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48 Cards in this Set
- Front
- Back
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Describe the etiology of partial seizures:
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originate in a small group of neurons and can result from head injury, brain infection, stroke, or tumor, but often the cause is unknown.
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Compare simple partial seizures with complex partial seizures
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Simple partial seizures: no loss of consciousness
Complex partial seizures: loss of consciousness |
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Define: postictal period
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The time after the seizure until normal neurological function returns
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What is another name for absence seizures? Is there a loss of consciosness? Is there an aura?
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- "Petit mal seizures."
- Momentary loss of consciousness - No aura |
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Describe tonic-clonic seizures
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Tonic phase - high frequency waves, lasting 30s, followed by symmetric jerking of limbs with a spike and then a slow wave with each clonic jerk.
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What wave is this? Describe it.
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- frequency of 8-13 Hz
- amplitude of 50-100 microvolts - parietal and occipital lobes with decreased levels of attention - relaxed with eyes closed |
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What wave is this? describe it
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- beta wave
- alert |
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Describe this sleep stage:
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- low voltage, mixed frequency pattern
- theta waves of 4-7 Hz |
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Describe this sleep stage:
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- sinusoidal waves called sleep spindles
- occasional high voltage biphasic waves called K complexes |
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Describe this sleep stage:
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- Stage 3
- delta waves |
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Describe this sleep stage:
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- Stage 4
- Maximum slowing with large waves |
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Why is REM sleep called paradoxical sleep?
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Because the waves return to looking like rapid, low-voltage waves like in awake and aroused states and in stage 1 sleep.
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What are pontogeniculo-occipital (PGO) spikes?
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large phasic potentials that originate in the cholinergic neurons in the pons and pass
rapidly to the lateral geniculate body and from there to the occipital cortex. |
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PET scans show increased activity and decreased activity in what areas during REM sleep?
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increased activity in the pontine area, amygdala, and anterior
cingulate gyrus, but decreased activity in the prefrontal and parietal cortex. Activity in visual association areas is increased, but there is a decrease in the primary visual cortex. This is consistent with increased emotion and operation of a closed neural system cut off from the areas that relate brain activity to the external world. |
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What carries out the entrainment of the sleep-wake cycles?
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The suprachiasmatic nucleus (SCN)
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The pineal gland converts what to what to help regulate the sleep-wake cycle?
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serotonin is converted into melatonin which is then secreted.
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Wakefulness is described by the activity of what neurotransmitters?
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Transitions from sleep to wakefulness may involve alternating reciprocal activity of different groups of RAS neurons. When the activity of norepinephrine- and serotonin-containing neurons is dominant, the activity in acetylcholine-containing neurons is reduced, leading to the appearance of wakefulness. The reverse of this pattern leads to REM sleep. Also, wakefulness occurs when GABA release is reduced and histamine release is increased.
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'Describe the circadian rhythm sequence from light to melatonin release
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Light
↓ Retina ↓ Retinohypothalamic tract ↓ SCN ↓ Superior cervical ganglion ↓ Pineal gland ↓ Inhibits melatonin |
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What EEG wave is characteristic of wakefulness and what is its frequency?
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Alpha wave (8-13 Hz)
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What are the characteristics of sleep stages 1, 2, and 3?
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1 - Theta (4-7 Hz) (2-5% TST)
2 - Sleep spindles, K-complexes - 40-50% of TST 3 - Delta (1.5-3 Hz) = slow wave. Most restorative sleep Highest arousal threshold. (15-25% TST) |
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What are the characteristics of REM sleep?
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Low amplitude, high frequency
Atonia Rapid eye movements. ↑HR, BP, penile/clitoral tumescence (20-25% of TST) |
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Which stage of sleep is more prominent in the first half of the night? Which stage is more prominent in the second half of the night?
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First half = Stage 3
Second half = REM |
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How does sleep change with age?
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Decreased slow wave sleep (N3)
Frequent spontaneous awakenings Decreased arousal threshold Early sleep onset Early morning awakening |
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What are the 3 diagnostic criteria for insomnia?
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Difficulty initiating sleep, maintaining sleep, or waking too early
Adequate opportunity and circumstances for sleep Deficits in daytime function |
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Name 3 pharmacologic treatments or sleep insomnia:
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Benzos – bind GABA receptors
Reduce sleep onset latency, increase TST Nonbenzos – bind GABA receptors (Zaleplon, zolpidem, eszopiclone) Melatonin Reduce sleep onset latency, mild increase in TST Ramelteon is melatonin agonist |
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What are the risk factors for obstructive sleep apnea?
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obesity, large neck, retrognathia, macroglossia, tonsillar hypertrophy, septal deviation
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How would a patient with obstructive sleep apnea typically present?
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snoring, daytime sleepiness, nonrefreshing sleep, apneas, awakening with choking, morning headaches
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What are five comorbidities to obstructive sleep apnea?
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systemic and pulmonary HTN, cardiac arrhythmias, coronary artery disease, stroke
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Name four treatments for obstructive sleep apnea
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Behavior modification: (weight loss, sleep position, avoid alcohol)
CPAP to keep airway open Oral appliances to hold mandible forward Surgery (enlarged tonsils) |
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How is obstructive sleep apnea diagnosed?
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PSG shows lack of airflow > 10 seconds despite ventilatory effort
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Describe the cycle of central sleep apnea caused by hyperventilation:
What conditions are associated with this type of CSA? |
o Hyperventilation (pulmonary disease, heart failure): hypoxia -> hyperventilation -> hypocapnia -> central apnea -> rise in PaCO2 to mild hypercapnia -> respiration restored +/- arousal
(pulmonary disease, heart failure) |
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Describe the cycle of central sleep apnea due to hypoventilation and the associated conditions:
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Hypoventilation during sleep the wakefulness stimuli to breathe disappear -> hypoventilation and central apneas
(CNS disease, neuromuscular disease) |
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Describe the risk factors for central sleep apnea:
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age, male, heart failure, stroke, opioids
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How does a patient with central sleep apnea present?
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witnessed apneas, daytime sleepiness
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How is central sleep apnea diagnosed?
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PSG shows lack of airflow with lack of ventilatory effort
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How is central sleep apnea treated?
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If secondary to other condition, treat underlying condition, Supplemental oxygen, CPAP helps in some
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What are the classic symptoms of narcolepsy?
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Daytime sleepiness in all, sudden sleep onset, naps are restorative
Hypnogogic (between awake and asleep) or hypnopompic (between asleep and awake) hallucinations Sleep paralysis upon awakening Cataplexy: sudden loss of muscle tone in extremities, trunk or face, triggered by strong emotions, consciousness intact |
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90% of narcoleptics with cataplexy have little or none of what neuropeptide?
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Orexin (aka hypocretin)
This neuropeptide is produced in the hypothalamus, promotes wakefullness and inhibits REM. |
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How is narcolepsy diagnosed?
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Cataplexy = narcolepsy
Multiple Sleep Latency Test (MSLT): 5 monitored naps looking for average sleep onset < 5 minutes, sleep-onset REM in >2 naps CSF orexin level |
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Name four treatment strategies for narcolepsy:
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Avoid sedating medications
Scheduled daytime naps Stimulants (amphetamines, methylphenidate, modafinil) REM suppressing meds for cataplexy (gamma hydroxybutyrate |
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What is the treatment for non-REM parasomnias (confusional arousals, sleepwalking, sleep terrors)
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Benzodiazepines (by shortening the N3 stage)
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What is the drug used to treat enuresis (bedwetting)
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Imipramine (by decreasing N3 stage)
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What is the treatment for a REM behavior disorder? (persistence of muscle tone during REM sleep--acting out dreams, flailing limbs, yelling or crying out)
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Clonazepam
(interestingly, 1/3 of these patients will develop Parkinson's). |
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Describe the pathogenesis of restless leg syndrome:
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Family history in >40% of cases, apparent autosomal dominant
Hypothesis that RLS is due to dysfunction of hypothalamic dopaminergic cells that are the source of spinal cord dopamine Association with iron deficiency (always check iron studies, especially ferritin level), uremia, pregnancy |
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What are 4 essential criteria for diagnosing restless leg syndrome?
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Urge to move legs, usually with uncomfortable sensation
Begins or worsens during periods of rest or inactivity Partially or totally relieved by movement Worse in the evening or night |
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Name 3 supportive criteria to restless leg syndrome
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Family history of RLS
Response to dopaminergic drugs Periodic leg movements during wakefulness or sleep on PSG |
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What should be avoided in the treatment of restless leg syndrome?
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Caffeine
Nicotine ETOH Antidepressants Neuroleptics Metoclopramide Antihistamines |
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What medications could be taken to treat restless leg syndrome?
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Dopamine Agonists
Pramipexole Ropinirole Other options Benzos Opioids Gabapentin Iron deficiency Oral iron supplementation IV iron if severe or refractory |
