Lecture 11: Epilepsy Flashcards
Essentials of Dx
- recurrent seizures
- characteristic EEG changes accompanying seizures
- mental status abnormalities or focal neuro sx’s may persist for hrs postictally
epilepsy definition
= any disorder characterized by recurrent unprovoked seizures
seizures
= transient disturbance of cerebral fxn due to an abnormal paroxysmal neuronal change in the brain
3 categories of Etiology of Epilepsy
1) Genetic Epilepsy: inherited autosomal dominant fashion
2) Structural/Metabolic Epilepsy
3) Uknown
Structural/Metabolic Epilepsy subtypes
- Pediatric age grps: congenital abnormalities and perinatal injuries may result in seizures
- metabolic disorders: withdrawal from EtOH/drugs, uremia or hypoglycemia
- Trauma ; important in young adults
- tumors: important cause in middle age; seizure is commonly initial sx
- Vascular dz: most common cause of seizures after 60 y/o
- Degenerative: AD
- Infectious Dz’s: bacterial meningitis, herpes encephalitis, neurosyphilis, cysticerosis, AIDs
Classification of Seizures
1) Focal: with or without altered consciousness
2) Generalized: tonic-clonic, atonic, absence or myoclonic
Focal (aka Partial) Seizure: features and types
- sx’s are very specific and can help localize lesion/source
- NO LOSS OF CONSCIOUSNESS
- Types= Simple Partial and Complex partial
Simple Partial Seizure
- without impairment of consciousness
- focal motor sx’s = twitching, convulsive jerking
- sensory sx’s = parathesias, abnormal visions/sounds/smells and distortions of perception
- autonomic = flushing, tingling, nausea
Complex Partial Seizure
- Loss of awareness of the surroundings, altered consciousness
- Aura = warning for the seizure; familiar feeling, nausea, heat, tingling or distortion of sensory perceptions
- other sx’s = autonisms: lip smacking, picking at clothes, walking around aimlessly, or saying nonsense phrases over and over again
Generalized Seizures types
1) Absence seizures (Petit Mal)
2) Tonic Clonic (Grand-Mal)
3) Atonic Seizure
4) Myoclonic Seizure
5) tonic seizure
Absence Seizure (petit mal)
- usually childhood but can persist into adulthood
- sx’s = staring spells lasting several secs in conjunction with eye fluttering or head nodding
- able to resume activities
- typical EEG: 3 Htz spike and wave
Tonic Clonic (Grand-Mal)
- sudden LOC and tonic activity (stiffening)
- followed by clonic activity (rhythmic jerking) of limbs
- eyes roll up, typically emit cryocontraction of resp. muscles (epileptic cry)
- lasts 1-3 min
- post ictal –> sluggish, sleepy, and confused for hrs
Atonic seizures
- drop attacks: suddenly become limp and fall to ground
- typically occurs in children/adults with widespread brain injuries
Myoclonic seizure
-brief unsustained jerking or series of jerks
Tonic seizure
- stiffening of muscles
- arms/legs mat extend forward and rise in air
- consciousness may or may not be altered
Most common type of seizure in adults
Complex partial
-followed by: simple partial, tonic clonic, absence, others
Steps of a Workup of acute seizures
- BMP: electrolyte abnormalities
- EtOH level
- Drug screen- Benzos
- LP
- MRI
- EEG
Tonic Clonic Management
- turn pt on side with head inclined toward ground to keep airway clear
- do not put anything in pts mouth
Medication Tx: Focal seizures
- carbamezapine, phenytoin, valproic acid
- other newer drugs: gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonidamide, lacosamide
Tx: Generalized
- valproic acid
- DO NOT USE: phenytoin, carbamezapine, and oxcarbazine
Myoclonic Seizure tx
-Keppra, clonezapam
Absence Seizure
-depakote, topamax, ethosuxamide, clonazepam
Rational for Seizure Tx
- use least amnt of med needed for control
- use mono therapy
- use appropriate med for seizure type
- if use multiple meds: pick complimentary mechanism
- use side effects to advantage (topomax: wt loss)
- give Folate and Ca to protect bones
Other Facts for Tx
- Do not use rescue drugs (Benzos) routinely
- Do not use valproic acid/phenobarb is pregnant
- Phenytoin: nonlinear PK
- Carbamezapine: autoinduction
- Genetics can affect metab
