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Neurology > Adult Seizure disorders > Flashcards

Adult Seizure disorders Flashcards

1
Q

Seizure?

A

Episode of abnormally synchronized and high frequency firing of neurons resulting in abnormal behavior or experience

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2
Q

Epilepsy?

A

Chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures

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3
Q

Causes of adult onset epileptic seizures?

A 
Cerebrovascular disease
Trauma
Tumors
Infections
Cerebral degeneration
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4
Q

Types of partial seizures?

A

Simple
Complex
Secondarily generalized

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5
Q

Is consciousness preserved in simple partial seizures?

A

Yes

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6
Q

Is consciousness preserved in complex partial seizures?

A

No

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7
Q

Characteristics of secondarily generalized?

A

Consciousness lost

Bilateral cerebral involvement

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8
Q

Characteristics of simple partial seizures?

A

Consciousness is intact
EEG may appear normal
Auras are brief

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9
Q

Signs/symptoms of simple partial seizures depend on?

A

Focus

  • Motor (Jacksonian)
  • Somatosensory
  • Autonomic
  • Psychic
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10
Q

What is a Jacksonian march?

A

A focal seizure that starts distally and marches proximally on the same side
Seen in simple partial seizures emanating from motor cortex

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11
Q

How do somatosensory partial seizures present?

A

Focus on the sensory cortex

Tingling and numbness of an extremity or side of face

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12
Q

Autonomic partial simple seizures present?

A

Rising epigastric sensations, nausea

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13
Q

Psychic partial simple seizures present?

A

Sensations of fear
Deja vu
Jamais vu

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14
Q

Characteristics of complex partial seizures?

A 
Impaied consciousness
Lasts about 1 minute
Blank stare
Oral/Ipsilateral hand automatisms 
Contralateral dystonic posturing
Amnesia for ictal event
Focal abnormality on routine EEG
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15
Q

Where do complex partial seizures typically emanate from?

A

Temporal or frontal lobes

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16
Q

What are typical hand automatisms?

A

Hand rubbing and picking movements

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17
Q

What are oral automatisms?

A

Chewing and lip smacking movements

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18
Q

What does contralateral dystonic posturing result from?

A

Spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia

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19
Q

Types of Primary generalized seizures?

A 
Absence (Petit Mal)
Tonic-clonic
Clonic
Tonic
Myoclonic
Atonic
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20
Q

Pathogenesis of primary generalized seizures?

A

Arise from deep structures within the brain and spread synchroniously toward cerebral hemispheres

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21
Q

Characteristics of Absence Seizure?

A

Brief (10-20 secs) loss of consciousness
Staring spell
NO post-ictal confusion
Subtle myoclonic movement, eyelid flutter
NO baseline neurologic defictis
Baseline EEG may show generalized 3 Hz spike - wave discharge

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22
Q

What is pathognomonic for absence seizures?

A

Baseline EEG may show generalized 3 Hz spike - wave discharges

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23
Q

Most recognized seizure?

A

Tonic-Clonic

24
Q

Presentation of Tonic-clonic seizure?

A 
Cry
Loss of consciousness
Muscular rigidity (tonic)
Patient may fall
Rhythmic jerking (clonic)
Tongue-biting/injury common
Bladder/bowel incontinence
Post-Ictal confusion/sleep
25
Q

Presentation myoclonic seizures?

A 
Brief, shock-like muscle contractions
 -Head
 -Upper extremities
Usually bilaterally symmetrical
Consciousness preserved
Precipitated by awakening or falling asleep
May progress into tonic-clonic seizures
Have trouble shaving/drinking coffee in the morning
26
Q

Presentation of Atonic Seizures?

A 
Impaired consciousness
Loss of muscle tone
Head drop
Fall (if standing and injury is common)
Brief duration (few seconds)
Injury common
27
Q

Ligand-gated ion channels are either excitatory or inhibitory depending on?

A

Ion selectivity

28
Q

What does GABA activate? That do?

A

GABAa Receptors that mediate fast synaptic inhibition (IPSP) by permitting rapid influx of Cl ions –> hyperpolarization

29
Q

What does glutamate activate? That do?

A

3 classes of ion channels (AMPA, Kainate, NMDA) that mediate fast synaptic excitation by permitting a rapid influx of Na and Ca

30
Q

When does a seizure occur?

A

When excitation significantly exceeds inhibition

31
Q

MoA of phenobarbital?

A

Enhances activity of GABA receptor
Depresses glutamate activity
Reduces Na/K conductance

32
Q

MoA of phenytoin?

A

Blockage of Na Channels and inhibitory action on Ca and Cl conductance

33
Q

MoA of carbamazepine?

A

Blockage of neuronal Na channel conductance

34
Q

MoA of Valproate?

A

affects GABA glutamatergic activity and reduce threshold of Ca and K conductance

35
Q

MoA of Ethosuximide?

A

Inhibits Ca T-channel conductance

36
Q

MoA of Lamotrigine?

A

Blockage of voltage-dependent Na conductance

37
Q

MoA of oxcarbazepine?

A

Na Channel blockage

38
Q

MoA of Topiramate?

A

Blockage of Na channels

Enhancement of GABA medicated chloride influx

39
Q

MoA of Zonisamide?

A

Blockage of Na, K, and Ca channels

Inhibits glutamate excitation

40
Q

MoA of Gabapentin?

A

Modulation of N-Type Ca channel

41
Q

What are effective for partial and tonic-clonic seizures?

A

Valproate, phenytoin, carbamazepine, and phenobarbital

42
Q

What are effective for absence seizures?

A

Ethosuximide

Valproate

43
Q

What are effective only for partial seizures?

A

Gabapentin

Oxcarbazepine

44
Q

What are effective for both partial and generalized seizures?

A

Lamotrigine
Topiramate
Levetiracetam
Zonisamide

45
Q

SEs of carbamazepine?

A

Aplastic anemia
Hepatotoxicity
Stevens Johnson syndrome
Lupus-like syndrome

46
Q

SEs of ethosuximade?

A

Bone marrow depression

Hepatotoxicity

47
Q

SEs of Lamotrigine?

A

SJS

Toxic epidermal necrolysis

48
Q

SEs of Phenytoin?

A

Aplastic anemia
Hepatic failure
SJS
Lupus

49
Q

SEs of Oxcarbazepine?

A

Hyponatremia

Rash

50
Q

SEs of Topiratmate?

A

Renal Calculi

Hypohidrosis

51
Q

SEs of Zonisamide?

A

Renal calculi

Hypohidrosis

52
Q

SEs of Phenobarbital?

A

Hepatotoxicity
Connective tissue disorder
SJS

53
Q

SEs of Valproate?

A 
Hepatotoxicity
Hyperammonemia
Leukopenia
Thromocytopenia
Pancreatitis
54
Q

Hepatic cytochrome P450 inducers?

A 
Caramazepine
Phenobarbital
Phenytoin
Oxcarbazepine
Topiramate
55
Q

Older AEDs are which category of drugs? Newer AEDS?

A

D

C

56
Q

Disabling seizures?

A

Causing impaird quality of life, limited educational or occupational opportunities, physical injuries, or social compromise

57
Q

Generalized convulsive status epilepticus?

A

Continuous, generalized convulsive seizure lasting more than 5 minutes or two or more sequential seizures occurring without full recovery of consciousness

Neurology (25 decks)

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