Lecture 11: Epilepsy Flashcards Preview

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Flashcards in Lecture 11: Epilepsy Deck (27):
1

Essentials of Dx

-recurrent seizures
-characteristic EEG changes accompanying seizures
-mental status abnormalities or focal neuro sx's may persist for hrs postictally

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epilepsy definition

= any disorder characterized by recurrent unprovoked seizures

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seizures

= transient disturbance of cerebral fxn due to an abnormal paroxysmal neuronal change in the brain

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3 categories of Etiology of Epilepsy

1) Genetic Epilepsy: inherited autosomal dominant fashion
2) Structural/Metabolic Epilepsy
3) Uknown

5

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

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Classification of Seizures

1) Focal: with or without altered consciousness
2) Generalized: tonic-clonic, atonic, absence or myoclonic

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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

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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

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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

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Generalized Seizures types

1) Absence seizures (Petit Mal)
2) Tonic Clonic (Grand-Mal)
3) Atonic Seizure
4) Myoclonic Seizure
5) tonic seizure

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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

12

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

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Atonic seizures

-drop attacks: suddenly become limp and fall to ground
-typically occurs in children/adults with widespread brain injuries

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Myoclonic seizure

-brief unsustained jerking or series of jerks

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Tonic seizure

-stiffening of muscles
-arms/legs mat extend forward and rise in air
-consciousness may or may not be altered

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Most common type of seizure in adults

Complex partial
-followed by: simple partial, tonic clonic, absence, others

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Steps of a Workup of acute seizures

-BMP: electrolyte abnormalities
-EtOH level
-Drug screen- Benzos
-LP
-MRI
-EEG

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Tonic Clonic Management

-turn pt on side with head inclined toward ground to keep airway clear
- do not put anything in pts mouth

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Medication Tx: Focal seizures

-carbamezapine, phenytoin, valproic acid
-other newer drugs: gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonidamide, lacosamide

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Tx: Generalized

-valproic acid
-DO NOT USE: phenytoin, carbamezapine, and oxcarbazine

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Myoclonic Seizure tx

-Keppra, clonezapam

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Absence Seizure

-depakote, topamax, ethosuxamide, clonazepam

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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

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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

25

When to D/C drugs

-only when pts have been seizure free for 2 yrs
-dose reduction should be gradual and withdrawn one at a time

26

Status Epilepticus

-NEURO EMERGENCY
-seizure or series of seizures lasting for 30 m in without return to normal
-any seizure that lasts > 5 min while on EEG; seizure that lasts until presentation in ER; seizure lasting longer than usual (postictal period)

27

Refractory seizures

-seizures are so frequent or so severe that they limit the pt's ability to live life fully according to his/her wishes OR necessitates the use of meds that produce adverse effects