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