Lecture 58: Epilepsy

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Lecture 58: Epilepsy
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2010-04-24 17:32:14
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Neuroscience
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Neuro Week 5
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  1. What is a seizure?
    Temporary alteration in brain function due to excessive and/or hypersynchronous neuronal activity
  2. What are the four different groups of epilepsy?
    localization-related, generalized, undetermined, and special syndromes
  3. What are the three types of epilepsy?
    partial, generalized, and unclassifiable
  4. What is epilepsy?
    The tendency to have recurrent, unprovoked seizures
  5. What are the requirements for a generalized (non-focal) seizure?
    EEG findings of bilateral origin and bilateral onset of symptoms
  6. What are the symptoms of a partial (non-focal) seizure?
    EEG findings consistent with a unilateral origin and unilateral onset of symptoms
  7. 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
  8. What is an ictus?
    The event of a seizure
  9. What is an aura?
    A type of warning for a seizure. It is a partial seizure that preludes a more serious seizure type
  10. What is "Todd Paralysis"?
    A transient postictal focal deficit such as aphasia, hemianopia, hemiparesis, or hemisensory loss lasting minutes to hours
  11. If you have a symptomatic seizure, what does that mean?
    It means that the cause of your seizure has been identified
  12. What is a cryptogenic seizure?
    presumed systomatic, but the cause is really unknown
  13. 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
  14. 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
  15. What are some non-epileptic disorders that mimic epilepsy?
    • syncope
    • migrane
    • cerebrovascular
    • sleep disorders
    • movement disorders
    • transient global amnesia
    • pyschiatric
  16. 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
  17. When is the risk of acute symptomatic seizures the highest?
    first year of life and last years of life
  18. When is the greatest risk of a recurrent seizure?
    within the first 6 months
  19. 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
  20. 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)
  21. Valproic Acid
    MAO:
    BS or NS?
    • MAO: enhanced central GABA action and NA+ channel blockage
    • Broad Spectrum Drug
  22. What are side effects of Valproate?
    • Tremors
    • Weight gain
    • Alopecia
    • GI Upset
    • Polycistic Ovaries
    • Idiosyncratic with hepatotoxicity, pancreatis, thrombocytopenia
    • teratogenicity (will cause spina bifida)
  23. Lamotrigine
    MAO:
    BS or NS?
    • Voltage dependent Na+ channel blockade and subsequent decrease in release of glutamate
    • broad spectrum drug
  24. The side effects of lamotrigine are dose related: what are they?
    • Fatigue
    • dizziness
    • diplopia
    • ataxia
    • rash (gross!)
  25. What are three options to consider after drug effectiviness has decreased?
    • Surgery: resection, such as anterior temporal lobectomy
    • Vagal Nerve Stimulation
    • Atkins Diet
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. What are the targets for drugs in epilepsy?
    • GABA receptors
    • Na+ channels
    • glutamate receptors particularly NMDA
    • Receptors associated with chloride channels
  32. 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
  33. 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
  34. What are the five traditional drugs used to treat seizures according to Dr. Bremer?
    • Phenobarbital
    • Phenytoin
    • Primidone
    • Carbamazepine
    • Valproate

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