| Question | Answer |
| 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 |
