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seizures & epilepsy - spartans1 - ArchivalUser - 09-23-2010
SEIZURES & EPILEPSY
EPILEPSY: CONDITION OF RECURRENT SEIZURES DUE TO A CHRONIC UNDERLYING PROCESS
SEIZURES is PAROXYSMAL EVENT DUE TO abnormal synchronization of the neurons electrical activity in the brain.
This can be caused by: VITAMINS
V-vascular eg stroke, hemorrhage, arteriovenous malformations
I-infection eg meningitis, abscess, encephalitis
T-trauma especially penetrating
A-autoimmune causes eg CNS vasculitis
M-metabolites eg Hypo-natremia, calcemia, magnesia, glicemia, poxia, and drug overdose/withdrawal
I-diopathic
N-neoplasm
pSychiatric
Seizures are classified in 2 ways: PARTIAL Vs GENERALIZED...COMPLEX Vs SIMPLE
Localized aka Partial - happen in 1 part of the brain, can be
-PARTIAL simple- no consciousNESS is effected or
- PARTIAL complex- consciencous is effected
Distributed aka GENERALIZED...- involve loss of consciencous but its categorized according to body that is effected.
GENERALIZED TONIC CLONIC [GRAND MAL] TONIC [ contration] CLONIC [ relaxation]
ABSENCE SZ [petit mal] ; loss of conciouness witjout loss of postural tone
-person stares into space for several seconds, no twitching or jerking
-myclonus seizures: muscle jerks, twitches that are sudden
-Clonus-involuntary muscle contrictions due to sudden stretch. Associated w/ upper motor neuron lesion eg Amyotropic lateral sclerosis, stroke, MS, spinal cord damage.
-tonic/clonic-affect entire brain. They can be induced via electro-convulsive therapy.
Signs: status epilepticus is a continous seizure that will NOT stop without intervention
Presentation: loss of memory, flashes odor, motor sensory congnitive thoughts aka aura.
Diag: -EEG abnormal is not enough for diagnosis
-Electrolytes
-Arterial Blood to rule out hypoxia
-CT or MRI of head to rule out lesion
Tx: acute seizure- check airway, call for help
-1st- Benzodiazepines: eg. Lorazepam or Diazepam
-if continous add Phenytonin or Fosphenytoin
-still seizing add phenobarbital
ANESTHESIA WITH Midozolam or Propofol
Partial ---Complex OR SIMPLE = 1st Carbamezepine +
Pheyntoin or Valproic acid + Lamotrigine or levetiracetam
Absent Seizures= 1st Ethosuximide or Valproic Acid
Generalized tonic/cloniC= Valproic Acid or Lamotrigine
Myclonic and Atonic Seizures= 1st Valproic Acid Pregnant women are treated with Carbamazepine
0 - ArchivalUser - 09-23-2010
Childhood absence epilepsy (CAE) is an idiopathic generalized epilepsy that affects children >>GIRL
These patients have recurrent absence seizures, brief episodes of unresponsive staring, sometimes with minor motor features such as eye blinking or subtle chewing.
between the ages of 4 and 12 years of age, although peak onset is around 5-6 years old.
The EEG finding in CAE is generalized 3 Hz spike and wave discharges.
NO aURA OR POStICTAL STATE
RX IST LINE ETHOSUXIMIDE
ALTERNATIVE VALPROIC ACID
Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epilepsy that occurs in
patients aged 8 to 20 years.
Patients have normal cognition and are otherwise neurologically intact. The most common seizures are myoclonic jerks, although generalized tonic-clonic seizures and absence seizures may occur as well. Myoclonic jerks usually cluster in the early morning after awakening.
The EEG reveals generalized 4“6 Hz spike wave discharges or multiple spike discharges.
Patients are often first diagnosed at first generalized tonic-clonic seizure later in life when they experience sleep deprivation (e.g., freshman year in college after staying up late to study for exams).
Alcohol withdrawal can also be a major contributing factor in breakthrough seizures as well. The risk of the tendency to have seizures is lifelong; however, the majority have well-controlled seizures with anticonvulsant medication and avoidance of seizure precipitants.
RX VALPROIC ACID
Lennox-Gastaut syndrome (LGS) is a generalized epilepsy that consists of a triad of
1]developmental delay or childhood dementia,2] mixed generalized seizures, and
3]EEG demonstrating a pattern of approximately 2 Hz "slow" spike-wave.
Onset occurs between 2-18 years. As in West syndrome, LGS result from idiopathic, symptomatic, or cryptogenic causes, and many patients first have West syndrome. Authorities emphasize different seizure types as important in LGS, but most have astatic seizures (drop attacks), tonic seizures, tonic-clonic seizures, atypical absence seizures, and sometimes, complex partial seizures.
Anticonvulsants are usually only partially successful in treatment.
West syndrome [Infantile SPASM] is
a triad of developmental delay, seizures termed infantile spasms, and EEG demonstrating a pattern termed hypsarrhythmia.
Onset occurs between 3 months and 2 years, with peak onset between 8-9 months. West syndrome may arise from idiopathic, symptomatic, or cryptogenic causes. The most common cause is tuberous sclerosis. The prognosis varies with the underlying cause. In general most surviving patients remain with significant cognitive impairment and continuing seizures and may evolve to another syndrome, Lennox-Gastaut syndrome.
WEST syndrome:
- Uncommon to rare and serious form of epilepsy in infants.
-Children: infantile spasms, arrest of psychomotor development and hypsarrythmya pattern on EEG
-RX: Due to their side-effects, two drugs are currently being used as the first-line treatment.
-ACTH - Use primarily in United States and -Vigabatrin (Sabril)
Dravet's syndrome Severe myoclonic epilepsy of infancy (SMEI). This generalized epilepsy syndrome is distinguished from benign myoclonic epilepsy by its severity and must be differentiated from the Lennox-Gastaut syndrome and Doose's myoclonic-astatic epilepsy. Onset is in the first year of life and symptoms peak at about 5 months of age with febrile hemiclonic or generalized status epilepticus. Boys are twice as often affected as girls. Prognosis is poor. Most cases are sporadic. Family history of epilepsy and febrile convulsions is present in around 25 percent of the cases.
Juvenile Absence Epilepsy JAE is an idiopathic generalized epilepsy with later onset that CAE, typically in prepubertal adolescence, with the most frequent seizure type being absence seizures. Generalized tonic-clonic seizures can occur. 3 Hz spike-wave or multiple spike discharges can be seen on EEG. Prognosis is mixed, with some patients going on to a syndrome that is poorly distinguishable from JME.
GENERALIZED SEIZURES
AURA LOSS OF CONSCIOUSNESS, EYES ROLL BACK, TONIC CONTRACTION, APNEA THEN CLONIC RYHTMIC CONTRACTIONS alternating with relaxation of ALL MX GROUPS
EEG ANTERIOR TEMPORAL LOBE SHOW SHARP WAVES OR FOCAL SPIKE
0 - ArchivalUser - 09-23-2010
Sturge Weber syndrome: can include focal or generalized seizures, mental retardation,
and a port wine stain or nevus flammeus along the territory of the trigeminal nerve, which
represents a congenital unilateral cavernous hemangioma.
Seizures are the usual neurological presentation and can start at any age. Other pertinent findings are
hemianopia, hemi paresis, hemisensory disturbance, and ipsilateral glaucoma.
Skull x-rays, taken after the age of 2 years reveal gyriform intracranial calcifications that
resemble a tramline.
Treatment is to control seizures, reduce IOP, and also argon laser
therapy to remove the skin lesions.
Vs. tuberous sclerosis: the initial presentation is ALSO a seizure, but the cutaneous
abnormality is called adenoma sebaceous, which appears between 5-10 years of age.
0 - ArchivalUser - 09-23-2010
Buproprion is contraindicated in patients with seizure disorders or conditions that
predispose to seizures (ie concurrent alcohol or benzodiasepine use, eating disorders).
Pts with anorexia or bulimia frequently develop electrolyte abnormalities that can
precipitate seizures.
0 - ArchivalUser - 09-23-2010
Thanks sparty!!
0 - ArchivalUser - 09-23-2010
IF sudden, rapid, tonic contraction of trunk and limb musculature that gradually relaxes over 0.5-2 seconds.
Contractions lasts 5-10 seconds.
The intensity varies from a subtle head nodding to a powerful contraction of the body, in clusters, often several dozens, separated by 5-30 seconds,frequently occur just before sleep or upon awakening,resemble a self-hugging motion and often are associated with a cry. The patient then relaxes, and the jerk repeats. These attacks occur in clusters throughout the day.
There is also contractions of the extensor musculature with sudden extension of the neck and trunk with extension and abduction of the limbs.
Normal psychomotor development occurs prior to the onset of symptoms, no underlying disorders or definite presumptive causes are present, and no neurological or neuroradiological abnormalities exist.
Amongst above options written by spartans,this comes under which category??
0 - ArchivalUser - 09-23-2010
It's Spartans or Spartys
0 - ArchivalUser - 09-23-2010
This is a idiopathic form of infantile spasms.Head nodding and heaving towards knees to a powerful contraction of the body and then sudden relaxation is presentation of infantile spasms.It can involve flexors or extensors or mixed kind of spasms..can also occur after awakening with clusters (as in JME)..Idiopathic because there was no psychomotor or neurological delay or malformation.
0 - ArchivalUser - 09-25-2010
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0 - ArchivalUser - 11-16-2010
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