SGD for Seizure (Students copy)

1.

Differentiate seizure from epilepsy.

- Seizures, abnormal movements or behavior due to unusual electrical activity in the brain, are a
symptom of epilepsy. But not all people who appear to have seizures have epilepsy, a group of
related disorders characterized by a tendency for recurrent seizures.
Non-epileptic seizures (called pseudoseizures) are not accompanied by abnormal electrical activity
in the brain and may be caused by psychological issues or stress. However, non-epileptic seizures
look like true seizures, which makes diagnosis more difficult. Normal EEGreadings and lack of
response to epileptic drugs are two clues they are not true epileptic seizures. These types of seizure
may be treated with psychotherapy and psychiatric medications.
Provoked seizures are single seizures that may occur as the result of trauma, low blood
sugar (hypoglycemia), low blood sodium, high fever, or alcohol or drug abuse. Fever-related (or
febrile) seizures may occur during infancy but are usually outgrown by age 6. After a careful
evaluation to estimate the risk of recurrence, patients who suffer a single seizure may not need
treatment.
Seizure disorder is a general term used to describe any condition in which seizures may be a
symptom. Seizure disorder is a general term that it is often used in place of the term ''epilepsy.''

What is a seizure?
To understand what a seizure is, you must first understand how the brain works. Your brain is comprised of thousands of neurons cells that process and transmit information by interacting
with each other. These interactions can be observed and assessed through an electroencephalogram (EEG).
In most brains, neuron interactions occur in a chaotic but balanced, orderly fashion with few disruptions. Occasionally, small disruptions (neuron misfires) may occur with little consequence.
When multiple cells misfire at the same time depending on the severity and location in the brain it may cause muscle twitches and spasms. This is a seizure. A seizure is defined as a
sudden, electrical discharge in the brain causing alterations in behavior, sensation, or consciousness.

The difference between epilepsy and seizures

Many believe that having a seizure equates to having epilepsy. Although the two terms are often used simultaneously, a seizure (which is a single occurrence) is different than epilepsy (which is
defined as two or more unprovoked seizures).

Seizures that appear to begin everywhere in the brain at once are classified as generalized seizures, while those beginning in one location of the brain are classified as partial seizures.

The three stages of a seizure

Aura The start of a partial seizure. If the aura is the only part an individual experiences, theyve had a simple partial seizure. If the seizure spreads and
affects consciousness, it is known as complex partial seizure. If the seizure spreads to the rest of the brain, it is classified as a generalized seizure.

Ictus Meaning stroke or attack, ictus is another word for the physical seizure.

Postictal Meaning after the attack, postictal refers to the aftereffects of the seizure, e.g., arm numbness, loss of consciousness, partial paralysis, etc.

2. What are the different classification of seizures and give example of each?
Focal / Partial Seizure
-only one part of body is affected/ one side of the brain
a. Simple Partial Seizure

- minimal spread of abnormal discharge

- preservation of consciousness and awareness
- patient aware of CPS attack and can describe it in detail.
b. Complex Partial Seizure
- localized onset, widespread discharge
- almost always involves the limbic system
- see trans
c. Secondarily-Generalized Attacks
-trans
Generalized Seizures
- all body parts
a. Generalized Tonic-Clonic Seizures
- "grand mal"
- trans
b. Absence Seizure
- "Petit mal"
- children?
- trans
c. Myoclonic Jerking
-trans

d. Atonic Seizures
e. Infantile Spasms

3. Give the basic pharmacology and pharmacokinetics of anti-seizure

medication.
-see trans and kaplan book
- use
-drug interaction
- cyt P450 inhibitor or inducer (valproate)
- side effect
4. Give the specific chemistry of GABA.
5. Differentiate benzodiazepines from barbiturates based on specific actions on
GABA complex.
6. Why does flumazenil antagonize benzodiazepines but not barbiturates?
- competitive antagonist at the GABAA (BZD receptor) and reverses the
sedative action of BZD and ZZZ (non benzo hypnotics)
7. Why does zolpidem act only as sleep inducer and not as a hypnotic?
- bec. of specificity? BZ1 only receptor
8. What are the possible differential diagnosis of seizure?
9. Give the first line and alternative drug treatment based on type of seizure.
10.Give the different drug subclass, MOA, pharmacokinetics, clinical application,
toxicities and different drug interactions.
- trans and Kaplan

11.In the treatment of seizure and epilepsy, what is the:

a. Acute management
b. Long-term therapy
c. Therapeutic goal
*NOTE: In number 11, the MOA can be further discussed to include presynaptic and
post presynaptic inhibitions including the ions involved.