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Epilepsy

Terms in this set (37)

paroxysms of abnormally hyperexcitable and hypersynchronous cortical activity, results in a change in sensation, behavior or sensorium

having two or more unprovoked seizures, separated by more than 24 hours (or a single unprovoked seizure with 60% or greater risk of recurrence within 10 years); clinical diagnosis

Structural/metabolic epilepsy

seizures arise from an evident structural lesion or metabolic condition

genetic epilepsy

epilepsies that are presumed to be the result of genetic defects (i.e. childhood absence epilepsy and benign rolandic epilepsy)

a seizure that arises from a particular region of the brain

generalized seizure

seizure that involves both hemispheres of the brain

focal to bilateral tonic-clonic seizure

seizure that begins as a focal seizure and then spreads to involve the other hemisphere (example: benign rolandic epilepsy)

Jacksonian March seizure

spread of clonic movements through contiguous body parts unilaterally

formerly simple partial seizure, fully preserved awareness

impaired awareness seizure

formerly complex partial seizure or dyscognitive, altered awareness

sustained muscle contraction, stiffening

rhythmic jerking

loss of muscle tone, "drop seizures"

a very rapid jerk of a muscle or muscle group without subsequent activation of antagonistic muscles

staring with decreased awareness

coordinated, repetitive motor activity often resembling voluntary movement during impaired cognition

subjective sensation which may proceed observable seizure; can be olfactory, somatosensory, visual or experiential

perceptual experience

changes including cardiovasuclar, sudomotor, vasomotor

dysmnesia (deja vu, jamais vu)

time after the seizure event, may be characterized by confusion, somnolence, hemiparesis and/or agitation

uncinate seizure

temporal lobe seizures that involve the primary olfactory cortex and begin with an olfactory aura

status epilepticus

continuous or recurring seizure(s) that may result in brain injury, variably defined as > 5-30 min.

Treatments for medically refractory epilepsy

Vagal nerve stimulator, ketogenic diet (most often used in children), surgery (temporal lobectomy)

First line medications for generalized seizures

Lamotrigine, valproate

First line medications for focal seizures

Lamotrigine, carbamazepine, phenytoin

Indication: focal epilepsy
Adverse effects: Rash, nystagmus, ataxia, sedation, impaired concentration
Mechanism: Voltage-gated sodium channel blocker
Note: Can make general/ myoclonic seizure worse

Indication: focal epilepsy
Adverse effects: Rash, diplopia, ataxia, sedation, confusion, hyponatremia (avoid in geriatric populations)
Mechanism: Voltage-gated sodium channel blocker

Indication: Focal and generalized epilepsy
Adverse effects: Rash, insomnia, less sedation, depression, impaired concentration, significant drug interactions, may make myoclonic seizure worse (<10%)
Mechanism: Voltage-gated sodium channel blocker, high voltage activated calcium channel block

Benzodiazepines (clonazepam, lorazepam, diazepam)

Indication: Acute seizure suppression (lorazepam, diazepam), adjuvant for myoclonic seizures (clonazepam)
Adverse effects: Sedation, unsteadiness, depression, delirium, tolerance and withdrawal
Mechanism: Enhances GABA-A mediated response (opening frequency)

Barbiturates (phenobarbitol)

Indication: Focal and generalized epilepsy, most often used in pediatric population
Adverse effects: Sedation, disorientation, incoordination, depression, delirium, paradoxical hyperactivity, rash, porphyria
Mechanism: Enhances GABA-A mediated response (opening duration)

Indication: Better for generalized epilepsy, bipolar disorder
Adverse effects: Weight gain, tremor, sedation, impaired concentration, hepatic failure in children, teratogenic (NTDs, lower IQ)
Mechanism: Enhances GABA-A mediated response, inhibits sodium current, inhibits glutamate receptors, inhibits T-type calcium channels

Indication: Generalized absence
Adverse effects: Abdominal pain, nausea, vomiting, diarrhea, anorexia, rash, movement disorders
Mechanism: Blocks T-type voltage gated calcium channels

Indication: Focal and generalized epilepsy, migraine prevention
Adverse effects: Weight loss, impaired concentration (not good for school age), depression, parasthesias, renal stones, glaucoma, metabolic acidosis
Mechanism: Blocker of sodium channels and high voltage activated calcium channels

Indication: Focal and generalized epilepsy
Adverse effects: Agitation, depression, diastolic hypertension
Mechanism: Binds to SV2A presynaptic protein and decreases synaptic release, very safe and easy to use

Treatment for status epilepticus

1. ABCs
2. Body temp., SaO2, blood glucose
3. Start IV
4. Administer 100 mg thiamine, 50 ml of 50% glucose
5. Lorazepam
6. IV antiepileptic (phenytoin or fosphenytoin)
7. EEG
8. Intubation
9. Phenobarbitol

Stevens-Johnson syndrome

Prodrome of malaise and fever followed by rapid onset of erythematous/ purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal necrosis and sloughing.

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