Seizure and Epilepsy

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is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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is a neurological disease marked by the sudden and recurrent episodes of seizures

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A person is considered to have epilepsy if they meet any of the following conditions:

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More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.

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Some seizures occur as single events
- Withdrawal of depressants
- During acute illnesses
- Systemic conditions
- Cocaine use
- Overdosing on
- disturbances
- Hypoglycemia

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Causes of seizures

: stroke, post-stroke, AV malformations
: meningitis, Lyme disease, brain abscess, HIV related
: Brain injury
: SLE
: hypoglycemia, electrolyte disturbances (Na⁺, Ca⁺⁺, Mg⁺⁺)
: versus cryptogenic
: primary brain tumor or metastatic
: Down’s Syndrome
: IV drug use, cocaine, ephedrine, herbal remedies

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are also called the electrical storms in the brain

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is the main inhibitory neurotransmitter

is the major excitatory neurotransmitter

1

Every individual has a seizure , which is the level of excitability at which neurons will discharge abnormally

1

Patients with epilepsy have a seizure threshold

1

( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure
- warning that a seizure is coming
- not considered part of the seizure

1

or warning is the first symptom of a seizure
- Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body
- Considered part of the seizure

1

phase is the middle of a seizure
- Correlates with the electrical activity in the brain
- Where the symptoms are observed

1

phase is the end of a seizure
- Recovery period after the seizure (immediate or can take minutes to hours)

1

Every person with seizures will not have every stage or symptom

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seizures start in one area or side of the brain

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seizures start on both sides of the brain at the same time and usually loss of consciousness is observed

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A partial seizure in which consciousness is not impaired is referred to as a partial seizure

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A partial seizure in which consciousness is impaired is referred to as a partial seizure

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A partial onset evolving to generalized tonic-clonic is referred to as a seizures

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Name the type of the seizure:

Generally occurs in young children
Sudden onset, interruption of ongoing activity
Blank stare
Possibly a brief upward rotation of the eyes

1

Name the type of seizure:

Brief shock-like muscular contractions of the face, trunk, and extremities

1

Name the type of seizure:

Rhythmic, repetitive, jerking muscle movement

1

Name the type of seizure:

Flexion, extension, and adduction of extremities
Extension of back and neck
Contraction of thoracic and abdominal muscles (may become apneic)
Upward eye movement and mouth partially open
May cry out as air is forced from the lungs

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Which of the following statements about Atonic seizures are true?

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There are NO diagnostic laboratory tests for epilepsy

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levels can be transiently elevated after GTC or CP seizures, however this observation can not be used as a diagnostic marker for epilepsy.

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( Electroencephalogram (EEG), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) ) is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)

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Which of the following is NOT useful in the diagnosis of seizure disorders?

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Focal seizures: previously called , these start in an area or network of cells on one side of the brain

Generalized seizures: previously called , these affect both sides of the brain at onset

Unknown onset: is the onset of the seizure is not known

Focal to bilateral seizure: previously called , it starts in one side of the brain and spreads to both sides

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Focal aware: replaces the term ; if awareness remains intact even if person is unable to talk or respond during a seizure

Focal impaired awareness: replaces the term seizure; if awareness is impaired or affected at any time during a seizure even if a person has a vague idea of what happened

Awareness unknown: for example if person lives alone or has seizures only at night

Generalized seizures: these are all presumed to affect a person’s awareness or consciousness in some way

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Which of the following statements are true in regards to febrile seizures?

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Which drugs can be used as prophylaxis in the treatment of febrile seizures?

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What medications can be given at the time of a febrile seizure?

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Initiation of AEDs is recommended in the following cases:
After one seizure in patients with
After two seizures that occurred within a period of months

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Risk factors for seizures (at least one is need to initiate treatment)

- insult (stroke, head trauma, bleeding)
- Family history of
- changes in
- some illness (babies born small for their age, babies who have seizure in the first month of life, babies born with abnormal areas in the brain)
- tumor
- autism
- use of such as cocaine

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The probability of a 2nd seizure can be as high as % after 5 years

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If the probability of a 2nd seizure is less than 10% in the 1st year and 24% after 2 years, you are NOT considered to be at risk and treatment initiation should not begin.

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A 50 year old male had a documented GTC seizure at 10am this morning. Patient has been recently diagnosed with a brain tumor. What is your recommendation regarding initiating AEDs for this patient?

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Which of the following are triggers for seizures?

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Diphenhydramine raises the seizure threshold

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Which of the following factors must be considered when selecting the appropriate AED therapy for a patient?

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An antiepileptic drug should not be considered ineffective unless patient develops an unacceptable ADR with continued seizure

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Despite appropriate initial treatment, ( 30-35, 20-30, 40-50 )% of patients are refractory to treatment

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carbamazepine half-life is variable because of which is usually complete 3 to 5 weeks after initiation of a fixed carbamazepine regimen

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Which of the following agents can cause acute hepatic failure, acute pancreatitis, and alopecia?

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Serum concentrations are useful when optimizing AED therapy, they should be assessed by:

- Checking "": different for each drug (average 1 to 3 weeks)
- Checking at a time: preferably first thing in the
- Its best to check a level first thing in the morning, hours after the last dose (lowest level)

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Give the following information, calculate the corrected phenytoin concentration.
(Total phenytoin is 8mcg/mL ; albumin 1mg/dL)

Corrected phenytoin = measured phenytoin / [(0.29 x albumin) + 0.1)

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What is the most common type of seizure experienced by adults?

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and phenytoin first line therapy in new-onset partial and generalized seizures

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Of the agents listed below, which received FDA approval for use as monotherapy in patients with partial seizures?

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( Lamotrigine, Gabapentin, Topiramate ) was determined to be a cost effective alternative to carbamazepine

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Indicate the appropirate drug therapy treatment for absence seizures:

1st line: ( Ethosuximide (Zarontin), Valproate (Depakote), Lamotrigine (Lamictal) )
2nd line: ( Valproate (Depakote), Ethosuximide (Zarontin), Lamotrigine (Lamictal) )
3rd line: ( Lamotrigine (Lamictal), Ethosuximide (Zarontin), Valproate (Depakote) )

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Which of the following agents are infective in absence seizures and can precipitate and increase seizure frequency

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What is the appropriate therapy to utilize in the treatment of mixed absence and partial or generalized:

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in combination with another AED is a n alternative therapy in the treatment of mixed absence and partial/generalized seizures.

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is the traditional treatment for tonic-clonic seizures. and Valproate (Depakote) are equally efficacious and have less side effects.

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What drugs are alternative in the treatment of tonic-clonic seizures?

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Seizure freedom for ≥ 2 years implies overall >% chance of successful withdrawal in some epilepsy syndromes

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Patients who are seizure free:

years: Absence
years: simple partial, complex partial, tonic-clonic seizures

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Sudden discontinuation of AED therapy can precipitate withdrawal seizures and status epilepticus. Especially with benzodiazepines and barbiturates

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When converting to monotherapy from polytherapy:
Eliminate drugs first
Withdraw antiepileptic agents over several months

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AEDs and Pregnancy

- AED teratogenicity is related to exposure in the trimester of pregnancy
- may be deleterious to the fetus
- Risks from seizures are greater than risks from
- All antiepileptic patient drugs carry risks
- Polytherapy of AED's risk
- is encouraged and can be done safely, advise the mother to take the AED immediately after breastfeeding

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AEDs and Pregnancy

Before pregnancy:
- Attempt AED monotherapy with effective dose
- supplementation (at least 1mg/day orally)

During pregnancy:
- Avoid use of: Barbiturates, , carbamazepine,
- Limit dose of during the 1st trimester (1,400 mg/day)
- is considered safe
- Continue supplementation (1mg/day)
- Consider (10mg/day) starting at 36 weeks (baby should receive 1 mg IM at birth)

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seizures are defined as lasting less than 5 minutes
seizure are defined as lasting between 5 and 30 minutes

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Status epilepticus (SE) is defined as more than minutes of either
(1) A seizure activity
(2) Two or more sequential seizures without full recovery of in between seizures

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The 30-minute definition is based on the duration of convulsive status epilepticus that may lead to permanent neuronal injury. What are some of the adverse consequences?

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Types of Status Epilepticus

status epilepticus consisting of repeated generalized tonic-clonic (GTC) seizures with persistent neurological depression of neurologic function between seizures

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Types of Status Epilepticus

status epilepticus where seizures produce a continuous “ epileptic twilight” state

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Types of Status Epilepticus

manifested as focal motor signs, focal sensory symptoms, or focal impairment of function (e.g. aphasia) not associated with loss of consciousness

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Causes of Status Epilepticus

; no structural lesion: infection, CNS infection, metabolic, low AED levels, alcohol, idiopathic

; structural lesion (poor prognosis): anoxia/hypoxia, CNS tumors, CVA, drug overdose, hemorrhage, trauma

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Clinical Presentation of Generalized Convulsive SE

Symptoms:
Impaired
once is controlled
Pain associated with injuries

Early signs:
Generalized
Acute injuries/CNS insults that cause extensor or flexor posturing
/fever suggestive of inter-current illnesses
Incontinence
Normal blood pressure/hypotension and respiratory

Late signs:
Clinical seizures/may not be apparent
edema with respiratory failure
Cardiac failure, hypotension or hypertension
Disseminated intravascular coagulation, multisystem failure
Rhabdomyolysis

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Which of the following is the proposed interventions for the treatment of Status epilepticus during the stabilization phase (0-5 minutes) ?

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Which of the following is the proposed interventions for the treatment of Status epilepticus during the initial therapy phase (5-20 minutes) ?

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Which of the following is the proposed interventions for the treatment of Status epilepticus during the second therapy phase (20-40 minutes) ?

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Which of the following is the proposed interventions for the treatment of Status epilepticus during the third therapy phase (40-60 minutes) ?

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Of the two major ingredients in marijuana, which one causes the psychoactive effect of getting "high"

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Medical Marijuana and Epilepsy

Currently open-labeled studies in the U.S. of produced by GW Pharmaceuticals, a drug derived from CBD (99% oil-based extract)

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Which of the following are non-pharmacologic treatment of seizures and epilepsy?

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Ketogenic Diet

Traditionally started gradually in the hospital after a hour fast

Ratio (fat: carbs and proteins)
- more strict
- for infants, adolescents
- Vitamins and minerals are supplemented

Side effects: due to large amount of fat consumption
-Constipation
-Weight
- when ill
- deficiency (if unsupplemented)
- stones
- Impaired weight and height
- Dyslipidemia
- Gastrointestinal upset

Requires strict control and patient compliance

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Which of the following statements are true in regards to Vagal Nerve stimulation?

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National Institute of Health Consensus Conference:

3 requirements for surgery:
(1) Absolute diagnosis of
(2) on adequate trial of drug therapy
(3) Definition of the electro clinical syndrome

NAPLEX Pharmacy (Neuro ) Quiz sobre Seizure and Epilepsy , criado por Mark W. em 10-01-2017.

Seizure and Epilepsy

Seizure and Epilepsy

is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

is a neurological disease marked by the sudden and recurrent episodes of seizures

A person is considered to have epilepsy if they meet any of the following conditions:

More than 30 minutes of: - continuous seizure activity - two or more sequential seizures without full recovery of consciousness between seizures.

Some seizures occur as single events - Withdrawal of depressants - During acute illnesses - Systemic conditions - Cocaine use - Overdosing on - disturbances - Hypoglycemia

are also called the electrical storms in the brain

is the main inhibitory neurotransmitter is the major excitatory neurotransmitter

Every individual has a seizure , which is the level of excitability at which neurons will discharge abnormally

Patients with epilepsy have a seizure threshold

Prodrome Aura Ictal phase post-ictal phase( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure - warning that a seizure is coming - not considered part of the seizure

or warning is the first symptom of a seizure - Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body - Considered part of the seizure

phase is the middle of a seizure - Correlates with the electrical activity in the brain - Where the symptoms are observed

phase is the end of a seizure - Recovery period after the seizure (immediate or can take minutes to hours)

Every person with seizures will not have every stage or symptom

seizures start in one area or side of the brain

seizures start on both sides of the brain at the same time and usually loss of consciousness is observed

A partial seizure in which consciousness is not impaired is referred to as a partial seizure

A partial seizure in which consciousness is impaired is referred to as a partial seizure

More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.

Some seizures occur as single events
- Withdrawal of depressants
- During acute illnesses
- Systemic conditions
- Cocaine use
- Overdosing on
- disturbances
- Hypoglycemia

is the main inhibitory neurotransmitter

is the major excitatory neurotransmitter

( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure
- warning that a seizure is coming
- not considered part of the seizure

or warning is the first symptom of a seizure
- Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body
- Considered part of the seizure

phase is the middle of a seizure
- Correlates with the electrical activity in the brain
- Where the symptoms are observed

phase is the end of a seizure
- Recovery period after the seizure (immediate or can take minutes to hours)

Name the type of the seizure:

Generally occurs in young children
Sudden onset, interruption of ongoing activity
Blank stare
Possibly a brief upward rotation of the eyes

Name the type of seizure:

Brief shock-like muscular contractions of the face, trunk, and extremities

Name the type of seizure:

Rhythmic, repetitive, jerking muscle movement

Name the type of seizure:

Flexion, extension, and adduction of extremities
Extension of back and neck
Contraction of thoracic and abdominal muscles (may become apneic)
Upward eye movement and mouth partially open
May cry out as air is forced from the lungs

( Electroencephalogram (EEG), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) ) is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)

Initiation of AEDs is recommended in the following cases:
After one seizure in patients with
After two seizures that occurred within a period of months