Pervasive developmental disorder; onset typically <3 years of age; impairment of communication skills; males:females (4:1); difficulty regulating emotions
What are the types of Autism?
Asperger syndrome, childhood disintegrative disorder, Rett syndrome, pervasive development disorder (PDD)
What are some factors of Asperger?
No language problems, score in the average or above-average range on intelligence tests, has social struggles and limited scope of interests
What are some factors of childhood disintegrative disorder?
Develop normally for patients over 2 years; lose communication and social skills
What are some factors of Rett syndrome?
Occurs only in girls, children begin to develop normally, they lose communication and social skills around ages 1-4 years, they exhibit repetitive hand movements
What is Pervasive development disorder (PDD)?
The category for children who display some autistic problems but who don't fit into other categories
What are some of the signs and symptoms of autism?
Impaired social interaction (lack of eye contact, doesn't know how to play with toys, doesn't smile), communication impairment (doesn't babble or point by 1 year of age, may not respond by name, low vocabulary by 2 years of age), repetitive activity (lines up toys, odd movement such as walking on toes, attachment to one particular toy/object)
What is some screening for autism?
CHAT and STAT testing
What is some of the treatment available for autism?
The tendency to have seizures on a chronic, recurrent basis; implies there is permanent changes in cortical function; seizures originate in groups of neurons which do not have normal electrical behavior
What is status epilepticus?
Neurologic emergency that can lead to permanent brain damage or death; a seizure lasting more than 30 minutes with or without consciousness; having recurrent seizures without regaining consciousness between episodes
About how many Americans does epilepsy affect?
2 million Americans
What kind of profound impact can epilepsy have on a patient's lifestyle?
Limits driving, can be difficult to manage, decrease in school attendance, learning disabilities (in some cases), patients often dependant on others
True/False: The etiology in most cases is unknown
True
What can be some causes of epilepsy?
Some onset due to head trauma and stroke; CNS tumors
Seizures involve a sudden...
...electric disturbance of the cerebral cortex, where neurons fire rapidly and repetitively for seconds to minutes.
How can neurotransmitters affect epiliepsy?
Excess of excitatory NT actions, failure of inhibitory NT actions or a combination
True/False: Epilepsy is considered a short term disorder.
False, it is generally considered a life-long disorder; patient must meet criteria before considering the discontinue of meds
What is the major excitatory NT in the cerebral cortex?
Glutamate
What does glutamate release result in?
The opening of membrane channels to allow sodium or calcium to flow into postsynaptic neurons which depolarizes it and transmits the excitatory signal
How do drugs interfere with the release of glutamate?
It blocks the sodium or calcium channels which prevents the excessive excitation
What is the major inhibitory NT in the cerebral cortex? How does it work?
GABA; it attaches to membrane and opens chloride channels, chloride becomes hyperpolarized and less excitable, this is critical for shutting off seizure activity
How is epilepsy diagnosed and identified?
Through the classification of epileptic seizures and also based on EEG findings combined with clinical findings
What are the main classification/types of seizures?
Primary generalized seizures and partial seizures
What are some treatment options for epilepsy?
Algorithms for medication use, International League Against Epilepsy, American Academy of Neurology
True/False: Many medications for seizures have unknown MOA.
True, medications are used based on seizure type and evidence-based decisions are made due to published data
Many seizure meds are highly bound to plasma protein, which ones especially?
Phenytoin and valproate
In phenytoin and valproate what does the small percent of the unbound medication do?
Produces clinical effects in the CNS and also the side effects
True/False: Patients with alterations in protein binding have decreased percentage of drug that is unbound (which results in increase dose-related adverse effects)
False; they have an increased percentage of drug that is unbound
What types of patients have decreased protein binding?
Those with renal failure, those with hypoalbuminemia, pregnant women, neonates, and patients in critical care
What are some of the concerns associated with epilepsy medications?
Efficacy (seizure control), toxicity, adverse drug reactions, drug interactions, changing medications
What is the brand name for phenytoin and what is it used for?
Dilantin, Kapseals; used for seizure control
What are some side effects associated with phenytoin?
Uncontrolled eye movement, lack of coordination, slurred speech, mental confusion
