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What is a seizure?
Temporary alteration in brain function due to excessive and/or hypersynchronous neuronal activity
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What are the four different groups of epilepsy?
localization-related, generalized, undetermined, and special syndromes
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What are the three types of epilepsy?
partial, generalized, and unclassifiable
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What is epilepsy?
The tendency to have recurrent, unprovoked seizures
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What are the requirements for a generalized (non-focal) seizure?
EEG findings of bilateral origin and bilateral onset of symptoms
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What are the symptoms of a partial (non-focal) seizure?
EEG findings consistent with a unilateral origin and unilateral onset of symptoms
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What are the main differences between a simple and a complex seizure?
The state of consciousness: in a simple seizure the state of consciousness is preserved....it is altered in a complex seizure
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What is an ictus?
The event of a seizure
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What is an aura?
A type of warning for a seizure. It is a partial seizure that preludes a more serious seizure type
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What is "Todd Paralysis"?
A transient postictal focal deficit such as aphasia, hemianopia, hemiparesis, or hemisensory loss lasting minutes to hours
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If you have a symptomatic seizure, what does that mean?
It means that the cause of your seizure has been identified
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What is a cryptogenic seizure?
presumed systomatic, but the cause is really unknown
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What is the difference between localization-related seizures and generalized seizures?
localization-related seizures involves one or more focal areas of the brain; generalized seizures are both hemispheres
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What is the difference between an EEG of a seizure and a syncope?
convulsive syncope involves release of the brain stem from the cortex and the EEG will be slow and flattening; seizures on the other hand nearly always involve biting and incontinence
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What are some non-epileptic disorders that mimic epilepsy?
- syncope
- migrane
- cerebrovascular
- sleep disorders
- movement disorders
- transient global amnesia
- pyschiatric
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What are the major risk factors for epilepsy?
- Traumatic Brain injury
- Infection: encephalitis>bacterial>aspetic meningitis
- Cerebrovascular disease
- Alzheimers
- Febrile Convulsions: complex>simple
- Family Hx
- Mental Retardation/cerebral palsy
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When is the risk of acute symptomatic seizures the highest?
first year of life and last years of life
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When is the greatest risk of a recurrent seizure?
within the first 6 months
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Juvenile Myoclonic Epilepsy is a specialized epilepsy. What are its presentations?
- Idiopathic origin
- myclonic jerks
- generalized, tonic-clonic seizures
- some have absence seizures, some have family hx of seizures
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What are the two medicational options for Juvenile Myoclonic Epilepsy (JME) and how do they differ?
- Valproate: can cause birth defects
- Lamotrigine: prefered for women of childbearing age (14-50)
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Valproic Acid
MAO:
BS or NS?
- MAO: enhanced central GABA action and NA+ channel blockage
- Broad Spectrum Drug
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What are side effects of Valproate?
- Tremors
- Weight gain
- Alopecia
- GI Upset
- Polycistic Ovaries
- Idiosyncratic with hepatotoxicity, pancreatis, thrombocytopenia
- teratogenicity (will cause spina bifida)
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Lamotrigine
MAO:
BS or NS?
- Voltage dependent Na+ channel blockade and subsequent decrease in release of glutamate
- broad spectrum drug
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The side effects of lamotrigine are dose related: what are they?
- Fatigue
- dizziness
- diplopia
- ataxia
- rash (gross!)
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What are three options to consider after drug effectiviness has decreased?
- Surgery: resection, such as anterior temporal lobectomy
- Vagal Nerve Stimulation
- Atkins Diet
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What is "status epilepticus"?
- 30 minutes of either continuous seizure activity or repetitive seizures without recovery between them
- Seizures are only supposed to last 2 minutes....anything over 5 minutes is of great concern
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What causes status epilepticus?
- Many things:
- mainly anticonvulsant withdrawl or not enough anticonvulsant
- alcohol withdrawl
- stroke
- anoxia
- and the usual suspects: infection, trauma, tumor, toxic metabolic conditions
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What should you do when you witness someone undergoing a status epilepticus attack?
- ABCs
- administer anticonvuslant: Benzodiazepines (such as Lorazepam), then Phenytoin
- administer glucose and thiamine
- get a focused history from family members
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Phenytoin
Half-life
BS or NS?
When is it given?
Dose
MAO
Kinetic order
- Half-life: 1 day
- Narrow Spectrum drug
- Given: at Bedtime
- Dosage: 300 mg/day
- MAO: blocks voltage dependent Na+ channels
- Zero order
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What are possible side effects of phenytoin?
- Ataxia
- Nystagmus
- Teratogenicity: cleft-palate, cardiac septal defects, fetal hydantoin syndrome
- Rash
- Agranulocytosis
- Coarse facial features (thickening of skin)
- Gum hyperplasia
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What are the targets for drugs in epilepsy?
- GABA receptors
- Na+ channels
- glutamate receptors particularly NMDAReceptors associated with chloride channels
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What is the difference between broad spectrum drugs and narrow spectrum drugs?
- BS drugs work on most or all seizures
- NS drugs work on one or a few seizure types
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When should one monitor serum levels in an epileptic patient?
- when first starting a drug
- when drug toxicity is suspected
- when seizures are poorly controlled
- when one suspects non-compliance
- special situations: pregnancy, dialysis, liver failure
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What are the five traditional drugs used to treat seizures according to Dr. Bremer?
- Phenobarbital
- Phenytoin
- Primidone
- Carbamazepine
- Valproate
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