L4: Epilepsy Flashcards
(125 cards)
1
Q
Def of Seizure
A
- A transient neurologic sign and/or symptom due to abnormal, excessive, synchronous neuronal activity in the brain.
- Defined as acute symptomatic seizures or provoked seizures.
2
Q
Cause of Seizure
A
- 25% have a clearly identifiable, temporally associated cause.
3
Q
Incidence of Seizure
A
- A very common neurological problem.
- Affects 10% of individuals at some point in their lives.
4
Q
Def of Epilepsy
A
- Disease of the CNS characterized by:
- Enduring predisposition to generate epileptic seizures
- Neurobiological, cognitive, psychological, and social consequences of this condition.
- Defined as two or more unprovoked seizures
5
Q
Cause of Epilepsy
A
- Having no identifiable acute, proximal cause
6
Q
Incidence of Epilepsy
A
- The most common try disorder of brain.
It has an age-specific incidence:
- Highest in the very young (20 y)
- Highest in the very old (75y).
7
Q
Difference between Seizure & Stroke in one sentence
A
- Seizure → Event
- Epilepsy → Recurrent unprovoked seizures
8
Q
Etiology of Seizures
A
9
Q
Etiology of Seizures
- Those who have identifiable Causes
A
10
Q
Etiology of Seizures
- Those who don’t have identifiable Causes
A
Often have a genetic or unidentified environmental cause as:
- Genetic epilepsy syndromes
11
Q
Criteria of Dx of Epilepsy
A
12
Q
Pathophysiology of Seizures
A
13
Q
Pathophysiology of Seizures
- Cellular Mechanism of Seizure Generation
A
14
Q
Pathophysiology of Seizures
- The Basic Mechanism of neuranal Excitability
A
Action Potential
15
Q
Pathophysiology of Seizures
- Hyperexcitable State may result from …..
A
16
Q
Action potentials occur due to depolarization of the neuronal membrane, with membrane depolarization propagating down the axon to induce neurotransmitter release at the axon terminal.
A
..
17
Q
Classification of Seizures
A
18
Q
Def of Focal Seizures
A
Start in network of cells on one side of the brain
19
Q
Types of Focal Seizures
A
20
Q
Def of Generalized Seizures
A
Start in network of cells on both side of the brain
21
Q
Types of Generalized Seizures
A
- Generalized Tonic-Clonic Seizures
- Absence Seizures
- Myoclonic Seizures
- Tonic Seizures
- Atonic Seizures
22
Q
Awarness in Focal Aware Seizures (Simple Partial)
A
Awareness remains intact, even if the person is unable to talk or respond during a seizure.
23
Q
Source of Focal Aware Seizures (Simple Partial)
A
Arise from any area of the cerebral cortex & produce a vast array
24
Q
Source of Focal Aware Motor Seizures (Simple Partial)
A
Arising from the Motor cortex
25
CP of **Focal Aware Motor Seizures (Simple Partial)**
26
Source of **Focal Sensory Motor Seizures (Simple Partial)**
Arising from the Sensory cortex
27
CP of **Focal Aware Sensory Seizures (Simple Partial)**
28
Source of **Focal Aware Cognitive &Emotional Seizures (Simple Partial)**
Arising from the Temporal lobe
29
CP of **Focal Aware Cognitive & Emotional Seizures (Simple Partial)**
30
Def of **Focal Impaired Awareness Seizures (Comple Partial)**
Focal seizures associated with impaired awareness at any time during a seizure.
31
Source of **Focal Impaired Awareness Seizures (Comple Partial)**
Arise from the temporal lobe.
32
CP of **Focal Impaired Awareness Seizures (Comple Partial)**
33
Duration of **Focal Impaired Awareness Seizures (Comple Partial)**
0.5 - 3 min
34
Source of **Focal to Bilateral Tonic-Clonic Seizures**
Start in one side of the brain and spreads to both sides.
35
CP of **Focal to Bilateral Tonic-Clonic Seizures**
36
Another Name for **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
Grand mal epilepsy
37
Duration of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
between 30 seconds and 2-3 minutes.
38
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- No preceding Aura or warning
- Ictal Stages
- Post-Ictal Stages
39
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- Aura
No preceding Aura or warning
40
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- Ictal Stage
41
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- Tonic Phase of Ictal Stage
42
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- Clonic Phase of Ictal Stage
43
CP of **Generalized Motor (Tonic-Clonic) Seizures "GTCS"**
- Post-Ictal Stage
44
Another Name of **Generalized Non-Motor (Absence) Seizures**
Petit mal epilepsy
45
Epidemeology of **Generalized Non-Motor (Absence) Seizures**
Begin in childhood or adolescence
46
Duration of **Generalized Non-Motor (Absence) Seizures**
Lasts for just a few seconds
47
CP of **Generalized Non-Motor (Absence) Seizures**
48
Epidemeology of **Myoclonic Seizures**
- Occur in children, adolescents or young adults as part of "juvenile myoclonic epilepsy".
- Occurs more on awaking up or falling asleep
49
CP of **Myoclonic Seizures**
Characterized by:
- Sudden, involuntary, brief jerks of a muscle or group of muscles.
50
Stimulus from **Myoclonic Seizures**
Provoked by fatigue or sleep deprivation.
51
Epidemeology of **Tonic Seizures**
Occur in individuals with mental retardation.
52
Duration of **Tonic Seizures**
10-20 seconds, with rapid return of consciousness or awareness.
53
CP of **Tonic Seizures**
- Sudden loss of consciousness & rigid posture of the entire body.
- They typically arise from sleep, & can occur repeatedly throughout the night.
54
Epidemeology of **Atonic Seizures**
Associated with individuals with mental retardation.
55
CP of **Atonic Seizures**
Sudden drop attacks in which the patient loses tone and falls to the ground.
56
DDx of **Seizures**
57
DDx of **Seizures**
- Syncope
58
What is Syncope Mostly Confused with?
Most commonly confused with GTCS
59
What is syncope preceded by?
lightheadedness, diaphoresis, and anxiety.
60
Characters of Syncope
A sudden, brief loss of consciousness that results from reduced cerebral blood flow.
61
What is syncope accompanied by?
Multifocal jerking movements that last for only 3-10 seconds.
62
Diffrentiation between syncope & Seizures
After syncope, Patients regain consciousness and coherence within a few seconds (no postictal state).
63
DDx of **Seizures**
- Migraine & TIA
64
What is Migraine/TIA mostly Conused With?
Simple and Complex focal seizures.
65
How to diffrentiate between Migraine/TIA & Seizures?
66
DDx of **Seizures**
- Movement Disorders
67
What are movement Disorders mostly confused with?
May be confused with motor seizures, especially myoclonus and hemiballismus
68
How to diffrentiate between Movement Disorders & Seizures?
- Most seizures are discrete events that Are separated in time by hours, days or months.
- Most movement disorders tend to be relatively continuous activities.
69
DDx of **Seizures**
- Sensory Symptoms
70
Dysfunction of the sensory end organ (e.g. eyes in patients with visual symptoms), before concluding that the problem is coming from the brain.
..
71
DDx of **Seizures**
- Sleep Disorders
72
DDx of **Seizures**
- Psychogenic Nonepileptic Seizures (Pseudo-seizures)
73
What are (Pseudo-seizures) mostly confused with?
Easily mistaken for epileptic seizures.
74
Def of **(Pseudo-seizures)**
- Attacks resemble seizures but secondary to psychiatric disorders "emotionally triggered attacks"
75
Characters of **(Pseudo-seizures)**
76
INVx for (Pseudo-seizures)
- The EEG record during the episode does not show the seizure activity "normal EEG".
- The gold standard in diagnosis remains simultaneous video and EEG monitoring.
77
Approach for a person with 1st Seizure
78
Dx of **Seizures**
79
Dx of **Seizures**
- Hx & Ex
80
Dx of **Seizures**
- Labs
81
Dx of **Seizures**
- Neuroimaging
82
Dx of **Seizures**
- EEG
83
Significance of EEG
- Differentiate epileptic seizures from conditions that mimic them.
- Classify seizure types
- Tailor therapy.
84
The yield of EEG increases with ......
- Sleep deprivation
- Performing multiple studies
- Performing the study in close proximity to the seizure.
85
TTT of **Seizures**
86
TTT of **Seizures**
- TTT of Provoked Seizures
87
TTT of **Seizures**
- TTT of Unprovoked Seizures & Epilepsy
88
ASMs may be prescribed for patients after a first unprovoked seizure if there is:
89
TTT of **Seizures**
- General Principles in drug therapy
90
The choice of ASM is usually based on:
91
Examples of **ASM**
92
Dose & SE of Phenobarbital
93
Dose & SE of Phenytoin
94
Dose & SE of Carbamazpine
95
Dose & SE of Valproate
96
Dose & SE of Lamotrigine
97
Dose & SE of Gabapentine
98
Dose & SE of Topiramate
99
Dose & SE of Oxcarbazepine
100
Dose & SE of Levetiracetam
101
Dose & SE of Zonisamide
102
Dose & SE of lacosamide
103
Dose & SE of Rufinamide
104
Dose & SE of Esclicarbazepine
105
Drug of Choice
- Focal seizures and secondarily Generalized seizures
Phenytoin, Carbamazepine, Oxcarbazepine, Levetiracetam,
Lamotrigine
106
Drug of Choice
- Primary generalized tonic-clonic seizures
Valproate, Lamotrigine
107
Drug of Choice
- Abxence Seizures
Valproate, Ethosuximide
108
Drug of Choice
- Juvenile myoclonic epilepsy
Valproate, Levetiracetam
109
Drug of Choice
- Patient taking multiple medications
Levetiracetam, Lacosamide
110
Drug of Choice
- Medication expense is a concern
Phenytoin, Carbamazepine, Valproate
111
Drug of Choice
- Pregnancy
Lamotrigine, Levetiracetam (avoid valproate)
112
Drug of Choice
- Hepatic Failure
Levetiracetam, Topiramate, Gabapentin
113
Drug of Choice
- Renal Failure
Carbamazipine, Oxcarbazepine, Lamorigine
114
Withdrawing ASMs
115
Ideal candidates for medication withdrawal have:
116
Def of **Status Epilepticus**
- A single seizure lasting more than five minutes or two or more seizures between which the patient does not recover.
- It is a life-threatening medical emergency.
117
TTT of **Status Epilepticus**
118
TTT of **Status Epilepticus**
- Life Support
119
TTT of **Status Epilepticus**
- Abort Seizures
120
TTT of **Status Epilepticus**
- Abort Seizures (Phase I)
Intravenous lorazepam (0.1 mg/kg) or diazepam (0.15 mg/kg)
121
TTT of **Status Epilepticus**
- Abort Seizures (Phase II)
- Intravenous phenytoin (15-20 mg/kg)
- Valproate (25-40 mg/kg) or Levetiracetam (1000- 3000 mg)
122
TTT of **Status Epilepticus**
- Abort Seizures (Phase III)
123
TTT of **Status Epilepticus**
- Abort Seizures (Phase IV)
- Pentobarbital is loaded at a dose of 5 mg/ kg followed by IV infusion of 1-10 mg/kg/hr, titrated gradually upwards to a burst- suppression pattern on EEG
124
TTT of **Status Epilepticus**
- Determine the etiology
- Once seizure control is established, focus on determining the etiology
- History, examination, Laboratory studies, Neuroimaging and sometimes CSF examination.
125
TTT of **Status Epilepticus**
- Prevent Further Episodes
- Correct the proximate cause of status epilepticus if detected.
- Patients with known epilepsy need ASM regimen modification to prevent seizure recurrence.
