decrease weight
63
What are two chronic side effects of sodium valproate?
1. Increase weight 2. Alopecia
64
List four indications for TDM in patients on ASM?
1. Establish individual therapeutic range 2. Assess lack of efficacy 3. Assess potential toxicity 4. Assess loss of efficacy
65
When can ASM treatment be stopped?
1. No seizures after minimum of 2 years 2. Low frequency or increased risk: after 2 years
66
Seizures are considered resolved once patient is free from seizure for ___ years and medication for ___ years.
10, 5
67
What are the ASM drugs that can be used in women of pregnancy age or pregnant women?
Levetiracetam and Lamotrigine
68
What is the ASM contraindicated in woman?
Valproate
69
What is the medication that may lower lamotrigine?
Oral contraceptive
70
ASM can be used in women who are ______.
breastfeeding
71
Man treated on valproate are at increased risk of children having _______ disorder.
neurodevelopmental
72
What is status epilepticus?
Failure of mechanism responsible for seizures termination or initiation of mechanism leading to abnormal prolonged seizures, which can have long term consequences depending on duration and type of seizures.
73
What should be done for status epilepticus in phase 1?
1. Stabilise airway, breathing, circulation 2. Time seizure 3. Check vital signs (oxygen, ECG, glucose)
74
What are the medications given to adult if blood glucose is less than 60mg/dl?
IV Thiamine + D50W
75
What are the medication given to children at phase 1?
IV D25W IV D12.5W (<2years)
76
What is the drug of choice for status epilepticus at phase 2?
Benzodiazepine (Diazepam, Lorazepam, midazolam)
77
What medication can be given at phase 3 for status epilepticus?
Phenytoin, valproic, levetiracetam

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