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Flashcards in Seizures Deck (88)
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1

Most common causes of medication-induced seizures

Tramadol
Bupropion
Venlafaxine
Theophylline
High-dose phenothiazines
Benzodiazapene or AED withdrawal

2

Partial seizures

Cause asymmetric manifestations
Begin in one hemisphere of the brain
Also called focal or localization related

3

General seizures

Begin in both hemispheres- diffusely throughout the cerebral cortex
Tonic- rigidity
Clonic- rhythmic jerks
Atonic- loss of muscle tone

4

Partial seizure sx

Motor
Sensory- visual, auditory, olfactory, gustatory
Autonomic- pallor, flushing, vomiting, sweating, vertigo, tachycardia
Psychic- hallucinations, emotional changes, dysphasia, cognitive changes

5

Partial seizure subtypes

Simple partial- no LOC
Complex- impaired consciousness
Secondarily generalized seizures

6

Types of generalized seizures

Myoclonic
Infantile spasms
Absence (petit mal)
Tonic-clonic (grand mal)

7

Myoclonic seizures

Brief jerking movements of whole body or upper body, occasionally lower extremities

8

Absence (petite mal) seizures

Nonconvulsive
Short LOC (10-30 secs)
Pt seems to stare, motionless, with distant facial expression

9

Tonic-clonic (grand mal) seizures

Convulsive motor activity with LOC
5 phases- flexion, extension, tremor, clonic, postictal

10

Non-pharmacologic interventions- seizure

Surgery
Ketogenic diet
-High diet
-Low carbohydrate, low protein
Pt education
-Disease and drug education is crucial
Vagus nerve stimulation
-Implantable, programmable pulse generator

11

Criteria for attempting discontinuation of seizure meds

2-5 yrs seizure free
Single seizure type
Nl neurologic exam and IQ

12

Process of discontinuation of AEDs

Go slow (6 weeks to 3 mos per drug)
Remove one agent at a time
Seizure activity may not indicate failure of withdrawal

13

Interaction of AEDs with OCPs

Enzyme inducers decrease estrogens and/or progestins
No interaction seen (yet) with valproate and levetiracetam
OCPs decrease lamotrigine concentration

14

AEDs in women of childbearing age

Increased incidence of menstrual dysfunction, infertility, birth defects, perinatal infant death

15

Mechanism of teratogenicity and AEDs

Major congenital malformations with AED exposure may be 2-3x the general population
Folic acid metabolism- supplementation is necessary

16

Side effects of carbamazepine

Pregnancy category D
Spina bifida
Facial changes
Nail hypoplasia
Small head circumference
Developmental delay

17

Side effects of phenytoin

Category D
Hydantoin syndrome (growth deficiency, craniofacial anomalies, mental retardation, nail/digital hypoplasia)

18

Valproic acid side effects

Category D
Spina bifida, craniofacial abnormalities, developmental delay, external ear anomalies

19

Phenobarbital pregnancy side effects

Category D
similar to phenytoin

20

Topiramate pregnancy side effects

Category D
Growth retardation and limb agenesis in animals

21

Felbamate pregnancy side effects

Category C
Negative findings in animals

22

Gabapentin pregnancy side effects

Category C
Fetal toxicity in high doses in rodents

23

Tiagabine pregnancy side effects

Category C
Growth retardation in animals

24

Lamotrigine pregnancy side effects

Category C
Does affect folate metabolism

25

Zonisamide pregnancy side effects

Category C
Animal problems

26

How do AEDs work in general?

Raise seizure threshold via stabilization of neuronal membranes
Limit seizure propagation via depression of synaptic transmission and/or reduction of nerve conduction

27

AEDs and serious rash

Serious rashes are rare though very severe idiosyncratic reactions
-Fever
-Mucocutaneous lesions
Risk is highest in the first 2 mos and those with HLA-B 1502 allele

28

Stevens Johnson Syndrome

Exfoliative rash with fever and hepatitis

29

AEDs and bone density

Chronic administration of enzyme inducing AEDs of valproate has been associated with decreases in bone mineral density

30

Hepatic enzyme inhibitors

Valproate