Lecture 58: Epilepsy
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Lecture 58: Epilepsy
Neuro Week 5
What is a seizure?
Temporary alteration in brain function due to excessive and/or hypersynchronous neuronal activity
What are the four different groups of epilepsy?
localization-related, generalized, undetermined, and special syndromes
What are the three types of epilepsy?
partial, generalized, and unclassifiable
What is epilepsy?
The tendency to have recurrent, unprovoked seizures
What are the requirements for a generalized (non-focal) seizure?
EEG findings of bilateral origin and bilateral onset of symptoms
What are the symptoms of a partial (non-focal) seizure?
EEG findings consistent with a unilateral origin and unilateral onset of symptoms
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
What is an ictus?
The event of a seizure
What is an aura?
A type of warning for a seizure. It is a partial seizure that preludes a more serious seizure type
What is "Todd Paralysis"?
A transient postictal focal deficit such as aphasia, hemianopia, hemiparesis, or hemisensory loss lasting minutes to hours
If you have a symptomatic seizure, what does that mean?
It means that the cause of your seizure has been identified
What is a cryptogenic seizure?
presumed systomatic, but the cause is really unknown
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
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
What are some non-epileptic disorders that mimic epilepsy?
transient global amnesia
What are the major risk factors for epilepsy?
Traumatic Brain injury
: encephalitis>bacterial>aspetic meningitis
Mental Retardation/cerebral palsy
When is the risk of acute symptomatic seizures the highest?
first year of life and last years of life
When is the greatest risk of a recurrent seizure?
within the first 6 months
Juvenile Myoclonic Epilepsy is a specialized epilepsy. What are its presentations?
generalized, tonic-clonic seizures
some have absence seizures, some have family hx of seizures
What are the two medicational options for Juvenile Myoclonic Epilepsy (JME) and how do they differ?
: can cause birth defects
: prefered for women of childbearing age (14-50)
BS or NS?
: enhanced central GABA action and NA+ channel blockage
Broad Spectrum Drug
What are side effects of Valproate?
Idiosyncratic with hepatotoxicity, pancreatis, thrombocytopenia
teratogenicity (will cause spina bifida)
BS or NS?
Voltage dependent Na+ channel blockade and subsequent decrease in release of glutamate
broad spectrum drug
The side effects of lamotrigine are dose related: what are they?
What are three options to consider after drug effectiviness has decreased?
: resection, such as anterior temporal lobectomy
Vagal Nerve Stimulation
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
What causes status epilepticus?
mainly anticonvulsant withdrawl or not enough anticonvulsant
and the usual suspects
: infection, trauma, tumor, toxic metabolic conditions
What should you do when you witness someone undergoing a status epilepticus attack?
such as Lorazepam), then
administer glucose and thiamine
get a focused history from family members
BS or NS?
When is it given?
: 1 day
Narrow Spectrum drug
: at Bedtime
: 300 mg/day
: blocks voltage dependent Na+ channels
What are possible side effects of phenytoin?
: cleft-palate, cardiac septal defects, fetal hydantoin syndrome
Coarse facial features (thickening of skin)
What are the targets for drugs in epilepsy?
Receptors associated with chloride channels
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
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
What are the five traditional drugs used to treat seizures according to Dr. Bremer?