Term
| What is the peak age of onset for myasthenia gravis? |
|
Definition
| There are two peak ages, ~20 and ~50-60 |
|
|
Term
| What is seen in younger (~20) myasthenia gravis pt's? |
|
Definition
hyperplasia of the thymus
Generally female |
|
|
Term
| What is seen in older myasthenia gravis pt's? |
|
Definition
neoplasms of the thymus (thymoma)
No gender preference |
|
|
Term
| What is the first s/sx seen with myasthenia gravis? |
|
Definition
| EOM's are generally affected first |
|
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Term
| What is a suspected reason that MG affects EOM's first? |
|
Definition
| Eyes and eyelids are the most active muscles in the body, so it seems reasonable they would be affected first. |
|
|
Term
| What is the main sx of myasthenia gravis? |
|
Definition
| muscle weakness and fatigability |
|
|
Term
| What are the main signs of MG? |
|
Definition
EOM weakness
facial weakness that progresses through the day
dysphagia
limb weakness
respiratory weakness most feared complication |
|
|
Term
| What is the most feared complication of MG? |
|
Definition
|
|
Term
|
Definition
History and physical show increased muscle weakness/fatigue
Check for thyroid dysfunction, perhaps ANA
tensilon test
CT of chest (looking for Thymoma)
electromyography shows rapid decline in muscle AP and nerve stimulation |
|
|
Term
| What is the tensilon test? |
|
Definition
| A DDX for MG vs cholinergic crisis; edrophonium chloride, an ACH agonist is applied. In MG, muscle weakness will be reduced. If it is cholinergic crisis, muscles will get weaker. Have atropine on hand in case reversal is needed |
|
|
Term
|
Definition
| In myasthenia gravis, applying ice for a few minutes will reduce ptosis by ~2mm if positive |
|
|
Term
|
Definition
| Eyelid 'twitch' where the lids overshoot the regular open position when opened. |
|
|
Term
| What should be kept on hand when doing the tensilon test? |
|
Definition
| atropine in case cholinergic crisis needs to be treated. |
|
|
Term
| What is the expected result for ANA test on MG pt's? |
|
Definition
|
|
Term
| What is used to treat MG? |
|
Definition
| Stop the ANA's with corticosteroids and immunosuppressive oral anti-cholinersterase agent Treat any thyroid dz thymectomy |
|
|
Term
|
Definition
oral anti-cholinesterase agent used to treat MG
Used to be first line, still used a lot but steroids are now DOC |
|
|
Term
|
Definition
| ANA suppressor/ immunosuppressive |
|
|
Term
| When is a thymectomy recommended for MG tx? |
|
Definition
| When the drugs have failed to work |
|
|
Term
|
Definition
| disorder with recurrent seizures |
|
|
Term
| Does a seizure indicate epilepsy? |
|
Definition
| Not necessarily. It must be a recurrent issue for it to be epilepsy |
|
|
Term
|
Definition
| A sense that a seizure is imminent in epilepsy pt's. |
|
|
Term
| When is an aura not seen in epilepsy? |
|
Definition
| If it is a full brain seizure, no warning will be sensed |
|
|
Term
| What is a postictal state? |
|
Definition
| post-seizure confusion that is common |
|
|
Term
| What is the pathology of a seizure? |
|
Definition
| abnormal neuronal discharge that disturbs cerebral function in a transient fashion |
|
|
Term
| What is a benign febrile convulsion? |
|
Definition
| 2-4% of children between 3 mo and 5 yrs will have one. Usually preceded by a fever, and on first day of fever child will have a short seizure (minute or two up to 15 minutes) |
|
|
Term
| What is the risk for recurrence of benign febrile convulsions? |
|
Definition
|
|
Term
| At what point should a child having a seizure be taken to the hospital? |
|
Definition
| If seizure lasts 15 minutes, take to hospital. If seizure lasts 10 minutes, call 911 so that ambulance will arrive around the 15 min mark. |
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|
Term
| When can benign febrile convulsions be indicative of epilepsy? |
|
Definition
| If there is family history, chances are elevated. |
|
|
Term
| What is a tx for benign febrile convulsions? |
|
Definition
| Give anti-pyretics to bring fever down |
|
|
Term
| Will anti-pyretics prevent benign febrile convulsions? |
|
Definition
|
|
Term
| What is the occurrence of idiopathic seizures? |
|
Definition
| 75% of seizure disorders are idiopathic |
|
|
Term
| When do seizure disorders generally begin? |
|
Definition
|
|
Term
| What does a later onset of idiopathic seizure tend to indicate? |
|
Definition
| possibility of stroke, tumor, trauma, or systemic dz |
|
|
Term
| What is a common trauma that causes seizures? |
|
Definition
|
|
Term
| What is the recurrence rate of idiopathic seizures? |
|
Definition
|
|
Term
| What % of head trauma pts present with seizure? |
|
Definition
|
|
Term
| If the seizure is in the first week since the head trauma, is it indicative of chronic disorder developing? |
|
Definition
|
|
Term
| What % of cerebral cortex stroke pt's produce seizures? |
|
Definition
|
|
Term
| Are early seizures after a stroke indicative of chronic epilepsy? |
|
Definition
|
|
Term
| What are common causes of seizures? |
|
Definition
mass lesions
meningitis or encephalitis
hypoglycemia
uremia
HIV encephalopathy |
|
|
Term
| What is the level of hypoglycemia that will cause a seizre? |
|
Definition
| 60-115 mg/dL is normal, but below 20-30 mg/dL can cause seizure |
|
|
Term
| When is seizure seen w/ uremia? |
|
Definition
| in some cases where uremia occurs rapidly |
|
|
Term
| What are systemic disorders that cause seizures? |
|
Definition
drug overdose
drug withdrawal |
|
|
Term
| What drug overdoses can cause seizures? |
|
Definition
antidepressants
anti-psychotics
cocaine
insulin
lidocaine
methylxanthines |
|
|
Term
| When can drug withdrawal cause seizures? |
|
Definition
Within 48 hrs of EtOH cessation or reduction
Sedatives |
|
|
Term
| What are large and small seizures called? |
|
Definition
Tonic-Clonic (grand mal)
absence seizures (petit mal) |
|
|
Term
| What are partial seizures? |
|
Definition
| single side of brain affected, so only left temporal lobe, or vice versa |
|
|
Term
| What is a complex seizure? |
|
Definition
| both sides of brain affected |
|
|
Term
| What is seen in the tonic phase of a tonic-clonic seizure? |
|
Definition
lose consciousness almost instantaneously
are not breathing
cyanosis due to lack of O2
contraction of masticatory muscles
extension of extremities and opishotonus
tonic contraction of limbs for 10-30 seconds
May be brief cry right before |
|
|
Term
| What is the clonic phase? |
|
Definition
Alternate muscle contractions and relaxation
symmetric limb-jerking for 30-60 seconds
lack of swallowing so frothing of mouth may be seen
ventilation efforts return after tonic phase
jerking will become less frequent until movements cease
incontinence (loss of sphincter control)
may remain unconscious for 30 minutes
pt will be really tired afterward |
|
|
Term
| What should people do when observing a person with seizures? |
|
Definition
| try to protect the head, keep them from hitting it on things |
|
|
Term
| What is seen in the recovery phase of a tonic-clonic seizure? |
|
Definition
postictal confusion w/ headache
May take 30 minutes to return to full orientation
pupil reflexes are normal throughout
hemiparesis during the postictal period (Todd's paralysis)
important to distinguish the condition from a stroke |
|
|
Term
| What is status epilepticus? |
|
Definition
seizure continues indefinitely, full consciousness not restored between episodes
may cause permanent brain damage |
|
|
Term
| What can cause permanent brain damage in status epilepticus? |
|
Definition
hyperpyrexia (T > 106*F)
circulatory collapse
excitotoxic neuronal damage |
|
|
Term
| What are absence (petit mal) seizures? |
|
Definition
childhood seizures that often disappear in 20's
brief loss of consciousness (5-10 seconds) without loss of postural tone
blinking or head turning may be seen
full orientation follows cessation of seizures
often caused by hyperventilation |
|
|
Term
| How can absence seizures be induced? |
|
Definition
|
|
Term
|
Definition
| no clonic phase after tonic phase |
|
|
Term
| What is a clonic seizure? |
|
Definition
| a loss of consciousness and clonic jerking without tonic phase |
|
|
Term
|
Definition
| A myoclonic jerk while falling asleep. |
|
|
Term
| What was Dr Smith's updated report on how to handle a seizure in a patient. |
|
Definition
| Keep person on the ground, remove clothing from neck, clear area, turn head to side, cushion the head, allow person to rest afterward. Be aware of concussion from the fall. Provide transportation back to home. Call an ambulance if the seizure lasts more than 5 minutes or if it is the person's first seizure |
|
|
Term
| What are simple partial seizures? |
|
Definition
Unilateral temporal lobe seizure
May proceed into a tonic-clonic seizure
consciousness is generally preserved with memory of the event intact |
|
|
Term
| What is a Jacksonian March? |
|
Definition
| clonic movements that spread to contiguous regions of motor cortex |
|
|
Term
| What is piloerection? Where may they be seen? |
|
Definition
| Hair standing on end, sometimes seen in partial seizures |
|
|
Term
| What kind of seizure maintains consciousness and memory of the event is retained? |
|
Definition
|
|
Term
| What is a complex partial seizure? |
|
Definition
Motor activity of oral, face, and neck movements
Usually involves both temporal lobes or medial frontal lobes
Consciousness is impaired, but not lost
No memory of event
May become frightened |
|
|
Term
| What kind of seizure is more likely to proceed into a tonic-clonic seizure in children than in adults? |
|
Definition
|
|
Term
| How is epilepsy diagnosed? |
|
Definition
| EEG reveals abnormal spikes, though a normal EEG does not exclude epilepsy dx |
|
|
Term
| When is an MRI or CT used to dx epilepsy? |
|
Definition
| If the pt begins their seizures after age 25 or if they have focal seizures |
|
|
Term
|
Definition
No tonic phase
May be a warning before the attac occurs
Shouting or obscene utterances during apparent loss of consciousness
No postictal confusion
No seizure activity seen on EEG during episode
clonic phase consists of wild thrashing where they do not hurt themselves |
|
|
Term
| What are the tx basics for epilepsy? |
|
Definition
Block glycolysis
Alter ionic transport
Enhance GABA activity
Decrease glutamateric transmission/activity |
|
|
Term
| What is an excitatory neurotransmitter that is targeted in epilepsy tx? |
|
Definition
|
|
Term
| What is an inhibitory neurotransmitter that is increased in epilepsy tx? |
|
Definition
|
|
Term
| What is a ketogenic diet? |
|
Definition
| glycolysis blocking diet that may help control epilepsy |
|
|
Term
| What is phenytoin (dilantin)? |
|
Definition
First line drug for epilepsy
Alters ionic transport
Blocks sodium channels |
|
|
Term
| What is an ocular SE of phenytoin? |
|
Definition
|
|
Term
|
Definition
epilepsy drug that blocks sodium channels
First choice for children with epilepsy |
|
|
Term
|
Definition
| Used to treat epilepsy or strong headaches |
|
|
Term
| What are the ocular SE of topiramate? |
|
Definition
Causes swelling of the ciliary body
increase in myopia
angle closure glaucoma |
|
|
Term
| How is topiramate induced glaucoma treated? |
|
Definition
| Use atropine if lens has moved forward |
|
|
Term
|
Definition
Only used for epilepsy in children
Mechanism unknown |
|
|
Term
| What are common secondary drugs for tx of epilepsy? |
|
Definition
Valproic acid
gabapentin
lamotrigine
felbamate |
|
|
Term
|
Definition
Ca++ channel blocking drug
Reduces depression
Also treats epilepsy |
|
|
Term
|
Definition
| Caused aplastic anemia, but for many was the only drug that controls their epilepsy, so still on the market despite the risks |
|
|
Term
| What drugs are used to treat new seizures (petit mal)? |
|
Definition
Ethosuximide (Zarontin); May cause skin rashes
Valproic acid (Depakote) |
|
|
Term
| What drugs are used for partial seizures? |
|
Definition
Tiagabine
Topiramate
Vigabatrin
Ezogabine |
|
|
Term
|
Definition
| GABA uptake blocker used to treat partial seizures |
|
|
Term
|
Definition
Used to treat partial seizures through GABA uptake inhibition
May cause permanent peripheral vision loss |
|
|
Term
| What is Ezogabine (Potiga)? |
|
Definition
Treats partial seizures
Stabilizes K+ channels (Keeps them open)
May cause urinary retention |
|
|
Term
| When are epilepsy drug regimens changed? |
|
Definition
| If recurrent seizure activity is not controlled by first drug, though control with a single drug usually possible |
|
|
Term
| What are the SE of anti-convulsants? |
|
Definition
Blood dyscrasias: aplastic anemia and increased bleeding time
GO TO SLIDE 72 IN CNS XL FILE AND FINISH THIS SLIDE |
|
|
Term
| What are surgical procedures used to treat epilepsy? |
|
Definition
Excision of epileptogenic zone assuming it can be identified and it is not vital for neurologic function
Usually in the temporal lobe |
|
|
Term
| What is the success rate of epilepsy excision procedures? |
|
Definition
| >75% are seizure free after 5 years |
|
|
Term
| What are SE of epilepsy excision procedures? |
|
Definition
| decrease in verbal recall memory in 33% of pts |
|
|
Term
| What epilepsy pt's are the best candidates for surgery? |
|
Definition
| Pt's who experience more than one type of aura |
|
|
Term
| What is corpus callosotomy? |
|
Definition
Cut the corpus collosum --> disconnect the two hemispheres
Only used for pt's with uncontrolled seizures? |
|
|
Term
| What is a hemispherectomy? |
|
Definition
| Remove on hemisphere of brain in severe eleptogenic lesions involving most or all of one hemisphere. |
|
|
Term
| What are SE of hemispherectomy's? |
|
Definition
permanent hemiplegia
hemisensory loss
hemianopsia |
|
|
Term
| What is left vagus nerver stimulation used for? |
|
Definition
Treating partial seizures
Stimulator in chest programmed to give 30 sec stimulationq 5 minutes
Pt waves a wand over sensor in chest during aura |
|
|
Term
| What is the reduction in seizures for left vagus nerve stimulation pt's? |
|
Definition
| 30-50% of pt's have a 50% reduction in seizure frequency --> decreased need for meds |
|
|
Term
|
Definition
| Tumor of the thymus gland |
|
|
Term
| What is a myasthenic crisis? |
|
Definition
| Inability to breath due to MG |
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|
