Seizure Disorders
What clinical feature can differentiate complex partial seizures from simple partial seizures?
Complex partial seizures are marked by an altered responsiveness to outside stimuli without loss of consciousness.
In simple partial seizures there is no change in responsiveness to outside stimuli.
For pregnant women with epilepsy, what important issues should be discussed?
Increased rate of polycystic ovarian syndrome.
Reduced fertility rate.
Seizures during pregnancy may cause hypoxia to the fetus.
Teratogenic antiepileptics: Carbamazepine, valproate, phenytoin.
Is the direction of eye deviation during a seizure related to the location of the seizure focus?
Yes. During a seizure, the eyes deviate in the direction of the seizure focus.
Post-ictally, the eyes deviate away from the seizure focus.
The principle is, the eyes always look in the direction of the excited neuron.
What antiepileptic drugs induce hepatic metabolism and therefore reduce efficacy of oral contraceptives?
Barbiturates (Luminal).
Carbamazepine (Tegretal, Carbatrol).
Lamotrigine.
Oxcarbazepine (Trileptal).
Phenytoin (Dilantin).
Topiramate (Topamax).
What antiepileptics can cause liver impairment?
Carbamazepine.
Valproate (Depakote, Depakene, Depacon).
What are clinical features of absence epilepsy?
It is considered a generalized seizure because of loss of consciousness. Almost always occurs in children.
Abrupt loss and quick resolution of consciousness, no post-ictal state. Automatisms such as blinking, lip smacking.
Average duration <10 seconds.
May be induced by hyperventilation.
Pathognomonic electroencephalogram (EEG): 3-Hz spike and wave.
What are concerns in prescribing antiepileptics in women of child-bearing age?
Polycystic ovarian syndrome (valproate).
Hyperandrogenism (valproate).
Reducing effectiveness of oral contraceptives (phenytoin and carbamazepine).
Fetal neural tube defects (valproate).
Which anticonvulsants do not have hepatic metabolism?
Gabapentin (Neurontin).
Levetiracetam (Keppra).
Topiramate has minimal hepatic metabolism.
What are features of partial and focal seizures with regard to anatomic location of brain pathology?
Primary motor cortex: Contralateral motor tonic-clonic seizures.
Supplementary motor cortex: Complex bizarre automatisms (facial muscle seizures often mistaken for psychosis).
Occipital lobe: Elementary visual hallucinations, ictal amaurosis (blindness).
Parietal lobe: Contralateral paresthesias, pain, gustatory hallucinations, language disturbances if seizure is from dominant lobe.
Mesial temporal lobe: Abdominal complaints, often an aura of focal seizures.
Superior temporal lobe: Auditory hallucinations, often an aura of focal seizures.
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