Epilepsy

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mmccaf9260
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19970
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Epilepsy
Updated:
2010-05-19 18:06:26
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Epilepsy
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Therapeutics 4
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  1. Define seizure:
    paroxysmal disorder of CNS, characterized by abnormal neuronal discharges with or without loss of consciousness. they very in cause, presentation, consequences, duration, and management
  2. Define epilepsy:
    two or more unprovoked seizures; symptoms of disturbed electrical activity in the brain
  3. What are the ages of highest incidence of having a first seizure?
    • under 2 years old
    • over 65 years old
  4. name special populations which are at risk for epilepsy
    • children with:
    • mental retardation(26%)
    • cerebral palsy (13%)
    • both disablities (50%)
    • alzheimer's patients (10%)
    • stroke patients (22%)
    • down syndrome (5-10%)
  5. Causes of seizures in neonates (<1 month)
    • perinatal hypoxia and ischemia
    • intracranial hemorrhage and trauma
    • acute CNS infection
    • metabolic disturbances (hypoglycemia, hypocalcemia, hypomagesemia, pridoxine deficiency)
    • drug withdrawal
    • development disorders
    • genetic disorders
  6. causes of seizures in 1 month to 12 yo
    • febrile seizures
    • genetic disorders
    • CNS infections
    • developmental disorders
    • trauma
    • idiopathic
  7. causes of seizures in 12 to 18 yo
    • trauma (drive)
    • genetic disorders
    • CNS infection
    • brain tumor
    • illicit drug use
    • idiopathic
  8. cause of seizures in 18-35 yo
    • trauma
    • alcohol withdrawal
    • illicit drug use
    • brain tumor
    • idiopathic
    • pregnancy- eclampsia
  9. causes of seizures in adults >35 yo
    • cerebrovascular disease
    • brain tumor
    • alcohol withdrawal
    • metabolic disorders
    • alzheimer's disease
    • idiopathic
  10. Possible triggers for seizures
    • elevated fever
    • lack of sleep
    • hormone fluctuations
    • specific phase of the menstrual cycle
    • flashing or flickering lights
  11. Pathophysiology of seizures
    alterations in the disturbution, number, type and biophysical properties of ion channels in the nueonal membranes (Na, Ca, K)
  12. Name the types of partial seizures
    • simple partial seizures
    • complex parital seizures
    • partial seizures with secondary generalization
  13. Types of primarily generalized seizures
    • absence (petit mal)
    • tonic-clonic (grand mal)
    • atonic
    • myoclonic
  14. Types of unclassified seizures
    • febrile
    • infantile
  15. Describe a simple partial seizure
    • does not loose consciousness
    • cause motor, sensory, autonomic, or psychic symptoms
    • may begin in fingers and gradually progress to a larger portion of the extremity
    • may allso manifest: somatic sensation, vision, equilibrium, flushing, sweating, hearing, smell, odd, internal feelings such as fear, illusions that objects are growing smaller or larger, deja vu
  16. Describe a complex partial seizure
    • frequently begin with aura
    • progress to the ictal phase, which may begin with a motionless stare
    • loose consciousness
    • typically confused following seizure, full recovery may be seconds to hours
  17. Describe a partial seizure with secondary generalization
    • can spread to involve both hemispheres and produce a generalized seizure, usually of the tonic-clonic variety
    • focal onset is not clinically evident and may be established only through careful patient hx and EEG anaylsis
  18. Describe a generalized absence seizure
    • sudden, brief lapses of consciousness withough loss of postural control
    • last for only seconds and returns suddenly
    • often accompanied by subtle, bilateral motor signs such as rapid blinking of the eyelides, chewing movements, clonic movements of the hands
    • usually begin in ages 4-8
    • first clue = daydreaming
  19. Describe a generalized tonic-clonic seizure
    • most common seizure type resulting from metabolic derangements
    • usually begins withough warning
    • inital phase = tonic contraction of muscles throughout the body, contraction of the jaw muscles may cause biting of the tongue
    • tonic phase = repeated by jerks of the arms and/or legs
    • posticital phase = unresponsiveness, excessive salivation
    • bladder or bowel incontinence
    • regain consciousness over minutes to hours, may have HA, fatigue, and muscle aches that lasts for hrs
  20. Describe an atonic seizure
    • sudden loss of normal muscle tone, lasting 1-2 seconds
    • consciousness is briefly impaired
    • quick head drop
    • collapse
  21. Describe a myoclonic seizure
    • sudden and brief muscle contraction that may involve one part or the entire body
    • muscle contractions causes jerks or twitches of the upper body, arms or legs
    • most commonly associated with metabolic disorders, degenerative CNS disease, anoxic brain injury
    • usually coexist with other forms of generalized seizure disorders, but are the predominant feature of juvenile myoclonic epilepsy
  22. Describe a febrile seizure
    • arising in late infancy (18-24 months)
    • occurs during the rising phase of the temperature and how rapidly in rises
  23. Describe an infantile spasms
    • disorder of infancy and early childhood
    • spasms are sudden, brief contractions (less than 10 seconds)
    • usually involve muscles of the neck, trunk, and extremities, often occur in clusters
    • some may be treated with ACTH or prednisone
  24. Diagnosis of epilepsy
    • medical hx
    • lab studies
    • EEG
    • brain scans (CT, MRI, PET, SPECT)
    • developmental, neurological, and behavioral tests
  25. EEG
    most common diagnostic test for epilepsy, can detect abnormalities in the brains electrical activity
  26. First line drugs for generalized tonic-clonic seizure
    • valproic acid
    • lamotrigine
    • topiramate
  27. First line drugs for partial seizures
    • carbamazepime
    • phenytoin
    • lamotrigine
    • oxcarbazepine
    • valproic acid
  28. First line drugs for absence seizures
    • valproic acid
    • ethosuximide
  29. First line drugs for myoclonic and atonic seizures
    • valproic acid
    • lamotrigine
    • topiramate
  30. alternatives for tonic clonic seizures
    • zonisamide
    • phenytoin
    • carbamazepine
    • oxcarbazepine
    • phenobarbital
    • primidone
    • felbamate
  31. alternatives for partial seizures
    • levetiracetam
    • topiramate
    • tiagabine
    • zonisamide
    • gabapentin
    • phenobarbital
    • primidone
    • felbamate
  32. alternatives for absence seizures
    • lamotrigine
    • clonazepam
  33. alternatives for myoclonic,atonic seisures
    • clonazepam
    • felbamate
  34. neurologic adverse effects of phenytoin
    • dizziness
    • nystagmus
    • ataxia
    • incorrdination
    • confusion
  35. systemic adverse effects of phenytoin
    • gum hyperplasia
    • lymphadenopathy
    • hirsutism
    • osteomalacia
    • skin rash
  36. drug interactions with phenytoin
    • level increase by isoniazid, sulfonamides, fluoxetine
    • level decreased by enzyme inducing drugs
    • altered folate metabolism
  37. Neuological effects of carbamazepine
    • ataxia
    • dizziness
    • diplopia
    • vertigo
  38. systemic adverse effects of carbamazepine
    • aplastic anemia
    • leukopenia
    • GI irritaion
    • hepatotoxicity
    • hyponatremia
  39. drug interactions with carbamazepine
    • levels decreased with enzyme inducing drugs
    • levels increased by erythromycin, propoxyphene, isoniazid, cimetidine, fluoxetine
  40. neurological adverse effects of valproic acid
    • ataxia
    • sedation
    • tremor
  41. systemic adverse effects of valproic acid
    • hapatotoxicity
    • thromobcytopenia
    • GI irritation
    • pancreatitis
    • weight gain
    • transiet alopecia
    • hyperammonemia
    • cat x
  42. drug interactions with valproic acid
    levels increased by enzyme inducing drugs
  43. neurological effects of ethosuximide
    • ataxia
    • lethargy
    • headache
  44. systemic effects of ethosuximide
    • GI irritation
    • skin rash
    • bone marrow suppression
  45. drug interactions with ethosuximide
    valproic acid
  46. Neurological effects of phenobarbital (same with primidone)
    • sedation
    • ataxia
    • confusion
    • dizziness
    • depression
  47. systemic effects of phenobarbital (same with primidone)
    skin rash
  48. drug interactions with phenobarbital (same for primidone)
    levels increased by valproic acid, phenytoin
  49. neurological effects with clonazepam
    • ataxia
    • sedation
    • lethargy
  50. systemic effects of clonazepam
    anorexia
  51. drug interactions with clonazepam
    levels drecreased by enzyme-inducing drugs
  52. neurological effects of lamotrigine
    • dizziness
    • diplopia
    • sedation
    • ataxia
    • headache
  53. systemic effects of lamotrigine
    • skin rash
    • stevens-johnson syndrome
  54. drug interactions with lamotrigine
    • level decreased by enzyme inducing drugs and oral contraceptives
    • levels increased by valproic acid
  55. neurologic effects of gabapentin
    • sedation
    • dizziness
    • ataxia
    • fatigue
  56. systemic effects of gabapentin
    • GI irritation
    • weight gain
    • edema
  57. drug interactions with gabapentin
    no known significant interactions
  58. neurologic effects of levetiracetam
    • sedation
    • fatigue
    • incooridation
    • psychosis
  59. systemic effects of levetiracetam
    • anemia
    • leukopenia
  60. drug interactions with levetiracetam
    none known
  61. neurologic effects with topiramate
    • psychomotor slowing
    • sedation
    • speech or language problems
    • fatigue
    • paresthesias
  62. systemic effects of topiramate
    • metabolic acidosis
    • renal stones
    • glaucoma
    • weight loss due to anorexia
  63. drug interactions with topiramate
    levels decreased by enzyme inducing drugs
  64. neurologic effects of oxcarbazepine
    • fatigue
    • ataxia
    • dizziness
    • diplopia
    • vertigo
    • headache
  65. systemic effects of oxcarbazepine
    same as carbamazepine
  66. drug interactions with oxcarbazepine
    • levels decreased by enzyme inducing drugs
    • may increase phenytoin
  67. neurologic effects of tiagabine
    • confusion
    • sedation
    • depression
    • dizziness
    • speech or language problems
    • paresthesias
    • psychosis
  68. systemic effects of tiagabine
    GI irritation
  69. drug interactions with tiagabine
    levels decrease by enzyme inducing drugs
  70. neurlogic effects of zonisamide
    • sedatoin
    • dizziness
    • confusion
    • headache
    • psychosis
  71. systemic effects of zonisamide
    • anorexia
    • renal stones
  72. drug interactions with zonisamide
    levels decreased by enzyme inducing drugs
  73. neurologic effects of felbamate
    • insomnia
    • dizziness
    • sedation
    • headache
  74. systemic effects of felbamate
    • aplastic anemia
    • hepatic failure
    • weight loss
    • GI irritation
  75. drug interactions with felbamate
    increases phenytoin, valproic acid, active carbamazepine metabolite

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