Seizures, HA, Sleep Flashcards by Stephanie Escobar

List 2 Focal onset seizures (involves a single cerebral hemisphere at onset)

Aware

Impaired awareness

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List 4 drugs used for focal onset seizures

Carbamazepine
Levetiracetam
Lamotrigine
Phenytoin

(CLLaP)

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List 3 General onset seizures (involves both cerebral hemisphere at onset)

Tonic-Clonic (grand mal)
Myoclonic
Absence (petite mal)

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How are
Tonic-Clonic & Myoclonic
seizures treated?

Valproic Acid

Levetiracetam

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How is an Absence seizure treated?

Ethosuxamide (1st line)

Valproic Acid

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Seizure is characterized by:
No loss of consciousness
No postictal state
\+/– automatisms – motor symptoms
Autonomic, Sensory or Cognitive symptoms

Aware (Focal)

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Seizure is characterized by:
looks Awake, but consciousness is altered (blank stare).
Has a postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)

Impaired awareness (Focal)

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Seizure is characterized by:
Loss of consciousness
Has a postictal state
Diffuse muscle contractions of limbs (Tonic) followed by
Rhythmic jerking (clonic)

Tonic-clonic

Generalized

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Seizure is characterized by:
No loss of consciousness
No postictal state
Brief jerking movements

Myoclonic (Generalized)

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Seizure is characterized by:
Brief episodes of altered consciousness (blank stare)
Usually no postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)

Absence (Generalized)

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Sudden impaired consciousness (staring spells)

Preserved muscle tone

Unresponsive to tactile/verbal stimuli

Short < 20 sec

+/- Automatism

Easily provoked by hyperventilation

Absence (Generalized)

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EEG: 3Hz spike waves during seizure

*Electroencephalogram

Absence (Generalized)

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Patients are awake and interactive, but have symptoms corresponding to the involved area of the brain

Face & limb Twitching/ jerking = Frontal lobe motor cortex

Auditory/ Olfactory hallucinations = Temporal lobe

Visual phenomena = Occipital lobe

Focal Aware seizures

simple partial

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Patients are awake, but not interactive and engage in frequent repetitive automatisms (lip smacking, hand wringing, repeating words)

Focal impaired awareness

complex partial

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The most common

recurrent seizure disorder is

Focal impaired awareness

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Focal seizures with impaired awareness are the typical manifestation of ____ epilepsy

temporal lobe

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Seizures are often preceded by a distinctive aura (uneasy epigastric sensation, unpleasant olfactory hallucinations) that localizes the origin of the epileptiform discharges to the

mesial temporal lobe (eg, hippocampus, amygdala, parahippocampal gyrus).

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Focal seizures with impaired awareness is usually due to underlying _____ which is associated with childhood febrile seizures.

hippocampal sclerosis
(mesial temporal sclerosis)
most common etiology

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Focal seizures with impaired awareness is usually due to underlying hippocampal sclerosis which is associated with childhood ____.

febrile seizures

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The ____ lobe plays a role in nonverbal spatial mapping and orientation.

A seizure affecting this part of the brain can cause:

distortions in a patient’s sense of position (a feeling of floating, changes in posture) or

visual interpretation (the size of objects).

nondominant parietal

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Seizures that originate in the ____ lobe characteristically have visual auras

(flashing lights, visual distortions, complex hallucinations).

occipital

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High fevers due to viral infection in infants can precipitate

febrile seizures

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febrile seizures are caused by _____ induced neuronal dysfunction.

hypethermia

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Temporal lobe epilepsy can also be caused by

congenital malformations, Strokes, Tumors (structural abnormalities)

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EEG: epileptiform waves

Temporal lobe epilepsy (Impaired aware focal)

Temporal lobe seizures can evolve into secondary

generalized seizures

a neuropathic disorder that typically presents with episodic, severe, unilateral, electric shock-like or stabbing-like pain in the distribution of CN V of the face.

``` trigeminal neuralgia (tic douloureux) ```

carbamazepine, a neuroleptic medication that inhibits neuronal high-frequency firing by reducing the ability of ____ channels to recover from inactivation.

sodium

Carbamazepine can cause _____ suppression; therefore, complete ____ should be monitored periodically

bone marrow CBC (complete blood cell counts) *may lead to anemia, agranulocytosis, thrombocytopenia

The first-line treatment for trigeminal neuralgia is

carbamazepine

Ethosuximide blocks T-type Ca2+ channels and decreases calcium current in thalamic neurons. Major side effects include (2)

gastrointestinal symptoms | drowsiness

Carbamazepine can cause

SIADH

Gingival hyperplasia is a common side effect of

phenytoin

an anticonvulsant effective in the treatment of grand mal (tonic-clonic) seizures, partial seizures, and status epilepticus.

Phenytoin

Treatment for narcolepsy includes ____ for daytime sleepiness.

psychostimulants (Modafinil)

Narcolepsy is characterized by episodes of irresistible sleep during the day and usually one or more REM sleep–related phenomena such as cataplexy (sudden weakness/sleep triggered by strong emotions) hypnagogic/hypnopompic hallucinations (hallucinations while falling asleep or awakening, respectively) & _____

sleep paralysis (physiologic sleep paralysis that persists on awakening/falling asleep).

Carbamazepine is used to treat (3)

seizures bipolar disorder trigeminal neuralgia

This young man with throbbing, UNILATERAL l periorbital headache associated with conjunctival injection, lacrimation and miosis has

cluster headaches

Can present with Ipsilateral autonomic symptoms (lacrimation, rhinorrhea, flushing, diaphoresis) due to parasympathetic hyperactivity and include nasal congestion, ptosis, miosis, and conjuntival injection. The headaches typically last 15-180 minutes and tend to occur in clusters over a period of several weeks.

cluster headaches * most prevalent in MEN

Typically presents with severe, pulsatile, unilateral headache often associated with photophobia, phonophobia, nausea, and vomiting.

Migraine | with/without aura

Typically occurs in patients with thrombophilia (malignancy, antithrombin deficiency) or as a septic thrombosis related to a sinus infection or facial cellulitis. Periorbital swelling, fever, and proptosis. Orbital pain is worsened with eye movement.

Cavernous sinus thrombosis

Headache lasts 4 to 72 hours and is most prevalent in women

Migraine

Dull, tight & persistent pain Band-like distribution around the head (bilateral) Muscle tenderness in the head, neck, or shoulders Precipitated possibly by stress Can last 30 minutes to months Affects women slightly more

Tension headache

Patients typically develop fever, generalized lymphadenopathy, facial swelling/edema, diffuse/confluent skin rash, EOSINOPHILIA, and internal organ dysfunction after starting a new medication

DRESS drug reaction with eosinophilia and systemic symptoms *can have liver (ALTs), Kidney (creatine), and lung (dyspnea) failure

DRESS syndrome typically occurs 2-8 weeks after exposure to high-risk drugs such as:

Sulfonamides (sulfasalazine) Anticonvulsants (phenytoin, carbamazepine) Antibiotics (minocycline, vancomycin) Allopurinol DRESS SAAA

Act as antiemetics and pain relievers for severe migraine headache associated with nausea and vomiting.

Dopamine (D2) receptor blockers | metoclopramide, prochlorperazine

Dopamine blockade treatment for migraines can result in excess cholinergic activity. ____ can be co-administered to prevent these reactions due to its anticholinergic activity.

diphenhydramine

patient with a normal neurologic examination has unilateral headache associated with nausea and vomiting, and photophobia features that are consistent with

migraine headache

Severe migraine headache with nausea and vomiting is typically treated with ___ & ___ to abort the migraine and treat associated n/v.

serotonin 1B/1D AGONIST (– triptans) Dopamine (D2) receptor blocker (metoclopramide, prochlorperazine)

List 4 medications for ABORTIVE migraine treatment

Serotonin 1B/1D AGONIST (– triptans) (D2) receptor blocker (antiemetics) NSAIDs/ Acetaminophen Ergotamine (vasoconstrictor)

List 4 medications for Preventative migraine treatment

Anticonvulsants (Topiramate, Valproate) Beta Blockers Antidepressants (–TCAs, venlafaxine)

Characteristic histopathologic findings of atrophy of the hippocampal neurons with marked reactive gliosis (astrocyte proliferation in response to injury).

Temporal lobe epilepsy

Hemosiderin-laden microglial cells are associated with prior

intracerebral hemorrhage

Form when cells of microglia surround a neuron and phagocytize it. Are most commonly seen in viral CNS infection (particularly HIV).

Microglial nodules

Electroencephalography reveals periodic sharp-wave complexes Spongiform changes in the brain

Cruetzfeldt-Jacob | Kuru

The pathogenesis of migraines involves a GENETIC predisposition to increased cerebral EXCITABILITY (cortical spreading depression), which leads to release of Trigeminal nerve afferent ______, a neuropeptide involved in pain transmission.

calcitonin gene-related peptide (CGRP) * CGRP also causes local vasodilation and increased neurogenic inflammation

causes headache and decreased vision associated with elevated intraocular pressures. Patients are typically older (age >60), and have severe eye pain and conjunctival erythema are common.

Acute angle-closure glaucoma

a demyelinating disorder that causes unilateral vision loss, that progresses over a period of weeks. ``` Eye pain (worse with movement) color vision is often affected afferent pupillary defect is present. ```

Optic neuritis

Orexin receptor antagonism is the mechanism of action for this insomnia medication

suvorexant

Serotonin receptor agonism is the mechanism of action of ____ used to treat migraine headaches and of psychedelics (LSD)

–Triptans

Are GABAa receptor agonist used for insomnia They are primarily hypnotics and do not produce the anxiolytic, muscle relaxant, or anticonvulsant effects associated with benzodiazepines.

Nonbenzodiazepine medications (zolpidem, zaleplon, eszopiclone)

Older children with absence seizures may also develop generalized _____ seizures. Although Ethosuximide is effective against ISOLATED absence seizures, _______ is a broad-spectrum antiepileptic that treats both types of seizures.

tonic-clonic OR myoclonic Valproic acid

Patient develops involuntary, rhythmic jerking of her right upper extremity that lasts for about a minute. She remains fully alert during and after the event. Diagnosis?

Focal seizure with retained awareness *originating in the contralateral motor cortex one hemisphere

β-hydroxybutyrate is a

ketone made from/ can make Acetoacetate

patient with abdominal pain, vomiting, HYPERGLYCEMIA, anion gap metabolic acidosis, and elevated beta-hydroxybutyrate (KETONE) has

diabetic ketoacidosis

Metabolic derangements (hyperglycemia, acidosis) in patients may cause neurologic dysfunction manifesting as: altered mental status, FOCAL neurologic deficits, and/or

seizures

This patient's initial right arm numbness and paresthesia was likely caused by a focal onset seizure originating in the left

primary somatosensory cortex | postcentral gyrus

The frontal eye field is the region of the cerebral cortex that controls _____ eye movement.

horizontal | *It is located superiorly to Broca motor speech

Activation of the LEFT _____ during a seizure would cause the eyes to deviate horizontally to the RIGHT

frontal eye field *After the seizure, eyes may temporarily deviate to the LEFT due to postictal neuroinhibition (aka TOWARDS the "lesion")

A seizure originating from the LEFT primary visual cortex would likely result in visual hallucinations affecting the RIGHT _____ visual fields.

homonymous

``` Normal changes in Elderly sleep patterns include decreased total sleep time, increased ______, sleepiness earlier in the evening earlier morning awakening, Decreased _____ sleep increased daytime napping. Increased sleep ______ ```

nighttime awakenings REM Latency

Nightmares occur during ____ sleep and are more frequent in the final third of the night when their periods become longer

rapid eye movement (REM)

REM sleep is characterized by the defining feature of rapid eye movements, vivid dreaming, and ____ due to inhibition of motor neurons.

voluntary muscle atonia

a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content.

sleep terrors

Intravenous ______ are the initial drug of choice for status epilepticus.

benzodiazepines (eg, lorazepam)

a GABA-B agonist that can treat chronic muscle spasticity (ex: cerebral palsy).

Baclofen

a dopamine depletion agent that can treat Tourette syndrome, a disorder characterized by motor and phonic tics that persist for >1 year.

Tetrabenazine

chlorpheniramine is a

1st generation antihistamine

The clinical diagnosis of narcolepsy can be confirmed by low cerebrospinal fluid levels of ____ or shortened REM sleep latency on polysomnography.

hypocretin-1 (orexin A) | made in Lateral Thalamus

Abortive Migraine therapy can be induced via stimulation of trigeminovascular seretonin receptors using which drug?

–Triptans

Sleepwalking and Sleep Terrors occur during _____ which is more prominent during the first half of the night

Deep, slow-wave sleep NR Stage 3 Delta waves

EEG pattern during | Non-REM stage 1 (N1)

Theta waves (4-7.9 Hz) Wakefulness-sleep transition Easy to wake

EEG pattern during | Non-REM stage 2 (N2)

Theta waves (4-7.9 Hz) Sleep spindles K-complexes *Largest percentage of sleep

EEG pattern during | Non-REM stage 3 (N3)

Delta waves (<4 Hz) Prominent 1st half of night Difficult to wake Sleep walking & night terrors

EEG pattern during | REM sleep

EEG resembles wakefulness Occasional sawtooth waves Prominent 2nd half of night DREAMS, REMs, muscle atonia REM sleep behavior disorder & NIGHTMARES

Lamotrigine, used to treat Focal seizures, has what concerning adverse reaction

Stevens-Johnson syndrome (Toxic epidermal necrolysis) Flu-like symptoms Rash Widespread mucocutaneous epidermal necrosis.

a single seizure lasting >5 minutes or the occurrence of multiple discrete seizures with incomplete recovery of consciousness between episodes.

Status epilepticus

To treat status epilepticus administer IV Lorazapam (Benzodiazepine) & IV _____ to prevent the recurrence of seizure activity, regardless of patient responsiveness to lorazepam

Phenytoin (or fosphenytoin)

Seizures, HA, Sleep Flashcards

(88 cards)