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Epilepsy
| Question | Answer |
|---|---|
| Partial seizures | begins in one side of hemisphere of brain; unilateral; assymetric movements; associated with aura |
| Generalized sizures | begins in both hemispheres of brain, bilateral movements, no aura |
| Absence seizures | blank stare, upward rotation of eyes, lip smacking, can be precipiated by hyperventilation |
| Absence DOC | ethosuximide; if has absence and generalized tonic-clonic and >2 years, can give VPA |
| Tonic Phase | rigid, violent, suddent muscular contractions, cry/moan deviation of eyes and head to one side; rotation of body and distortion of features, suppression of respiration, fall to ground, loss of consciousness, tongue biting, urination |
| Clonic Phase | repetitive jerks, cyanosis, foaming of mouth, small grunts, deep respirations |
| DOC for tonic-clonic seizures | phenytoin, CBZ, topiramate, VPA |
| drugs that cause epilepsy | recreations, imipenam, lindane, lidocaine, metoclopramide, theophylline, TCAs, meperidine, CBZ, ethosuxamide, Phenytoin, phenobarbital |
| phenobarbital indication | neonatal seizures; generalized (except absence |
| phenobarbital ADRS | drowsiness, dizziness, light headedness, incoordination, HAs, nervousness, hyperactivity in children, low memory, low IQ, folate deficiency, vitamin K deficiency hemorrhage, hepatic failure, SJS, teratogenic |
| phenytoin indications | all except absence and febrile seizures |
| phenytoin ADRs | N/V, drowsiness, dizziness, peripheral neuropathy, hydantoin facies, acne, hirsituism, gingival hyperplasia, osteomalacia, Vit K deficiency, folate deficiency, hepatic failure, SJS, teratogenic |
| phenytoin reference range | 10-20 |
| CBZ reference range | 4-12 |
| CBZ indications | most widely used in children; doc for complex partial seizures; good in generalized seizures except absence and febrile |
| CBZ BBW | aplastic anemia |
| CBZ ADR | rash, N/V, drowsiness, dizziness, neutropenia, SIADH, osteomalacia, folate deficiency, hepatotoxicity, aplastic anemia, teratogenic |
| VPA reference range | 50-150 |
| VPA indications | all types generalized and partial, doc for absence; not used in children less than 2 years |
| VPA ADRs | n/v, weight gain, alopecia, tremo, thrombocytopenia, elevation in LFTs, fatal hepatotoxicity, pancreatic hemorrhage, teratogenicity |
| VPA BBW | hemorrhagic pancreatitis, fatal hepatotoxicity, teratogenicity |
| Felbamate | Felbatol |
| Felbamate indications | lennox gastaut, tonic clonic, tonic myoclonic, refractory partial seizures with or without generalization |
| Felbamate ADR | weight loss, hepatotoxicity, aplastic anemia |
| Felbamate BBW | aplastic anemia, hepatotoxicity |
| Gabapentin indicatons | partial seizures; more for peripheral neuropathies |
| lamotrigine indications | partial seizures, primary or secondary generalized tonic-clonic; absence, lennox gastaut |
| lamotrigine ADR | BBW-skin rash |
| topiramate indications | > 10 years, partial onset seizures, primary generalized tonic-clonic seizures (MONOTHERAPY); 2-16 years and adults-partial onset, primary generalized tonic-clonic (ADJUNCTIVE; >2 years, Lennox-Gastaut |
| Topiramate ADRs | drowsiness, dizziness, difficulty concentration, loss of appetite, mood changes, paresthesias, metabolic acidosis, acute myopia and closed angle closure, kidney stones, paresthesias, word finding difficulties, significant weight loss, oligohidrosis |
| tiagibine | gabitril |
| tiagiibe indication | partial seizures |
| zonisamide | zonegran |
| zonisamide indications | partial seizures |
| zonisamide ADR | kidney stones, weight loss, oligohydrosis, reversible or irreversible pyschosis |
| zonisamide BBW | oligohydrosis |
| antiepileptics that cause kidney stones and oligohydrosis | zonisamide and topiramate |
| Levetiracetam indication | partial seizures |
| levetiracetam ADRs | dizziness, drowsiness, sedation |
| status epilepticus | seizure > 5 minutes or 2 or more discreet seizures where there is incomplete recovery of consciousness; it is medical emergency |
| status epileticus treatment | 1) BZDs - ativan, valium, 2) IV phenytoin 3) IV phenobarbital 4) IV Midazolam 5) medically induced coma (pentobarbital) |
| other therapies for status epilepticus | propofol, topiramate, magnesium, lidocaine, IVIg |
| febrile seizure treatment | 1) rectal BZD with ativan or valium; 2) diastat - diazepam gel |