DISEASE EPILEPSY MYASTHENIA GRAVIS MULTIPLE SCLEROSIS GUILLAIN BARRE SYNDROME

S/Sx recurrent seizures ptosis, diplopia (due to weakness of extraocular muscle) diplopia, nystagmus, blurry vision, upward weakness, areflexia
(card) others: symmetrical paralysis, mask-like facial expression, descending muscle weakness others: paresthesia, hypotonia, symmetric weakness
dysphonia, bulbar symptoms(facial)
Main Epileptogenic Zone(EZ) Antibodies produced by thymus destruction of OLIGODENDROCYTE destruction of SCHWANN CELLS (may be due to
Culprit virus- Epstein Barr or bacteria-Campylobacter jejuni)
Dx Tests EEG, SPECT(to identify EZ) Tensilon Test (Edrophonium Chloride), an anticholinesterase MRI(to reveal plaques), EMG(dec. nerve cond), MRI
inhibitor and MRI(enlarged thymus) Electrophoresis(IgG)
Goals promote safety, control seizure improve fxn esp muscle endurance, get rid of antibodies promotion of physical mobility maintain adequate ventilation
Meds Valium/Phenobarbital-for children Neostigmine Bromide and Pyridostigmine Bromide Interferonβ-1a(AVONEX /REBIF) Anticoagulants,
Fosphenytoin-DOC **both are cholinergics Interferonβ-1b(BETASERONE)
anesthetics-to depress muscle **antidote for OD is Atropine Sulfate Glatiramer Acetate(COPAXONE)
Corticosteroids
(HYDROCORTISONE)
**interferon prevents t-cell
proliferation
Other Tx Transcranial Magnetic Stimulation Plasmapheresis of Plasma Exchange --- Plasmapheresis, Mech Vent, Intubation
Excision of EZ Thymectomy
Vagal Stimulation
Compli Status Epilepticus (ng ix is to start Myasthenic Crisis Cholinergic Crisis Pneumonia, UTI, DVT Miller Fisher Syndrome- a clinical variant characterized
cause underdose overdose by ataxia, opthalmoplegia and areflexia
an IV cm extreme weakness weakness
tensilon test relief worsen
mgt cholinergics atropine
Ng Dx Risk for injury r/t involuntary muscle Fatigue, related to increased energy needs from muscular Impaired physical mobility r/t Ineffective breathing pattern: dyspnea r/t weakness of
movements secondary to seizure disorder involvement demyelination of neurons the muscles needed for breathing secondary to GBS
Other PHASES OF A SEIZURE an AUTOIMMUNE d/o COURSES OF MS also known as POLYRADICULONEURITIS
Stuff ***prodromal and aural are considered Pre- ng ix include: eye care, nonverbal communication, maintaining a. Relapsing-Remitting first discovered this disease Landry-Strohl
ictal in some books respiration b. Primary Progressive Jean Landry, Georges Guillain, Jean Alexandre Barré,
a. Prodromal-remove stimulus w/c triggers c. Secondary Progressive André Strohl
attack d. Progressive Relapsing
b. Aural-insert padded tongue dep
c. Ictal
d. Postictal-monitor v/s
FAQs
 Common S/sx of the 4: weakness, sensory disturbances, seizures, pain, dizziness, visual o Partial-involves only 1 part of brain
disturbances.  Simple Partial-without loss of consciousness
 Perception refers to senses while coordination refers to motor.  Complex Partial-with loss of consciousness
 The myelin ii the protein covering of the axon.  Unclassified
 The reason while GBS is reversible is that Schwann cells are capable of regenerating while  Pattern of Tonic-Clonic: Aura, Epileptic Cry,Tonic-contraction of muscle, Clonic-jerking mov’ts
Oligodendrocytes are not.  Central Sulcus is the landmark of division of motor(anterior, precentral gyrus) and
 TYPES OF SEIZURES sensory(posterion, postcentral gyrus)
o Generalized-involves the whole brain
 Grand Mal
 Seizure is a symptom, Epilepsy is a recurrence and Conulsion is an
 Petit Mal involuntary muscle contraction