10 Questions
What are the common acute symptomatic causes of epilepsy related to fluid and electrolyte imbalances?
Na+, Ca+, Mg+
Which drug class may cause seizures?
All of the above
Febrile seizures are considered a form of epilepsy.
False
Status epilepticus is defined as continuous seizures with no recovery of consciousness lasting for longer than ____ minutes.
30
Match the drug with the epilepsy treatment:
Valporate = Myoclonic and Tonic seizures Clonazepam = Myoclonic and Tonic seizures Carbamazepine = Partial seizures Phenytoin = Partial seizures
What are some acute symptomatic causes of epilepsy related to fluid and electrolyte imbalances?
Na+, Ca+, Mg+
What is a common precipitating factor for epilepsy, such as photosensitive epilepsy or sleep deprivation?
Psychological stress
Which drug class includes specific drugs that may cause seizures?
Antimicrobials
Febrile seizures are considered a form of epilepsy.
False
Match the following seizure types with their descriptions:
Grand mal = Generalized tonic-clonic seizure Petit mal = Absence seizure Myoclonic seizure = Sudden, brief muscle jerks Febrile convulsions = Seizures often occurring with fever in children
Study Notes
Cellular Mechanisms of Seizure Generation
- Fluid and electrolyte imbalances: Na+, Ca+, Mg+
- Metabolic disorders: diabetic coma, hypoglycemic coma, uremia, hypothyroidism, alkalosis, B6 deficiency
- Drugs and toxins
- Stroke
- Head injury: 40% in open head injuries, 5% in severe closed head injuries
- CNS infection
Etiology of Epilepsy
- Acute Symptomatic causes: fluid and electrolyte imbalances, metabolic disorders, drugs and toxins, stroke, head injury, CNS infection
- Remote Symptomatic causes:
- Drugs that may cause seizures
- Antimicrobials: penicillins, cephalosporins, quinolones, Amphotericin, chloroquine, fluconazole, isoniazid, zidovudine
- Cardiovascular: Lignocaine (intravenous), procaine
- Antidepressants: tricyclic antidepressants, lithium, phenothiazines, baclofen, clozapine
- Antipsychotics: cocaine, Amantadine, antimuscarinics
- Stimulants: Aminophylline, caffeine, theophylline
Clinical Classification of Epilepsy
- Partial seizures:
- Simple partial seizures: motor, autonomic, psychic, somatosensory, special sensory
- Complex partial seizure (TLE, psychomotor)
- Partial seizure 2ry generalized
- Generalized seizures:
- Petit mal
- Grand mal
- Tonic seizure
- Clonic seizure
- Tonic clonic seizure
- Atonic seizure
- Myoclonic seizure
- Special seizure syndromes:
- Febrile convulsions
- Infantile spasm (west syndrome)
Clinical Features of Epilepsy
- Partial seizures:
- Simple partial seizures: motor, autonomic, psychic, somatosensory, special sensory
- Complex partial seizure (TLE, psychomotor)
- Generalized seizures:
- Petit mal
- Grand mal
- Special seizure syndromes:
- Febrile convulsions
- Infantile spasm (west syndrome)
Strategy for Medical Treatment of Epilepsy
- Starting therapy: consider risk of seizure recurrence (>60%) with remote symptomatic seizure, previous history of febrile seizure, family history of epilepsy, neurological deficit, abnormal examination findings, and EEG that shows epileptiform discharges
- Choice of drugs: depends on seizure type
- How to start antiepileptic drugs: use a first-line drug for the seizure type, start at a low dose and introduce slowly, add additional drugs if first drug pushed into maximum tolerated dose and seizure still not controlled
- When to stop medication: individualized approach
Status Epilepticus
- Definition: continuous seizures with no recovery of consciousness lasting for longer than 30 minutes
- Clinical Data:
- Hyperpyrexia
- Hypotension
- Acidosis
- Hypoglycemia
- Cardiac dysrhythemia
- Shock
- Reflex pulmonary edema
- Aspiration pneumonia
- Neuronal damage which may be irreversible
- Causes: usually organic, e.g. metabolic, infection (meningitis or encephalitis), stroke, trauma, tumors, sudden withdrawal of AED
- Management:
- On admission: care of vital functions, intubation, and low-flow O2 inhalation
- Start IV infusion of glucose 5% and 0.9 saline 500ml, 100mg thiamine
- Draw blood sample for antiepileptic serum level, glucose level, electrolytes, renal and hepatic function tests, and blood gases
Cellular Mechanisms of Seizure Generation
- Fluid and electrolyte imbalances: Na+, Ca+, Mg+
- Metabolic disorders: diabetic coma, hypoglycemic coma, uremia, hypothyroidism, alkalosis, B6 deficiency
- Drugs and toxins
- Stroke
- Head injury: 40% in open head injuries, 5% in severe closed head injuries
- CNS infection
Etiology of Epilepsy
- Acute Symptomatic causes: fluid and electrolyte imbalances, metabolic disorders, drugs and toxins, stroke, head injury, CNS infection
- Remote Symptomatic causes:
- Drugs that may cause seizures
- Antimicrobials: penicillins, cephalosporins, quinolones, Amphotericin, chloroquine, fluconazole, isoniazid, zidovudine
- Cardiovascular: Lignocaine (intravenous), procaine
- Antidepressants: tricyclic antidepressants, lithium, phenothiazines, baclofen, clozapine
- Antipsychotics: cocaine, Amantadine, antimuscarinics
- Stimulants: Aminophylline, caffeine, theophylline
Clinical Classification of Epilepsy
- Partial seizures:
- Simple partial seizures: motor, autonomic, psychic, somatosensory, special sensory
- Complex partial seizure (TLE, psychomotor)
- Partial seizure 2ry generalized
- Generalized seizures:
- Petit mal
- Grand mal
- Tonic seizure
- Clonic seizure
- Tonic clonic seizure
- Atonic seizure
- Myoclonic seizure
- Special seizure syndromes:
- Febrile convulsions
- Infantile spasm (west syndrome)
Clinical Features of Epilepsy
- Partial seizures:
- Simple partial seizures: motor, autonomic, psychic, somatosensory, special sensory
- Complex partial seizure (TLE, psychomotor)
- Generalized seizures:
- Petit mal
- Grand mal
- Special seizure syndromes:
- Febrile convulsions
- Infantile spasm (west syndrome)
Strategy for Medical Treatment of Epilepsy
- Starting therapy: consider risk of seizure recurrence (>60%) with remote symptomatic seizure, previous history of febrile seizure, family history of epilepsy, neurological deficit, abnormal examination findings, and EEG that shows epileptiform discharges
- Choice of drugs: depends on seizure type
- How to start antiepileptic drugs: use a first-line drug for the seizure type, start at a low dose and introduce slowly, add additional drugs if first drug pushed into maximum tolerated dose and seizure still not controlled
- When to stop medication: individualized approach
Status Epilepticus
- Definition: continuous seizures with no recovery of consciousness lasting for longer than 30 minutes
- Clinical Data:
- Hyperpyrexia
- Hypotension
- Acidosis
- Hypoglycemia
- Cardiac dysrhythemia
- Shock
- Reflex pulmonary edema
- Aspiration pneumonia
- Neuronal damage which may be irreversible
- Causes: usually organic, e.g. metabolic, infection (meningitis or encephalitis), stroke, trauma, tumors, sudden withdrawal of AED
- Management:
- On admission: care of vital functions, intubation, and low-flow O2 inhalation
- Start IV infusion of glucose 5% and 0.9 saline 500ml, 100mg thiamine
- Draw blood sample for antiepileptic serum level, glucose level, electrolytes, renal and hepatic function tests, and blood gases
This quiz covers the cellular mechanisms of seizure generation and the etiology of epilepsy, including acute symptomatic causes and other factors.
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