Term
| What is the definition of a convulsion? |
|
Definition
| sudden attack of involuntary muscular contractions and relaxations |
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Term
|
Definition
| Abnormal central nervous system electrical activity |
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|
Term
|
Definition
| A group of recurrent disorders of cerebral function characterized by both seizures and convulsions |
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Term
| What is the prevalence of epilepsy in the US? |
|
Definition
| approximately 2.5 million people; 1% |
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Term
| What are the causes of seizures? |
|
Definition
| genetic (autosomal dominant genes), congenital defects, severe head trauma, ischemic injury, tumor, drug abuse, idiopathic |
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Term
| What does your EEG look like during a seizure? |
|
Definition
pre-seizure= more activity, chaotic
Seizure= chaotic intense activity
post-seizure= very little activity, flat lining almost |
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Term
| What is the definition of a partial seizure? |
|
Definition
| excessive electrical activity in one cerebral hemisphere; affects only part of the body |
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|
Term
| What is another name for a partial seizure? |
|
Definition
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Term
| What are the symptoms of a simple partial seizure? |
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Definition
| person may experience a range of strange or unusual sensations= motor, sensory, autonomic |
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Term
| What type of seizure has a key feature of preservation of conciousness? |
|
Definition
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|
Term
| What are the symptoms of a complex partial seizure? |
|
Definition
| loss of awareness at seizure onset; person seems dazed or confused and exhibits meaningless behaviors |
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Term
| Where do complex partial seizures typically originate? |
|
Definition
| frontal or temporal lobes |
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Term
| What is the definition of a generazlied seizure? |
|
Definition
| excessive electrical activity in both cerebral hemispheres, affects the whole body and loss of consciousness is common |
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Term
| What type of seziure affects the whole body? |
|
Definition
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|
Term
| Where do generalized seizures usually originate? |
|
Definition
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Term
|
Definition
| brief, shock-like muscle jerks generalized or restricted to part of one extremity |
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Term
|
Definition
| sudden loss of muscle tone |
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|
Term
|
Definition
| sudden stiffening of the body, arms, or legs |
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|
Term
|
Definition
| rhythmic jerking movements of the arms and legs without a tonic component |
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Term
| What is another name for grand mal seizures? Describe the seizure. |
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Definition
| tonic-clonic seizure; tonic phase followed by clonic phase |
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Term
| What are the different types of generalized seizures? |
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Definition
| myoclonic, atonic, tonic, clonic, tonic-clonic, absence, lenox-glastaut syndrome |
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Term
| What is another name for a petit mal seizure? |
|
Definition
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Term
| What type of seizure presents as the person "blanking out" or "daydreaming"? |
|
Definition
| absence seizure (petit mal) |
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Term
| What are the three types of absence seizures? |
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Definition
| simple absence (primarily effects consciousness only), complex absence (involve change in mucle activity), atypical absence (involves physical symptoms like eye blinking or lip movement) |
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|
Term
| What is lenox-glastaut syndrome? |
|
Definition
| atypical absence, atonic, and myoclonic seizures |
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|
Term
| What is status epilepticus? |
|
Definition
| a seizure lasting longer than 30 minutes, or 3 seizures without a normal period in between; may be fatal, emergency intervention required |
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|
Term
| How long do absence seizures last? |
|
Definition
| from a second to several minutes |
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|
Term
| What are the 3 most common types of seizures? |
|
Definition
| complex partial, then tonic clonic, then simple partial |
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Term
| Why do patients turn blue during a seizure? |
|
Definition
| breathing may cease for a few seconds |
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|
Term
|
Definition
| people don't feel pain during a seizure; muscles may be sore afterward |
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Term
| What is the first thing you should think of when treating a new onset seizure? |
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Definition
| is there an underlying cause of the seizures that needs to be treated |
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|
Term
| What percent of patients with epilepsy can have their seizures controlled with medication? |
|
Definition
|
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Term
| How long do you treat someone with epilepsy syndrome? |
|
Definition
| recommended for AT LEAST two years; 6-12 months for individuals with a lower risk of occurrence |
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Term
| Why should patients with epilepsy avoid suddenly stopping their medication? |
|
Definition
| sudden withdrawal can exacerbate seizures |
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Term
| What are the three main types of MOA of seizure therapeutics? |
|
Definition
1. inhibition of voltage gated Na+ channels to slow neuron firing
2. enhancement of the inhibitory effects of the neurotransmitter GABA
3.inhibition of calcium channels |
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Term
| What are the CNS effects of antiseizure meds? |
|
Definition
| drowsiness/sedation/somnolence, depression, confusion, learning difficulties, headache, dizziness, vertigo, diplopia, nystagmus, slurred speech, ataxia, tremor |
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|
Term
| What are the non-CNS side effects of anticonvulsants? |
|
Definition
| dry mouth, nausea, vomiting, anorexia, diarrhea, rash, fetal abnormalities and birth defects |
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|
Term
| What percent of patients discontinue their first perscribed seizure meds due to adverse effects? |
|
Definition
|
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Term
| Name the anti-seizure meds that are Na+ channel inhibitors? |
|
Definition
| carbamazepine, phenytoin, topiramate, lamotrigine, valproate, zonisamide |
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Term
| What types of seizures do you use phenytoin with? |
|
Definition
| first choice for partial and generalized tonic-clonic seizures; some efficacy in clonic, myoclonic, atonic, no effect on infantile spasms or absence seizures |
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|
Term
| What are the drug interactions associated with phenytoin? |
|
Definition
| decreases blood levels of many medications, increases blood levels of phenobarbital and warfarin |
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|
Term
| What are the adverse effects of phenytoin? |
|
Definition
| hirsutism and coarsening of facial features, acne, gingival hyperplasia (20-40%), decreased serum concentrations of folic acid, thyroxine, and vitamin K with long-term use |
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|
Term
| What's a good reason of why not to perscribe phenytoin to children? |
|
Definition
| you need to brush your teeth more than 8 times per day to prevent gingival hyperplasia |
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Term
| What are the indications for carbamazepine? |
|
Definition
| first choice for complex partial and generalized tonic-clonic seizures |
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|
Term
| What are the CI of carbamazepine? |
|
Definition
| may exacerbate absence or myoclonic seizures, blood disorders, liver disorders |
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|
Term
| What are the drug interactions of carbamazepine? |
|
Definition
| CBZ metabolism is affected by many drugs, and CBZ affects the metabolism of many drugs |
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|
Term
| What are the adverse effects of carbamazepine? |
|
Definition
| mild leukopenia or hyponatremia; circulating concentrations of thyroid hormones may be depressed; TSH remains normal |
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|
Term
| What is the difference between oxcarbazepine and carbazepine? |
|
Definition
| fewer adverse effects than CBZ, phenytoin |
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|
Term
| What is oxcarbazepine used for? |
|
Definition
| complex partial seizures, primary and secondarily generalized tonic-clonic seizures, no effect on absence or myoclonic seizures |
|
|
Term
| What is the MOA of valproic acid? |
|
Definition
| some inhibition of T type Ca2+ channels, increases GABA production and decreases GABA metabolism, and Na+ channel inhibitor |
|
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Term
| What types of seizures can be treated by valproic acid? |
|
Definition
| simple or complex partial, and primary generalized tonic clonic; also used for absence, myoclonic and atonic seizures; highly effective for photosensitive epilepsy and juvenile myoclonic epilepsy |
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|
Term
| What are the contraindications for valproate? |
|
Definition
|
|
Term
| What are the drug interactions of valproate? |
|
Definition
| affects metabolism of many drugs through liver enzyme inhibition; phenobarbital= drunkenness, clorazepam= prolonged absence seizures |
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|
Term
| What are the adverse effects of valproic acid? |
|
Definition
| weight gain, bone loss, ankle swelling, dose-related tremor, transient hair loss, polycystic ovary syndrome and menstrual disturbances |
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Term
| What is the MOA of lamotrogine? |
|
Definition
| na channel inhibitor and may inhibit synaptic release of glutamate |
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|
Term
| What are the indications for lamotrigine? |
|
Definition
adjunct therapy (ages 2 and up)= for simple and complex partial seizures and generalized seizures of lennox gastaut syndrome
monotherapy (adults)= simple and complex partial seizures |
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|
Term
| What are the contraindications of lamotrigine? |
|
Definition
| may make myoclonic seizures worse |
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|
Term
| What are the adverse effects of lamotrigine? |
|
Definition
| rash (10%; rarely progresses to serious systemic illness), increased alertness |
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|
Term
| What is the MOA of topiramate? |
|
Definition
| enhances post-synaptic GABA(A) receptor currents, kainate receptor antagonist (blocks a certain type of glutamate channel) |
|
|
Term
| What are the indications of topiramate? |
|
Definition
| adjunct therapy for partial and primary generalized tonic clonic seizures in adults and children over two; decreases tonic and atonic seizures in children with Lennox-Gastaut syndrome |
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|
Term
| When is topiramate contraindicated? |
|
Definition
|
|
Term
| What are the drug interactions of topiramate? |
|
Definition
| CBZ, phenytoin, phenobarbitaland primidone decrease blood levels |
|
|
Term
| What are the adverse effects of topiramate? |
|
Definition
| nervousness and paresthesias, psychomotor slowing, word-finding difficulty, impaired concentration interference with memory, weight loss and anorexia, metabolic acidosis |
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|
Term
| What are teh MOAs of zonisamide? |
|
Definition
| Na+ channel inhibitor, inhibits T-type Ca2+ currents, binds to GABA receptors, facilitates dopaminergic and serotonergic neurotransmission |
|
|
Term
| What types of seizures does zonisamide treat? |
|
Definition
| approved for adjunct treatment of partial seizures in adults; appears to have a broad spectrum (myoclonic seizures, infantile spasms, generalized and atpyical absence seizures, lennox-gastaut syndrome) |
|
|
Term
| What are the drug interactions with zonisamide? |
|
Definition
| phenytoin and carbamazepine decrease its half-life by half |
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|
Term
| What are the adverse effects of zomisamide? |
|
Definition
| weight loss, abnormal thinking, nervousness, agitation/irritability, usually well tolerated |
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|
Term
| When is lidocaine used to treat epilepsy? |
|
Definition
| only when other drugs are refractory for status epilepticus |
|
|
Term
| Name the barbiturate drugs? |
|
Definition
| phenobarbital and primidone |
|
|
Term
| What is the mechanism of action of barbiturates? |
|
Definition
| increases the duration of GABA(A) activated Cl-channel opening |
|
|
Term
| What are the indications for phenobarbital? |
|
Definition
| second choice for partial and generalized tonic clonic seizures, status epilepticus |
|
|
Term
| What age group is best for phenobarbital? |
|
Definition
| rapid absorption has made it a common choice for seizures in infants, but adverse cognitive effects cause it to be used less in older children and adults |
|
|
Term
| What are the contraindications of phenobarbital? |
|
Definition
|
|
Term
| What are the indications of primidone? |
|
Definition
| adjuvant or monotherapy for partial and generalized tonic-clonic seizures; may control refractory generalized tonic-clonic seizures |
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|
Term
| What are the contraindications of primidone? |
|
Definition
|
|
Term
| What are the drug interactions with barbiturates? |
|
Definition
| synergy with other CNS depressants, increased metabolism of vitamin D and K; phenytoin increases the conversion of primidone to phenobarbital |
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|
Term
| What are the adverse effects of barbiturates? |
|
Definition
| agitation and confusion in the elderly, worsening of pre=existing hyperactivity and aggressiveness in children, sexual side effects, physical dependence |
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|
Term
| What is the mechanism of action of benzodiazepines? |
|
Definition
| increases the frequency of GABA(A)-activated Cl- channel opening |
|
|
Term
| Name the different benzodiazepine drugs. |
|
Definition
| clorazepate, clonazepam, diazepam, lorazepam |
|
|
Term
| Which benzodiazepines are approved for long term treatment? |
|
Definition
|
|
Term
| What is clorazepate used for? |
|
Definition
| incombination for partial seizures |
|
|
Term
| What is clonazepam used for? |
|
Definition
| lennox-gastaut syndrome, myoclonic, atonic, and absence seizures |
|
|
Term
| Although clonazepam can be used for long term treatment, it may not be because... |
|
Definition
| tolerance develops after about 6 months |
|
|
Term
| Which benzodiazepines can be used in the treatment of status epilepticus? |
|
Definition
| diazepam and lorazepam; diazepam is painful to inject however so lorazepam is more commonly used in acute treatment |
|
|
Term
| What is Diazepam used for? |
|
Definition
| intermittent use for control of seizure clusters |
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|
Term
| Diazepam is frequently combined with what other drug? |
|
Definition
|
|
Term
| What are the contraindications of diazepam? |
|
Definition
| children under 9; also narrow angle glaucoma |
|
|
Term
| What are hte contraindications of benzodiazepines? |
|
Definition
|
|
Term
| What are the adverse effects of benzodiazepines? |
|
Definition
| hypotonia, dysarthria, muscle in-coordination (clonazepam), behavioral disturbances (especially in children)= aggression, hyperactivity, irritability, and difficulty concentrating |
|
|
Term
| What is the MOA of tiagabine? |
|
Definition
| inhibition of GABA (GAT-1) --> reduces reuptake of GABA by neurons and glial cells |
|
|
Term
| When is tiagabine indicated? |
|
Definition
| approved in 1998 as an adjunct therapy for partial seizures in patients at least 12 years old |
|
|
Term
| What are the contraindications of tiagabine? |
|
Definition
|
|
Term
| name some drug interactions with tiagabine. |
|
Definition
| blood levels decreased by CBZ, phenytoin, phenobarbital and primidone |
|
|
Term
| What are the adverse effects of tiagabine? |
|
Definition
| asthenia and abdominal pain |
|
|
Term
| Name the seizures medications whose main mechanism of action is blocking calcium channels. |
|
Definition
| ethosuximide; gabapentin; pregabalin; levetiracetam |
|
|
Term
| What is the MOA of ethosuximide? |
|
Definition
| reduces low threshold Ca2+ currents (T currents) in the thalamic neurons |
|
|
Term
| What is the half-life of ethosuximide? |
|
Definition
| 60 hrs in adults; 30 hours in children |
|
|
Term
| What are the indications of ethosuximide? |
|
Definition
| first line for absence seizures |
|
|
Term
| What are the contradications of ethosuximide? |
|
Definition
| may exacerbate partial and tonic-clonic seizures |
|
|
Term
| What are the adverse effects of ethosuximide? |
|
Definition
| psychotic behavior, blood dyscrasias, persistent headaches, anorexia, hiccups, lupus-like syndrome |
|
|
Term
| What are the toxicities of ethosuximide? |
|
Definition
| parkinson-like symptoms, photophobia |
|
|
Term
| What is the MOA of gabapentin? |
|
Definition
| originally designed to be a centrally acting GABA agonist; selective inhibition of v-g Ca2+ channels containing the alpha 2 delta 1 subunit |
|
|
Term
| What are the indications for using gabapentin? |
|
Definition
| adjunct therapy in adults and children with partial and secondarily generalized seizures; also effective as monotherapy |
|
|
Term
| What are the contraindications of gabapentin? |
|
Definition
| can exacerbate myoclonic and absence seizures |
|
|
Term
| What are the adverse effects of gabapentin? |
|
Definition
| weight gain with ankle edema, irritability, behavioral problems in children, has been associated with movement disorders |
|
|
Term
| What is the MOA of pregabalin? |
|
Definition
| selective inhibition of voltage gated calcium channels containing the alpha 2 delta 1 subunit |
|
|
Term
| What are the indications for pregabalin? |
|
Definition
| approved in 2005; adjunct therapy for partial and secondarily generalized seizures |
|
|
Term
| What are the contraindications of pregabalin? |
|
Definition
| no effect on absence, myoclonic or primary generalized tonic-clonic seizures |
|
|
Term
| Besides seizures, what else can pregabalin be used to treat? |
|
Definition
| neuropathic pain and fibromyalgia |
|
|
Term
| What is the MOA of Levetiracetam? |
|
Definition
| not exactly known; binding affinity to synaptic vesicle protein 2A correltes with its anticonvulsant activity; also blocks calcium channel N-currents, increases intracellular Ca2+ levels, modulates GABA channel currents |
|
|
Term
| What are the indications for levetiracetam? |
|
Definition
| approved in 1999 as an adjunct therapy for adults with partial seizures; some patients have success with monotherapy |
|
|
Term
| What are the contraindications of levetiracetam? |
|
Definition
|
|
Term
| What are the adverse effects of levetiracetam? |
|
Definition
| asthenia, infection, behavioral problems in children |
|
|
Term
| What are the uses of magnesium chloride? |
|
Definition
| used for magnesium deficiency and seizures |
|
|
Term
| What are teh uses of paradldehyde? |
|
Definition
| alcohol withdrawal seizures |
|
|
Term
| Name the seizures medications that have unknown mechanisms of action? |
|
Definition
| magnesium chloride; paraldehyde |
|
|
Term
| Name the DOCs for primary generalized tonic-clonic seizures? |
|
Definition
| phenytoin, carbamazepine, oxcarbazepine, valproate |
|
|
Term
| What the alternative drugs for primary generalized tonic-clonic seizures? |
|
Definition
| lamotrigine, topiramate, zonisamide, levetiracetam, primidone, phenobarbital, diazepam |
|
|
Term
| What are the drugs of choice for partial and secondarily generalized seizures? |
|
Definition
| phenytoin, carbamazepine, oxcarbazepine, valproate |
|
|
Term
| what are the alternative drugs for partial/secondarily generalized seizures? |
|
Definition
| lamotrigine, topiramate, zonisamide, levetiracetam, primidone, phenobarbital, gabapentin, pregabalin, tiagabine |
|
|
Term
| What are the drugs of choice for absence seizures? |
|
Definition
|
|
Term
| What are the alternative treatments for absence seizures? |
|
Definition
|
|
Term
| What is the drug of choice for atypical absence/myoclonic and atonic seizures? |
|
Definition
|
|
Term
| What are the alternative drugs for atypical absence/myoclonic/atonic seizures? |
|
Definition
| clonazepam, topiramate, zonisamide, levetiracetam |
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