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71 Cards in this Set

  • Front
  • Back
what are the types of seizures
partial simple
partial complex
absence
myoclonic
tonic-clonic
tonic or clonic
atonic
what is main difference between simple and complex
loss of consciencness
which partial seizure has loss of consciecness
complex
most common seizure in adults
partial secondary generalized
the most common aura is what
indescribable
when is the onset of absence seizures
between 4-12
what are the characteristics of absence seizures
brief loss of consciencness
no memory of episode
mulitple daily
how can absence seizures be induced
via hyperventalation
how do you treat absence seizures
valproic acid
what are the characteristics of myoclonic seizures
brief suden shocklike muscle contraction
polyspike pattern on EEG
what might patients do who are experiencing myoclonic seizures
drop objects
spill food
be propelled out of chairs or beds
onset of atonic seizures
2-5
characteristics of atonic seizures
in developmentally disabled
legs lose tone
patients fall to ground
brief up to one minute
what are the firing modes of thalamic neurons
oscillatory and tonic
oscillatory firing depends on what structure
nucleus reticularis thalami
what type of neurons are those in the NRT
gabaergic neurons
what effect does increased GABA have on NRT neurons
inhibits NRT neurons reducing duration of spike-wave discharges
what is the other important mechanism in some types of epilepsy
glutamate mediated excitation of thalamocortical and corticothalamic pathways
indications for pheytoin and fospheytoin
simple/complex partial
generalized tonic/clonic
pheytoin and fospheytoin do not work for what
myoclonic, atonic or absence
MOA for phenytoin and fosphenytoin
sodium channel antagonist
brand names for carbamazepine
tegretol and carbatrol
what are indication for carbamazepine
simple/complex partial
generalized tonic-clonic
MOA of carbamazepine
sodium channel antagonist
what has longer half life phenytoin or carbamazepine
phenytoin
what are indications for valproic acid
myoclonic
absence
simple/complex partial
generalized
valproic acid is treatment of choice in what cases
idiopathic epilepsies
MOA of valproic acid
enhances GABA mediated inhibitory activity
sodium channel antagonist
preferred treatment for generalized
valproic acid
dosing for valproic acid
BID-TID
indications for phenobarbital/primidone
partial and generalized seizures
MOA of phenobarbital/primidone
increases open state in GABA mediated chloride channels
reduces effect of glutamate
reduces presynaptic Ca channel effect blocking neurotransmission
primidone is metabolized to what
phenobarbital/phenylethylmalonamide
what is half life of pheonbarbital
1-5 days
side effect of phenobarbital
significant sedation
New drugs
gabapentin
lamotrigine
tiagabine
topiramate
oxcarbazepine
levetriacetam
indication for gabapentin
complex partial seizures
what is dosing with gabapentin
TID
what is needed maintenance dose in gabapentin
300mg
what is real world max dose of gabapentin
4800mg daily
what is indication for lamotrigine
adjunct for complex partial seizures
MOA of lamotrigine
sodium channel antagonist
inhibits glutamate release
what happens to half life when used with valproic acid
it is increased
where is lamotrigine metabolized
in the liver
indications for tigabine
complex partial
tigabine may exacerbate what type of seizures
generalized seizures
MOA of tigabine
inhibits GABA uptake at axonal terminal increasing levels of GABA at synapse
where is tigabine metabolized
in the liver
indications for topiramate
partial and generalized seizures
lennox-gastaut
MOA for topiramate
sodium and calcium channel antagonist
increases GABA mediated antagonism
weak carbonic anhydrase inhibitor
indications for oxcarbazepine
complex partial seizures
MOA for oxcarbazepine
sodium channel antagonist
what is advantage of oxcarbazepine over carbamazepine
not autoinducing
oxcarbazepine is a what
prodrug
what is the metabolite of oxcarbazepine
monhydroxycarbamazepine
what is indication for levetiracetam
partial and generalized seizures
what is 1st choice drug in hepatic failure
levetiracetam
what should be included in work up for seizures
MRI brain with/without contrast
if negative sleep deprived EEG
fasting glucose, routine labs
what is risk of 2nd seizure with normal EEG
24% in two years
what is risk of 2nd seizure with abnormal EEG
50% in two years
what is risk of 2nd seizure with symptomatic seizure and abnormal EEG
65%
what is risk of seizure after second seizure
80%
status epilepticus
more than one seizure with no cognitive revovery between seizures or continous seizure of more than 10 min
what is treatment of status epilepticus if seizing
load with benzodiazepines
what is the preferred benzo
lorazepam
what is the next step in status epilepticus treatment after benzos
phenytoin 20mg/kg
what is infusion rate for phenytoin with status epilepticus
no faster than 50mg/min
what is the infusion rate for fosphenytoin in status epilepticus
150mg/min
if seizure recur what is done
give another 10mg/kg load
if seizure recur after this what is done
phenobarbital 20mg/kg
if seizure recurs after this what is done
pentobarbital coma or midazolam drip with intubation