Seizures And Epilepsy

Front 1

tonic clonic seizures duration

Back 1

1 min or less

freeze - flex, then extend,
tonic CRY
then tremor

Front 2

cause of tonic clonic seizure

Back 2

metabolic or toxic

Front 3

when to take seizure to the hospital

Back 3

status epilepticus (prolonged)
pregnant
diabetic (hypoglycemia)
multiple, repeated seizures with LOC

can go later for:
injured
FIRST seizure

Front 4

know the toxic metabolic causes for seizures

Back 4

HYPOGLYCEMIA
Na, Ca, Mg
stimulant or proconvulsant
sedative withdrawal

SLEEP DEPRIVATION

if you really suspect infection: LP

then after you have ruled these out:
EEG, MRI

Front 5

Posterior rhythm:
where?
when?

Back 5

- occipital region, need HIGH voltage

- eyes closed and not focusing on much

Front 6

when do you see epileptiform discharges?

Back 6

INTERictally

focal = partial
- only one node is firing
diffuse = generalized

Front 7

what are waves during seizures called?

Back 7

focal epileptic seizures
or generalized..

Front 8

aura v prodrome: duration

Back 8

aura- mins
pro- hours to days

Front 9

aura v prodrome: which type of seizure

Back 9

aura: partial complex only

Front 10

simple v complex partial seizures

Back 10

complex have LOC

Front 11

auras in temporal lobe partial complex seizures

Back 11

- viscerosensory
- experiential
- auditory

have the same aura each time

Front 12

EEG for diagnosis of epilepsy

Back 12

interictal = only gets 50% of them

More sensitive: sleep deprivation, longer time of recording

Front 13

gold std for diagnosis

Back 13

VIDEO telemetry + EEG

Front 14

Seizure 5 year recurrence if untreated

Back 14

50%

Front 15

When do you treat a first seizure-- when they have an INCREASED risk of relapse

Back 15

- EEG abnormal
- abnormal imaging
- FOCAL neuro deficit
- Fhx

Front 16

lifestyle modifications

Back 16

SLEEP
reduce stress
DIET
alcohol, stimulants

Front 17

DRUGS for partial epilepsy

Back 17

all are approved

Best tolerated: Phenytoin, CBZ

Best control of seizures: CBZ

Front 18

Drugs for generalized epilepsy

Back 18

Valproate

this is as good as CBZ, but CBZ may be better tolerated

Front 19

Name the old epilepsy drugs

Back 19

Valproate
CBZ
phenytoin
PB
primidone

Front 20

Name the new epilepsy drugs

Back 20

Gabapentin
topiramate
lamotrigine

Front 21

Generalized seizures

Back 21

VALPROATE
- more effective than lamotrigine
- better tolerated than either topi or lamo

use this first for gen epilepsy

Front 22

What is up with the new antiepileptics?

Back 22

- not as effective as old drugs
- MOre tolerable than older drugs

but: much more expensive

Front 23

Contraindications: Phenytoin

Back 23

generalized seizures

Front 24

Contraindications: CBZ

Back 24

JME is made worse

Front 25

Contraindications: valproate

Back 25

not during pregnancy

women of childbearing age

Front 26

which drugs are highly protein bound?

Back 26

Valproate
Phenytoin

Front 27

Which drugs induce metabolism of other drugs

Back 27

CBZ, Phenytoin, phenobarb

Front 28

Which drugs inhibit metabolism of other drugs

Back 28

Valproate

Front 29

Phenytoin ISSUES?

Back 29

- LONG half life = 4-5 days

ZERO order kinetics at high doses

Front 30

CBZ things to think about:

Back 30

AUTOINDUCTION - you will need to start a dose and then step it up slowly

- ELDERLY: will have a longer half life so start them LOWER

Front 31

CBZ side effects

Back 31

rash

Front 32

Valproate side effects

Back 32

hair loss
Gain weight
tremor

dont give to women in CHILDBEARING years

Front 33

Of none of the old drugs work, which is the cleanest NEW DRUG on your metabolism?

Back 33

- GABAPENTIN

this is NOT the same as phenobarbital. PLEASE DONT CONFUSE THEM

Front 34

gabapentin profile: PK

Back 34

not metab by liver,
not changed by kidney
NOT bound to protein

DOES not mess with other drugs!!

Front 35

Topiramate issues

Back 35

word finding difficulties
kids will be at lower grade level!

Front 36

primidone side effect

Back 36

libido decreased

Front 37

Phenytoin side effects

Back 37

dysmorphic issues ( bossing)
GI

Front 38

phenobarbital: NOT GABAPENTIN

good things

Back 38

less motor issues
less GI disturbances

Front 39

use of the MRI

Back 39

tells you if there is a structural lesion -- WORSE outcome

Front 40

Causes of recent onset epilepsy

Back 40

MRI: gadolinium enhancing tumor
- tumor
infection
inflammation

Front 41

MRI finding on CHRONIC epilepsy

Back 41

Benign tumor
AVM
Neuronal abnormalities or gliosis
Mesial Temporal Sclerosis

Front 42

Describe the typical tumor that causes epilepsy

Back 42

- SMALL
slow growing
near the cortex
Sharp borders and not much edema

Not much contrast

Front 43

DNET: location

Type of seizures it causes

Back 43

temporal lobe

partial complex

Front 44

Vascular causes of CHRONIC epilepsy

Back 44

AVM
cavernous malformation

Front 45

3 stages of neuronal development that can be messed up in seizures

Back 45

1) proliferation
2) migration
3) organization

Front 46

which of these is messed up in Focal cortical dysplasia

Back 46

Organization

Front 47

problem with periventricular heterotopia

Back 47

MIGRATION
- periventricular neurons take over the brain surface

Front 48

which is the best MRI sequence for SEIZURE imaging?

Back 48

FLAIR
- better matched with EEG

Front 49

When do you start thinking about SURGERY

Back 49

after 3 tries with drugs?

Medically refractory
- FOCAL lesion that you could target

Front 50

examples of tumors that would be good for surgery = medically refractory

Back 50

DNET

Mesial temporal sclerosis