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40 Cards in this Set
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Can involve visual
auditory olfactory or gustatory regions of the brain. Autonomic symptoms – epigastric sensations sweating flushing pupillary dilation |
Partial seizure
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Begin in childhood and cease by age 20
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Absence (petit mal)
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Marked changes in tone
attacks may have a more gradual onset and termination than in typical absence commonly occur in patients with multiple seizure types accompanied by mental retardation or by developmental delay |
Atypical absence
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Consist of single or multiple myoclonic jerks
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Myoclonic seizures
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Characterized by sudden loss of consciousness
patient becomes rigid and falls to the ground respiration arrested (1 minute) followed by clonic phase in which there is a jerking of the body musculature (2-3 minutes) |
Tonic-clonic (grand mal)
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Immediately after seizure
patient may either recover consciousness drift into sleep have further convulsions without recovery of consciousness between attacks |
Status epilepticus
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External plantar responses (positive Babinski) seen when?
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In post ictal period
lateralized or focal signs |
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MRI indicated for patients with
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Focal neurologic symptoms
especially in new onset of seizures after the age of 20 (may indicate neoplasm) |
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Conditions that must be considered in the differential diagnosis of partial seizures.
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Transient ischemic attack
rage attack panic attack |
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Conditions that must be considered in the differential diagnosis of generalized seizures.
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Syncope
cardiac dysrhythmia brainstem ischemia pseudoseizures |
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What to remember when changing seizure drugs
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The dose increased depending on tolerance
the first drug is gradually withdrawn |
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In most cases
seizures of a single type can be controlled with |
A single anticonvulsant drug
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Treatment with two drugs may further reduce seizure frequency or severity
but usually at the cost of |
Greater toxicity
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Must be monitored to provide a reference point for the maximum tolerated dose
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Trough levels
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Discontinuation of medication only when
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Seizure free for 2 years
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Only when patients are refractory to drug therapy
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Surgical intervention
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Treatment with anticonvulsive drugs is not required for
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Alcohol withdrawal seizures
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Benzodiazepines are effective and safe for preventing seizures of what type?
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Further alcohol induced seizures
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Cause is uncertain
sometimes inherited in an autosomal dominant manner may begin at any age and is enhanced by emotional stress |
Benign essential tremor
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Treatment often unnecessary
but when it is required: propanolol primidone then ........ alprazolam clozapine topiramate gabapentin mirtazapine then ........ consider antiepileptic agents. |
Benign essential tremor
(familial tremor) |
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MPTP for recreational purposes
gene mutations exposure to certain toxins severe CO poisoning neuroleptic drugs progressive space occupying lesion (Use acronym mtpt) |
Causes of parkinsonism
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MPTP definition
a neurotoxin C 12 H 15 N destroys dopamine-producing neurons of the substantia nigra causes symptoms (as tremors and rigidity) similar to those of Parkinson's disease [ 1- m ethyl-4- p henyl-1,2,3,6- t etrahydro p yridine ] : |
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Tremor conspicuous at rest
rigidity bradykinesia postural instability mild decline in intellectual function characteristically flexed posture seen in many patients less swinging of arms while walking |
Parkinson's
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Dopamine depletion due to degeneration of the dopaminergic nigrostriatal system leading to an imbalance of dopamine and acetylcholine
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Parkinson’s
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Post encephalatic
typical and reversible are all non-idiopathic forms of what disease? |
Parkinson’s
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In Parkinson’s
repetitive tapping over the bridge of the nose produces a sustained blink response called what? |
Myerson sign
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T or F: Parkinson’s disease cause muscle weakness and alteration in dtrs
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False
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Old age
depression Wilson disease Huntington disease Shy-Drager syndrome Creutzfeldt-Jacob disease and cortical-basal ganglionic degeneration is the Ddx for what disease? |
Parkinson’s
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Most commonly used medications for parkinsonism.
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Levodopa and carbidopa
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Unstable
CAG nucleotide repeat onset usually between 30 and 50 earliest mental changes are behavioral Irritability, Moodines, Antisocial Psychiatric Disturbance, Dementia |
Huntington's disease.
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More common in Western Europeans
who live in temperate zones. No populations are at higher risk for ??This Dz?? when living between latitudes 40N and 40S |
MS
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Genetic susceptibility
(association with specific HLA antigens) focal areas of demyelination w reactive gliosis found scattered in the white matter of brain spinal cord & optic nerves axonal damage also occurs |
Multiple sclerosis
(MS) |
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Examination often reveals a residual deficit.
Optic Atrophy Nystagmus Dysarthria; Pyramidal, Cerebellar & Sensory DEFICITS |
MS
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What are the two different presentations in the course of MS?
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Relapsing <-----> remitting
primary -----> progressive secondary -----> progressive |
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Weakness
numbness tingling unsteadiness of limb spastic paraparesis retrobulbar neuritis diplopia disequilibrium or sphincter disturbance (urinary urgency or hesitancy) common initial presentation of ? What Dz ? |
MS
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Imaging for MS
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MRI
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May be mild lymphocytosis
or slightly increased protein IgG in CSF but dx is NEVER based on lab findings |
MS
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Rule for definite diagnosis of MS
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Two Lesions
in Space or Time |
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Name that MS drug?
Recovery from acute relapses may be hastened. Rx daily x1 week after which Rx tapered over the following 2-3 wks. Long term Tx provides no benefits & does not prevent further relapses |
Corticosteroids
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Name that MS drug?
Used in patients w relapsing-remitting or secondary progressive Dz can be used indefinitely reduces frequency of exacerbations. |
Beta-interferon
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Name that M.S. Rx
Used in Pts w relapsing-remitting or secondary progressive Dz. Reduces frequency of exacerbations administered subQ |
Glatiramer
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