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TX III - Module I

Epilepsy 1

Pathophysiology (2) 1. Abnorm excessive excitation 2. Disordered inhibition of cortical neurons
Symptoms depends on (3) site of focus Degree of spread Intensity of impulse
NT that play a role in pathophysiology (5) Glutamate GABA Ach NE 5HT
Types of Partial seizures (3) Simple Complex 2nd-arily generalized
Types of Generalized seizures Absence Myoclonic Clonic Tonic Tonic-Clonic Atonic Infantile spasms
All types of seizures Partial General Unclassified Status Epilepticus
Def: Partial (Simple) w/o impairment of conscious 1 motor sx 2 special sensory or somatosensory sx 3 psychic sx
Def: Partial (complex) with impairment of consciousness 1 simple followed by unconscious w/ or w/o automatism
Def: Secondarily generalized Partial -> General tonic-clonic
Def: Absence sudden onset loss of consciousness for a moment blank stare, possible upward rotation of eyes commonly not aware of event
Children commonly have which type of seizure Absence
Def: Myoclonic breaf shock-like muscular contractions can be isolated or rapidly repetitive
Def: Clonic rapidly alternating contraction and relaxation
Def: Tonic muscle tone is greatly increased; sudden stiffening movements
Def: Tonic-clonic sudden sharp tonic followed by period of rigidity and clonic movements
How may a px with tonic clonic act? during and after lose sphincter control, bite tongue, cyanosis altered consciousness, drowsiness, confusion
Def: Atonic sudden loss of muscle tone ie head drop, limb, slump
Def: Infantile 3m-4y sudden jerking then stiffening
Def: Epileptic syndromes juvenile myoclonic epilepsy Lennox-gastaut syndrome Childhood absence epilepsy(petit mal) Temporal lobe epilepsy
Def: Juvenile starts as tonic-clonic -> myoclonic absence seizures also common
Def: Lennox-Gastaut Various gen (atypical absence, atonic, myoclonic, tonic)
Lennox-Gastaut px are frequently Devolpmentally disabled
Def: Childhood Absence absence in clusters asso. w/ tonic-clonic
Def: Temporal Lobe Complex partial w/automatisms May have simple partial aura
50% of what type of seizure/epilepsy will become 2nd'arily generalized Temporal lobe Epilepsy
Tests and Diagnostics Prolactin EEG MRI
Non RX Ketogenic diet, surgery, Vagus nerve stimulation
Discribe Ketogenic diet especially for refractory px hi fat, lo protein lo carb poorly tolerated
DI: Oral contraceptives Enzyme inducing AEDs increase metabolism of sex hormones
Def: Catamenial Epilepsy pattern of seiqures just before and during menses
DI: Pregnancy May alter threshold Need prior planning Valproic Acid increases tertirtogenic
Therapeutic considerations in women Oral contraceptives catamenial epilepsy Pregnancy Lactation
DI: Lactation brease feeding ok AED conc are v.lo in breast milk MONITOR
AED MOAs Enhance GABA Inhibit excitatory neurotransmitters Modulate ion channels (Na,Ca, etc)
Tx: Partial seizures (4) Carbamazepine Lamotrigine Valproic Acid Oxcarbazepine
Tx: Absence Valproic Acid Ethosuximide
Tx: Myoclonic Valproic Acid Clonazepam
Tx: Tonic-clonic Pheyntoin Carbamazepine Valproic Acid
DI: Carbamazepine VA increases metabolite -> decreases Carbamazepine conc
DI: Carbamazepine VA 3A4 May induce metabolism of other Rx
Created by: deann1