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39 Cards in this Set
- Front
- Back
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What are seizures?
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sudden episode of neurological dysfunction due to excess CNS neuron electrical discharge
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What is epilepsy?
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syndrome of recurrent unprovoked seizures
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What's the etiology of epilepsy?
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acquired: head trauma, CNS infection, stroke, tumors, vascular malformations, neurodegenerative disease
genetic: gene defects |
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What to evaluate for a seizure patient?
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could be something else
typical episode description risk factors precipitating factors labs/scans |
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What are some alternative diagnoses?
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syncope, insufficient blood flow
TIA migraine sleep disorder psychogenic event |
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What are the types of partial seizures?
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simple: various sx depending on origin
complex: impaired consciousness, automatisms |
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What are the types of generalized seizures?
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absence: no aura, blank stare
generalized tonic-clonic: classic shaking & rigidity myoclonic tonic atonic: sudden dropping, loss of muscle tone |
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How to classify epilepsy syndromes?
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focal/localized or generalized
idiopathic/genetic or lesional (symptomatic or cryptogenic) |
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What information to use to determine seizure type?
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patient behavior
ictal EEG pattern |
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What information to use to determine epileptic syndrome type?
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seizure type & history
EEG during & between seizures imaging etiology/genetics |
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Does lesional symptomatic localization-related epilepsy respond to meds?
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No, but surgery works 80-90%
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Does idiopathic generalized epilepsy respond to meds?
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Yes - valproic acid or lamotrigine
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Does juvenile myoclonic epilepsy respond to meds?
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Yes - valproate
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Does lesional symptomatic generalized epilepsy respond to meds?
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No - may consider surgery or other tx
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Which epilepsy disorder has impaired intellect?
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symptomatic generalized epilepsy
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How to treat epilepsy in general?
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avoid triggers
meds are 1st line don't always need to treat after 1st seizure (consider exam, hx, etc) surgery |
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What kinds of surgeries are done for epilepsy?
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focal resection (most surgeries)
corpus callostomy (atonic seizures) vagus nerve stimulation (only palliative) |
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What kinds of focal resection are done?
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anterior temporal lobectomy
selective amygdalohippocampectomy |
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How do antiepileptic drugs help?
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lowers seizure frequency/severity
doesn't address the cause |
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What causes neural excitation?
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inward Na, Ca currents
glutamate, aspartate |
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What causes neural inhibition?
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inward Cl, outward K currents
GABA |
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How many treatments to try?
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few respond to 1 or 2 switches in meds
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What's first line for partial onset seizures?
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phenytoin, carbamazepine
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What to use for generalized seizures?
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valproate
lamotrigine ethosuximide topiramate levetiracetam zonisamide rufinamide |
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To what extent are the antiepileptics absorbed?
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complete, except for gabapentin
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How long is absorption in general? What can slow absorption?
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several hours; food
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What shouldn't be given if on enteral feeding?
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phenytoin - use is controversial, serum levels can significantly drop if using tubing to feed
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How long to go seizure free until you consider stopping meds?
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2 years
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What kinds of acute SEs of AEDs to expect?
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neurologic/psychiatric most common (sedation, dizziness, mood changes)
nausea/heartburn mild-med lab changes weight changes |
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What kinds of idiosyncratic SEs of AEDs to expect?
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rash, exfoliation
potential SJS hematological damage hepatic failure concentric visual field loss |
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What kinds of chronic SEs of AEDs to expect?
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neuropathy, cerebellar syndrome
endocrine/metabolic effects (osteoporosis, anemia, teratogenesis, altered connective tissue metabolism) |
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How to adjust in peds?
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neonates have lower metabolism - lower dose/kg
children have higher metabolism - higher, more frequent dosing |
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How to adjust in women?
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some AEDs have effect on OCPs
consider risks vs benefits in pregnancy drug conc in milk inversely proportional to protein binding, avoid sedating AEDs |
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What to do for status epilepticus?
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treat early & aggressively
BZDs 1st line (rectal diazepam gel or IV diazepam or IV lorazepam) phenytoin/fosphenytoin 2nd line barbiturates, continuous BZD infusion, propofol 3rd line |
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What's the MOA of phenytoin & carbamazepine?
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block voltage-dep Na channels at high firing frequencies
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What's the MOA of barbiturates?
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prolong GABA-mediated Cl channel openings, block voltage-dep Na channels
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What's the MOA of BZDs?
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increase frequency of GABA-mediated Cl channel openings
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What's the MOA of gabapentin?
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GABA analog but doesn't bind to GABA receptor - binds Ca channel, reduces excitatory NT release
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What's the MOA of valproate?
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enhance GABA transmission in specific circuits, block voltage-dep Na channels
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