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Epilepsy

Terms in this set (37)

Seizure
paroxysms of abnormally hyperexcitable and hypersynchronous cortical activity, results in a change in sensation, behavior or sensorium
Epilepsy
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)
focal seizure
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
aware seizure
formerly simple partial seizure, fully preserved awareness
impaired awareness seizure
formerly complex partial seizure or dyscognitive, altered awareness
tonic
sustained muscle contraction, stiffening
clonic
rhythmic jerking
atonic
loss of muscle tone, "drop seizures"
myoclonic
a very rapid jerk of a muscle or muscle group without subsequent activation of antagonistic muscles
absence
staring with decreased awareness
automatism
coordinated, repetitive motor activity often resembling voluntary movement during impaired cognition
aura
subjective sensation which may proceed observable seizure; can be olfactory, somatosensory, visual or experiential
sensory
perceptual experience
autonomic
changes including cardiovasuclar, sudomotor, vasomotor
mnemonic
dysmnesia (deja vu, jamais vu)
post-ictal
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
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
Carbamazepine
Indication: focal epilepsy
Adverse effects: Rash, diplopia, ataxia, sedation, confusion, hyponatremia (avoid in geriatric populations)
Mechanism: Voltage-gated sodium channel blocker
Lamotrigine
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)
Valproate
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
Ethosuximide
Indication: Generalized absence
Adverse effects: Abdominal pain, nausea, vomiting, diarrhea, anorexia, rash, movement disorders
Mechanism: Blocks T-type voltage gated calcium channels
Topiramate
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
Levetiracetam
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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