Mock test for Seizure Flashcards

1
Q

Excessive abnormal electrical discharge from cortical neurons
Causes: idiopathic, CNS infection, fever, metabolic
disturbance, cerebral trauma

is the physical findings or changes in behavior that
occur after an episode of abnormal electrical activity in the
brain.

A

Seizures

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2
Q

occur when a person’s body shakes rapidly and
uncontrollably. à violent, involuntary contractions of the voluntary muscles.

A

Convulsions

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3
Q

may precede the seizure by hours or days.

–in behavior or mood
typically occur during the _____. This phase may include an aura–subjective
sensation, such as unusual smell or
flashing light

A

PRODROME

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4
Q

the seizure itself. In some cases, a scream or cry
heralds its onset.

A

ICTAL PHASE

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5
Q

takes place immediately after the seizure.
The patient typically exhibits
lethargy, confusion, and behavioral
changes

A

POSTICTAL PHASE

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6
Q

recurrent unprovoked seizures
a chronic seizure disorder, or group of disorders,
characterized by seizures that usually recur
unpredictably in the absence of a consistent
provoking factor.

first described by Hughlings Jackson as an
intermittent derangement of the nervous
system due to a sudden, excessive, disorderly
discharge of cerebral neurons.

A

Epilepsy

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7
Q

2 kinds of Partial Seizure:

A

simple and complex seizure

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8
Q

6 kinds of Generalized Seizure

A

GTC, absence, myoclonic, Clonic, Tonic, Atonic

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9
Q

throw or toss with a quick abrupt
motion

A

JERKING

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10
Q

an abnormal sensation, typically tingling or pricking

A

PARESTHESIA

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11
Q

language disorder marked by deficiency in the generation of speech

A

DYSPHASIA

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12
Q

rare movements when the present feels like the past

A

Deja vu

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13
Q

most common seizure type

-occurring in approximately 80% of epileptic
patients.

  • clinical and EEG changes indicate initial
    activation of a system of neurons limited to
    part of one cerebral hemisphere that may
    spread to other or all brain areas.
A

Partial Seizure

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14
Q

most common seizure type

-occurring in approximately 80% of epileptic
patients.

  • clinical and EEG changes indicate initial
    activation of a system of neurons limited to
    part of one cerebral hemisphere that may
    spread to other or all brain areas.

generally do not cause loss of consciousness.

A

Partial Seizure

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15
Q

accompanied by impaired consciousness;
however in some cases, the impairment precedes
or follows the seizure.

§ Purposeless behavior is common.
§ The affected person may have a glassy stare, may
wander about aimlessly, and may speak
unintelligibly.
§ Psychomotor (temporal lobe) epilepsy may lead
to aggressive behavior (e.g., outbursts of rage or
violence).

Postictal confusion usually persists for 1-2
minutes after the seizure ends.

A

COMPLEX PARTIAL SEIZURES

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16
Q

generally do not cause loss of consciousness

SIGNS AND SYMPTOMS: MOTOR SIGNS: convulsive
jerking, chewing motions and lip smackling.
Ø SENSORY AND SOMATOSENSORY
MANIFESTATIONS: paresthesias and auras.
Ø AUTONOMIC SIGNS: sweating, flushing and pupil
dilation.
Ø BEHAVIORAL MANIFESTATIONS: sometimes
accompanied by impaired consciousness, include déjà
vu experiences, structured hallucinations, and dysphasia.

BEHAVIORAL MANIFESTATIONS:
sometimes accompanied by impaired
consciousness, include
§ déjà vu experiences,
§ structured hallucinations,
§ and dysphasia.

A

SIMPLE PARTIAL SEIZURES

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17
Q

(e.g., picking at clothes) is
common and may follow visual, auditory or
olfactory hallucinations)

A

Automatism

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18
Q

¡ Entire brain is involved
¡ motor manifestations are bilateral.
¡ diffuse, affecting both cerebral hemispheres.
¡ clinical and EEG changes indicate initial involvement of both
hemispheres

A

generalized seizures

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19
Q

§ present as alterations of consciousness (absences)
lasting 10-30 seconds.
¡ Staring (with occasional eye blinking) and
loss or reduction in postural tone is typical.
¡ Enuresis

brief loss of consciousness

A

ABSENCE (Petit mal) SEIZURES

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20
Q

(bilateral massive epileptic myoclonus)
§ present as involuntary jerking of the facial, limb, or
trunk muscles, possibly in rhythmic manner.

§ consist of sporadic jerks, usually on both sides of
the body. Patients sometimes describe the jerks as
brief electrical shocks. When violent, these seizures
may result in dropping or involuntarily throwing
objects.

A

MYOCLONIC SEIZURES

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21
Q

§ characterized by sustained muscle contractions
alternating with relaxation
§ are repetitive, rhythmic jerks that involve both
sides of the body at the same time.

A

CLONIC SEIZURES

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22
Q

involve sustained tonic muscle extension
(stiffening).

A

TONIC SEIZURES

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23
Q

cause sudden loss of consciousness.
unconsciousness, convulsion & muscle rigidity

The individual becomes rigid and falls to the
ground. Respirations are interrupted. The
leg extended, and the back arches;
contraction of the diaphragm may induce
grunting. This tonic phase lasts for about 1
minute.

A clonic phase follows, marked by rapid
bilateral muscle jerking, muscle flaccidity,
and hyperventilation. Incontinence, tongue
biting, tachycardia, and heavy salivation
sometimes occur.

¡ Postictal phase
§ the individual may experience headache,
confusion, disorientation, nausea, drowsiness,
and muscle soreness. This phase may last for
hours.

A

GENERALIZED TONIC-CLONIC SEIZURES
(grand mal)

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24
Q

seizures occur repeatedly with no recovery of
consciousness between attacks

A

status epilepticus

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25
characterized by a sudden loss of postural tone so that the individual falls to the ground. They occur primarily in children.
ATONIC SEIZURES (drop attacks)
26
have no identifiable cause.
PRIMARY (idiopathic) SEIZURES
27
occur _______ to an identifiable cause ¡ Intracranial neoplasms ¡ Infectious diseases (meningitis, influenza, toxoplasmosis, mumps, measles, syphilis) ¡ High fever (in children) ¡ Head trauma ¡ Congenital diseases ¡ Metabolic disorders (hypoglycemia, hypocalcemia) ¡ Alcohol or drug withdrawal ¡ Lipid storage disorders ¡ Developmental abnormalities
SECONDARY SEIZURES (symptomatic or acquired seizures)
28
GTC and partial seizures
valproic acid, carbamazepine, phenytoin
29
ABSENCE Drugs
ethosuximide, valproic acid
30
Myoclonic Drugs
clonazepam, valproic acid
31
Status epilepticus
diazepam, lorazepam, phenytoin
32
Febrile seizures
phenobarbital
33
TONIC CLONIC
Lamotrigene, VPA, Topiramide
34
TONIC CLONIC
Lamotrigene, VPA, Topiramide
35
Partial seizures drug list
▪ Carbamazepine, phenytoin ▪ Valproic acid, lamotrigine, gabapentin, benzodiazepines, barbiturates ▪ Adjunct: Tiagabine, topiramate, levetiracetam, zonisamide
36
Tonic-clonic (grand mal):
§ Carbamazepine, phenytoin § Valproic acid, lamotrigine, gabapentin, benzodiazepines, barbiturates § Adjunct: Topiramate, zonisamide
37
Absence (petit mal):
§ Ethosuximide § Valproic acid (when absence seizures coexist with tonic-clonic seizures) § Clonazepam § Adjunct: Lamotrigine, benzodiazepines
38
Myoclonic syndromes:
§ Valproic acid § Clonazepam and other benzodiazepines § Adjunct: levetiracetam
39
Treatment is intravenous diazepam or lorazepam followed by intravenous fosphenytoin (or phenytoin) or phenobarbital
Status epilepticus
40
by selectively binding to the channel in the inactive state and slowing its rate of recovery
blocks voltage-gated sodium channels
41
by selectively binding to the channel in the inactive state and slowing its rate of recovery
blocks voltage-gated sodium channels
42
MOA: closes Na channels ¡ Oldest nonsedative antiepileptic drug CNS: ataxia, nystagmus, diplopia ¡ Connective: hirsutism, gingival hyperplasia (20-40%) “Fetal hydantoin syndrome” DERMATOLOGICAL EFFECTS: , SJS, and lupus erythematosus. No effect on infantile spasms or absence seizures CyP450 inducer (carbamazepine, valproate, warfarin, OCPs) ¡ Displaced from protein binding by aspirin, sulfonamides Decreased serum concentrations of folic acid, thyroxine, and vitamin K with long-term use.
Phenytoin (Dilantin/ Epilantin)
43
includes growth retardation, microencephaly, and craniofacial abnormalities (e.g., cleft palate) and is possibly due to an epoxide metabolite of phenytoin.
Fetal hydantoin syndrome
44
is a prodrug ¡ rapidly converted to phenytoin in the blood, providing high levels of phenytoin within minutes. ¡ may also be administered intramuscularly (IM). ¡ Phenytoin sodium should never be given IM because it can cause tissue damage and necrosis. drug of choice and standard of care for IV and IM administration.
Fosphenytoin (Cerebyx)
45
Congeners of phenytoin (withdrawn form the market) (1)
Mephenytoin (Mesantoin)(1) Ethotoin (peganone) Phenacemide
46
METABOLITE that contributes most of the antiseizure activity of mephenytoin.
NIRVANOL
47
used for trigeminal neuralgia MOA: closes Na channels ¡ First choice: complex partial and generalized tonic-clonic seizures. ¡ Tricyclic, antidepressant (bipolar)
Carbamazepine (Tegretol)
48
ADR: ¡ CNS effects: dizziness, ataxia, diplopia ¡ GI: nausea, vomiting ¡ Metabolic: hyponatremia ¡ Hematopoietic: leukopenia ¡ Derma: rashes, SJS ¡ CyP450 inducer (warfarin, phenytoin, valproate, OCPs), autoinducer (induces its own metabolism) § Common: Diplopia and ataxia (most common), gastrointestinal disturbances; sedation at high doses § Occasional: Retention of water and hyponatremia; rash, agitation in children § Rare: Idiosyncratic blood dyscrasias and severe rashes § Drug Interactions: ▪ CBZ metabolism is affected by many drugs, and CBZ affects the metabolism of many drugs. § Determination of plasma levels and clearance may be necessary for optimum therapy. Exhibits AUTOINDUCTION
Carbamazepine (Tegretol)
49
FDA approved in 2000 for partial seizures ▪ Complex partial seizures ▪ Primary & secondarily generalized tonic-clonic seizures § Is a prodrug whose actions are similar to those of carbamazepine; it has a short half-life of 1—2 hour. § Its activity is due to a 10-hydroxy metabolite with a half-life of 10 hours. § Fewer adverse effects than CBZ, phenytoin
Oxcarbazepine (Trileptal)
50
Brand name: (ESL) (Stedesa) Na channel blockers § Prodrug § Advantage: once daily dosing regimen
Eslicarbazine
51
¡ closes Na channels § Other Mechanisms of Action: ▪ 1) Some inhibition of T-type Ca2+ channels. ▪ 2) Increases GABA production and decreases GABA metabolism. (Inhibition of GABA transaminase) ¡ 90% protein bound- displaced by phenytoin and aspirin ¡ S/E: ¡ GI disturbance, rare pancreatitis and hepatotoxicity, sedation and ataxia at high doses, ¡ fetal malformation (spina bifida) ¡ CyP450 inhibitor (phenytoin, carbamazepine, Phenobarbital) caused "spina bifida" § Indications: ▪ Simple or complex partial, & primary generalized tonic-clonic ▪ Also used for absence, myoclonic, and atonic seizures. ▪ Highly effective for photosensitive epilepsy and juvenile myoclonic epilepsy. § Contraindications: ▪ Liver disease
Valproic Acid (Valproate; Depakene, Depakote)
52
Valproic acid ADR
▪ Weight gain (30-50%) ▪ Dose-related tremor ▪ Transient hair loss ▪ Polycystic ovary syndrome and menstrual disturbances ▪ Bone loss ▪ Ankle swelling
53
¡ Other Mechanism of Action: § Also inhibits voltage gated calcium channels (N and P/Q type) § May inhibit synaptic release of glutamate. § Adverse Effects: ▪ Rash (10%) ▪ Rare progression to serious systemic illness ▪ Increased alertness § Indications: ▪ Adjunct therapy (ages 2 & up): ▪ Simple & complex partial seizures ▪ Generalized seizures of Lennox-Gastaut Syndrome ▪ Monotherapy (adults): ▪ Simple & complex partial seizures § Contraindications: ▪ May make myoclonic seizures worse
Lamotrigine (Lamictal)
54
¡ is the most distressing of childhood epilepsies. ¡ The children suffer frequent fits of many different types, and experience gradual mental deterioration. is a form of severe epilepsy that begins in childhood. It is characterized by multiple types of seizures and intellectual disability.
Lennox-Gastaut syndrome
55
Other Mechanism of Action: ▪ Enhances post-synaptic GABA receptor currents. ▪ Kainatereceptor antagonist (blocks a certain type of glutamate channel) S/E: Incidence of renal stone formation or renal calculi in older patients is associated § Indications: ▪ Adjunct therapy for partial and primary generalized ▪ seizures in adults and children over 2. ▪ Decreases tonic and atonic seizures in children with Lennox-Gastaut syndrome. § Contraindications: ▪ History of kidney stones
Topiramate (Topamax)
56
Topiramate (Topamax): § Drug Interactions: decrease blood levels
CBZ, phenytoin, phenobarbital, & primidone
57
§ is a sulfonamide derivative that has a broad spectrum of action § Other Mechanism of Action: ▪ Inhibits T-type Ca2+ currents. ▪ Binds to GABA receptors. ▪ Facilitates dopaminergic and serotonergic neurotransmission § Indications: ▪ Approved for adjunct treatment of partial seizures in adults. ▪ Appears to have a broad spectrum: ▪ Myoclonic seizures ▪ Infantile spasms ▪ Generalized & atypical absence seizures ▪ Lennox-Gastaut Syndrome
Zonisamide (Zonegran)
58
Zonisamide (Zonegran) drug interaction: decrease its half-life by half.
Phenytoin and carbamazepine
59
Zonisamide (Zonegran) ADR :
▪ Weight loss ▪ Abnormal thinking ▪ Nervousness ▪ Agitation/irritability ▪ Usually well tolerated
60
§ Amino acid related compound § Also binds to collapsin-response mediator protein (CRMP) thereby blocking the effect of neurotrophic factors such as BDNF and NT3 on axonal and dendritic growth ▪ Brain derived neurotrophic factor
Lacosamide (Vimpat)
61
§ Triazole derivative § Prolong the inactive state of the sodium channel § Adjunct for Lennox-Gastaut syndrome
Rufinamide (Banzel)
62
Indications: § Second choice for partial and generalized tonic-clonic seizures. § Rapid absorption has made it a common choice for seizures in infants, but adverse cognitive effects cause it to be used less in older children and adults. § Status epilepticus
Phenobarbital (Luminal)
63
§ 2-desoxyphenobarbital § was metabolized to phenobarbital and phenylethylmalonamide (PEMA) § Indications: ▪ Adjuvant or monotherapyfor partial and generalized tonic-clonic seizures ▪ May control refractory generalized tonic-clonic seizures § Contraindications: ▪ History of porphyria
Primidone (Mysoline)
64
Barbiturate drugs: Drug Interactions: § Other CNS depressants § Increased metabolism of vitamin D and K § Phenytoin increases the conversion of_____
Phenobarbital (Luminal) & Primidone (Mysoline)
65
Phenobarbital & Primidone ADR:
▪ Agitation and confusion in the elderly. ▪ Worsening of pre-existing hyperactivity and aggressiveness in children ▪ Sexual side effects ▪ Physical dependence
66
▪ Only _______ & ______ approved for long-term treatment. ▪In combination for partial seizures (1) (2) ▪ Lennox-Gastaut Syndrome, myoclonic, atonic, and absence seizures ▪ Tolerance develops after about 6 months
clonazepam (2) clorazepate (1)
67
_________are used in treatment of status epilepticus. ▪(1)_____ is painful to inject ▪ (2)_____ is more commonly used in acute treatment.
Diazepam (1) and lorazepam (2)
68
Intermittent use for control of seizure clusters ▪____ frequently combined with phenytoin. Contraindications: ▪_____ in children under 9 ▪ Narrow angle glaucoma
Diazepam
69
§ Interactions: ▪ Blood levels decreased by CBZ, phenytoin, phenobarbital, & primidone § Adverse Effects: ▪ Asthenia (weakness) ▪ Abdominal pain § Mechanism of Action: ▪ Inhibition of GABA transporter (GAT-1) – reduces reuptake of GABA by neuronsand glial cells. § Indications: ▪ Approved in 1998 as an adjunct therapy for partial seizures in patients at least 12 years old. § Contraindications: ▪ Absence seizures
Tiagabine (Gabitril)
70
§ Adjunct therapy for refractory generalized tonicclonic seizure in patients with severe myoclonic epilepsy in infancy § Barbiturate-like effect § Potent inhibitor of CYP3A4, CYP1A2, CYP2C19
Stiripentol (Diacomit)
71
§ Irreversible inhibitor of GABA aminotransferase (GABA-T) § Also inhibits the vesicular GABA transporter § Uses: partial seizure and infantile spasms (reserve drug) § ADRs: ▪ Typical: drowsiness, dizziness, weight gain ▪ Irreversible lesion in the retina
Vigabatrin (Sabril)
72
especially in thalamic neurons that act as pacemakers to generate rhythmic cortical discharge.
nhibit lowthreshold (T-type) Ca 2+ currents
73
especially in thalamic neurons that act as pacemakers to generate rhythmic cortical discharge.
inhibit lowthreshold (T-type) Ca 2+ currents