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78 Cards in this Set
- Front
- Back
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What % population has 1+ sz in life?
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10%
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DEFINITION OF EPILEPSY (compared to sz disorder)
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Epilepsy = 2+ szs
1 sz = sz disorder |
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Do partial szs always originate in one part of brain?
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Yes; never whole brain at once
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Simple partial sz: more common to see POS or NEG sxs?
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POS (all szs)
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What TYPE of sz and where located focus in brain?:
Rhythmic jerk of one limb; no change MS |
Simple partial
Motor frontal cortex |
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Name for:
Rhythmic jerking of 1 limb --> electrical discharge spread along motor strip --> rhythmic jerking spread along body parts |
Jacksonian March
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Jacksonian March: what type of sz?
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Simple partial
Jerk 1 limb --> electric spreads motor strip --> jerk other limbs |
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Where is sz located?:
-Sensory changes -Visual changes? -Psych changes? |
Sens = parietal
Visual = occip Psych = temp |
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What TYPE of sz & WHERE located?:
Running in circles; unaware |
Complex partial
Frontal motor cortex |
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Complex partial szs:
-Where in brain commonly arise? - Able to continue normal actions? |
TEMPORAL
Often continues folding laundry, etc |
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What TYPE of sz:
LIP-SMACKING in adult |
Complex partial
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What TYPE of sz:
Picking at clothes |
Complex partial
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Another name for:
Grand mal sz |
Generalized tonic-clonic
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What TYPE of sz:
Epileptic cry |
Gen tonic-clonic; 2/2 stiffining of phonation muscles
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Generalized tonic-clonic: how long last?
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1-2 mins
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What TYPE of sz:
3Hz spike & wave |
Absence
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Absence sz: what EEG finding?
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3Hz spike & wave
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What TYPE of sz:
Hyperventilation is common trigger |
Absence
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Common to see onset of epilepsy in ELDERLY?
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YES
(extremes of age) |
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What % 6mo-5yo have febrile szs?
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10%
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Awake person: what is normal EEG rhythm at posterior head?
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ALPHA
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Febrile szs: partial or generalized at onset?
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GENERALIZED
(if partial --> higher risk of future epilepsy) |
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Febrile szs: which has higher risk of future epilepsy:
Partial or generalized at onset |
PARTIAL
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Febrile sz: does duration of sz affect risk of future epilepsy?
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If prolonged sz --> higher risk
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What epileptic SYNDROME:
CHILD with szs (ton-clon, myoclon, absence) & RETARD |
Lennox-Gastaut
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Lennox-Gastaut: 2 features
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1. Szs: gen ton-clon, myoclon, absence
2. Retard |
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What epileptic SYNDROME:
slow 1-2 Hz spike-wave |
Lennox-Gastaut
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What epileptic SYNDROME:
child with SIMPLE PARTIAL (esp mouth) worse at NIGHT |
Benign Rolandic epilepsy
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Benign Rolandic Epilepsy: what features?
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1. Partial seizures (esp mouth)
2. worse at night |
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Absence szs: how tx (2)
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1. Ethosux
2. VPA |
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What epileptic SYNDROME:
Child with EARLY AM szs |
Juvenile Myoclonic epilepsy (contrast Benign Rolandic - worse at PM)
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What epileptic SYNDROME:
4-6 Hz polyspike & wave |
Juvenile Myoclonic epilepsy
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Juvenile Myoclonic epilepsy: what EEG feature?
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4-6 Hz polyspike & wave
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Juvenile Myoclonic epilepsy: szs worse in AM or PM?
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AM
(contrast Benign Rolandic: worse at PM) |
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How tx:
Lennox-Gastaut syndrome |
1. VPA
2. Lamotrigine |
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How tx:
Benign Rolandic epilsepy |
No treat OR CARBAMAZEPINE
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Todd's paralysis:
-general or hemi paresis? -assume which TYPE of sz? |
HEMI
Assume: PARTIAL ONSET --> SECONDARIL GENERALIZED |
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Generalized tonic-clonic sz: expect increased or decreased HCO3?
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Lactic acidosis --> decreased HCO3
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If NEW-ONSET partial sz --> order what imaging?
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MRI (looking for structural malform)
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EEG is normal in what % known epileptics?
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50%
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Common to see post-ictal HA?
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Possible
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Initiate AEDs if:
-sz 2/2 EtOH? -sz 2/2 Meningitis? -single sz of unknown etio? |
NO!
ONLY initiate after 2nd unprovoked sz |
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How tx: epilepsy not controlled by single AED
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1st: increase dose
2nd: initiate 2nd & taper 1st Goal is monotherapy |
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Epilepsy: monotherapy controls what % szs?
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70%
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Vagal n stimulation: used to tx which type of sz? stims L or R vagal?
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PARTIAL
L vagus |
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Epileptic surgical resection is successul in what % medial temporal lobe?
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90%
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Status Epi protocol: ADMIN WHICH DRUGS
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Finger BG --> 100 mg thiamine IV --> 50% dextrose infusion -->
1. Lorazepam IV 2. Phenytoin IV 3. Phenobarb IV |
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Gent tonic-clonic sz: how should you protect tongue?
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DONT --- put nothing in mouth
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What % med-refractory szs are psychogenic?
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10-30%
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If cannot control status epi --> should you induce coma?
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YES -- barbs, midazolam, propofol
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Szs in preg:
-is absolute risk of AEDs low or high? -which drug S/E NTDs? -how much folic acid per day? |
Low
VPA --> neural tube defects Give folic acid >1mg/d |
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Blocks what channel?:
Phenytoin |
Na+
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Brand name for:
Phenytoin |
Dilantin
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Generic name for:
Dilantin |
Phenytoin
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Blocks what channel?:
-Phenytoin -Carbamazepine -VPA -Phenobarb -Ethosuximide -Gabapentin -Lamotrigine -Topiramate -Tigabine |
Phenytoin: Na+
Carbamazepine: Na+ VPA: Na+ and GABA-R Phenobarb: GABA-R Ethosux: T-type Ca2+ Gabapentin: unknown Lamotrigine: Na+ & glutamate R Topiramate: unknown -Tigabine: GABA-R |
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Which AED:
Blocks Na+ channel AND GABA-R |
VPA (Depakote)
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Brand name for:
VPA |
Depakote
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Which AED:
Blocks T-type Ca channel |
Ethosuximide
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Which AED:
Blocks Na+ channel & GLUTAMATE R |
Lamotrigine
(contrast VPA: Na+ & GABA-R) |
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Phenytoin: txs partial or generalized szs?
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BOTH
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Which AED:
s/e gingival hyperplasia |
Phenytoin
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Carbamazepine: txs partial or gen?
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BOTH
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Which AED:
S/E SIADH; agranulocytosis |
Carbamazepine
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Carbamazepine: check which lab?
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CBC -- S/E agranulocytosis
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Which AED:
S/E GI sxs, wt gain, hepatotox, thrombocytopenia |
VPA (Depakote)
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VPA: toxic to which organ?
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Hepatotox
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Phenobarb: txs partial or gen szs?
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BOTH
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Ethosuximide: what S/E?
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GI sxs
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Gabapentin: txs partial or gen szs?
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PARTIAL ONLY
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Which AED:
Only txs PARTIAL szs (2) |
Gabapentin
Tigabine |
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Lamotrigine: txs partial or gen szs?
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BOTH
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Which AED:
S/E Rash, SJS |
Lamotrigine
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Lamotrigine: what S/E?
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SJS
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Topiramate: txs partial or gen szs?
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BOTH
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Which AED:
S/E RENAL STONES |
Topiramate
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Which AED:
S/E word-finding difficulty |
Topiramate
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Tigabine: partial or gen szs?
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PARTIAL ONLY
(same as gabapentin) |
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Tigabine: S/E sedation or activation?
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Sedation
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