Week 2

A chronic condition that consists of recurrent seizures

-Generalized
-Focal
-Unknown
*further categorized as motor or nonmotor

-Prodromal
-Early ictal or aura
-Ictal
-Postictal

-Occurs hours to days before the seizure occurs
-May experience anxiety, mood changes, and difficulty sleeping

-First sign of seizure activity
-May experience strange tastes, smells, or feelings, such as deja vu or excitement

-Occurs from the time of the first manifestation until seizure activity ends

-Both sides of the brain or start on one side and spread to the other
-Clients are often unaware or lose consciousness

Sudden stiffness or tension in the muscles of the arms, legs, or trunk during seizure activity

Repeated jerking movements of the arms and legs on one or both sides of the body during seizure activity

-Type of Generalized Seizure
-Presents with a loss of muscle tone and consciousness, which can result in the client falling if they are standing
-More common in children than adults

-Type of Generalized Seizure
-Maintains consciousness and partial awareness
-May experience brief muscle contractions or jerks
-May experience only one or a series

-Classified as generalized onset, non-motor
-Start and stop abruptly
-Awareness is altered and differs amonst clients
-Also presents with clonic movements of the face

-Categorized as a focal (partial) seizure
-No loss of consciousness
-Automatisms (lip smacking, picking as clothes)

Classified as a seizure lasting five minutes or more or recurrent seizures without time for recovery between
*Medical emergency that requires immediate treatment

-Occurs after all seizure activity ends and can last between five and 30 minutes until the client reaches their baseline
-Client recovers from the seizure and may experience confusion, fatigue, headache, alterations in mental status, weakness, nausea, or anxiety

MRI or a CT scan of the brain
-Electroencephalography (EEG) is often performed following a seizure and measures the electrical activity in the brain

-Benzodiazepines (lorazepam, diazepam, and midazolem)

-Levetiracetam or barbiturates

A chronic disease affecting the brain and spinal cord with no known cause

Insulating layer that forms around nerves to facilitate electrical nerve impulses

Loss or destruction of the myelin sheath

Sensation that happens without warning and is painless. It is described as numbness, itching, skin crawling, or tingling

Inflammation and demyelination of nerves occur, leading to disrupted messages from the brain and spinal cord to the rest of the body
-The disruption of the electrical impulses can lead to vision impairments, muscle weakness, paresthesia, cognitive and memory issues, and difficulty with coordination and balance

-No specific manifestations or lab tests that lead to a client being diagnosed with MS
-Other medical conditions must be ruled out

-Relapse remitting (RRMS)
-Primary progressive (PPMS)
-Secondary progressive (SPMS)
-Clinically isolated syndrome (CIS)

-Characterized by episodes of new or increasing neurological manifestations followed by episodes of limited or complete remissions
-Persistant manifestations can become permanent
-During periods of remission, there is no progression of the disease

-Characterized by progressive worsening of neurologic manifestations from the onset of manifestations
-No early remissions or relapses

-A progressive worsening of neurologic manifestations over time with an initial period of relapses and remissions
-There are periods of active disease with progression and active periods without progression of neurologic manifestations

-Refers to the first occurrence of neurological manifestations lasting at least 24 hours
-Does not yet meet the diagnostic criteria for MS
-If lesions are identified on an MRI, the client is at high risk of developing MS

Described as stabbing pain in the face or jaw area. The pain is intermittent and unpredictable

A brief pain similar to an electrical shock that extends from the back of the head down the spine and can affect the extremities. This pain is experienced when the client bends their neck forward, indicating damage to the cervical spine

A squeezing feeling around the trunk of the body that is described as feeling like a blood pressure cuff is tightening around the client

Intermittent, painful spasms of the muscles that can occur throughout the day or night

A chronic pain not usually associated with a relapse
-Described as burning, electrical, ice-cold, or stabbing pain that interferes with the overall quality of life

-Vision: optic neuritis, blurred vision, double vision
-Cognitive: difficulty with concentration, memory impairment, executive function impairment
-Sensory: numbness, tingling, pins and needles sensation
-Psychiatric: anxiety, depression
-Vestibular: vertigo, gait issues
-Motor: fatigue, spasticity, tremor, weakness
-Urinary and bowel: incontinence, urgency, retention, reflux, diarrhea, constipation

A rare disease caused by a viral infection, which can often lead to severe disability or death
-Clients with autoimmune disorders such as MS treated with medications such as natalizumab are at higher risk of developing PML

-Memory loss
-Vision difficulty
-Progressive weakness in the arms and legs
-Loss of coordination
-Clumsiness
-Aphasia

-Pacing: integrate short breaks into activities regularly to avoid overexertioin and proceed with activities at a moderate pace
-Prioritization: complete important tasks before others that are less important and rest as needed
-Planning: determine which tasks need to be accomplished on which day and organize the tasks according to priority and effort
-Positioning: practice using good posture, body mechanics, and ergonomics, placing needed supplies within reach

A chronic autoimmune disorder that affects the neuromuscular junction, the point where nerves meet muscles
-It causes muscle weakness that typically worsens with activity and improves with rest

-Weakness of arm or leg muscles
-Double vision
-Drooping eyelids
-Problems with speaking, chewing, swallowing, and breathing

Double vision, which may be horizontal or vertical, and improves or resolves when one eye is closed

-The immune system makes antibodies that block or destroy many of your muscles' receptor sites for a acetylcholine
-This leads to fewer nerve signals reaching muscles, resulting in muscle weakness
*Antibody-negative myasthenia gravis is not caused by antibodies blocking acetylcholine; it is still a problem with autoimmunity, but the antibodies involved just can't be found yet

-In some adults with myasthenia gravis the thymus gland is larger than usual
-Some people with myasthenia gravis also have tumors of the thymus gland
-Researchers believe that the thymus gland makes or helps produce the antibodies that block acetylcholine

*Life-threatening condition
-When the muscles that control breathing become too weak to work
-Emergency treatment and mechanical assistance with breathing are needed

-Underactive or overactive thyroid
-Autoimmune conditions

-A temporary form of MG found in babies born to mothers with MG

-Presents 3-72 hours after birth
-Poor sucking
-Respiratory distress
-Generalized hypotonia in association with a weak cry and facial diplegia

-Chronic pharmacotherapy to increase the availability of acetylcholine neurotransmitters
-Immunomodulation drugs
-Immunosuppressive drugs

-Classical form outcome is excellent, assuming appropriate respiratory and nutritional support
-Most patients experience spontaneous remission after weeks to months

A chronic bone disorder characterized by abnormal bone remodeling, leading to enlarged, deformed, and weakened bones
*The pelvis, skull, spine and legs are most commonly affected

-Bone pain
-Bone deformities
-Fractures

-Age: people older than 50 are most likely to develop the disease
-Sex: men are more commonly affected than women
-National origin: More common in England, Scotland, central Europe, and Greece
-Family history: More likely to develop the condition if you have a relative who has Paget's disease

-Fractures and deformities
-Osteoarthritis
-Neurological problems: bone can compress and damage the nerve, causing pain, weakness, or tingling in an arm or leg or hearing loss
-Heart failure
-Bone cancer

-X-rays
-Bone scan
-Lab tests: usually elevated levels of alkaline phosphatase

-Osteoporosis drugs (biphosphonates)
-If biphosphonates are not tolerated, calcitonin may be used
-Surgery

-Phenytoin
-Levetiracetam
-Valproate
-Carbamazepine

Examples: phenytoin, carbamazepine, lamotrigine
-Stabilizes inactive state of sodium channels to prevent repetitive neuronal firing

Examples: phenytoin, carbamazepine, lamotrigine
-Partial and generalized tonic-clonic seizures

Examples: phenytoin, carbamazepine, lamotrigine
-Dizziness, drowsiness, ataxia
-Diplopia
-Rash (Lamotrigine: risk for Stevens-Johnson)
-Gingival hyperplasia (phenytoin)

Examples: phenytoin, carbamazepine, lamotrigine
-Heart block
-Hepatic impairment (carbamazepine)
-Pregnancy (phenytoin - teratogenic)

Examples: phenytoin, carbamazepine, lamotrigine
-Monitor serum drug levels (especially phenytoin)
-Watch for signs of toxicity: nystagmus, ataxia, confusion
-Monitor liver function, CBC

Examples: phenytoin, carbamazepine, lamotrigine
-Take this medication at the same time daily, do not stop abruptly
-Report rash or unusual bleeding
-Avoid alcohol, use non-hormonal birth control

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Enhances GABA (inhibitory neurotransmitter) activity

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Generalized seizures
-Status epilepticus
-Myoclonic seizures

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Sedation
-Respiratory depression
-Dizziness
-Hepatotoxicity (valproic acid)
-Dependency

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Liver disease (valproic acid)
-Respiratory insufficiency
-Pregnancy (barbiturates)

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Monitor respiratory rate and level of consciousness
-Check LFTs and ammonia levels with valproic acid

Examples: phenobarbital, diazepam, lorazepam, valproic acid
-Avoid driving until response is known
-Do not stop abruptly - risk of rebound seizures
-Report signs of liver dysfunction (abdominal pain, jaundice)

Examples: ethosuxamide
-Indication: absence seizures
-Mechanism of Action: Inhibits T-type calcium channels in thalamic neurons
-Common side effects: GI upset, drowsiness, fatigue, headache, rash
-Contraindications: hypersensitivity
-Nursing care: monitor for mood changes, suicidal ideation; check CBC and LFTs regularly
-Patient education: Take with food to reduce GI upset; notify provider of rash or behavioral changes

Examples: interferon beta, glatiramer acetate
-Indication: relapsing-remitting MS
-Modulates immune response and reduces inflammatory activity in CNS

Examples: interferon beta, glatiramer acetate
-Common side effects: flu-like symptoms, injection site reactions, depression (interferons)
-Contraindications: Hypersensitivity, severe liver disease

Examples: interferon beta, glatiramer acetate
-Nursing Care: monitor liver enzymes and CBC, assess for depression or suicidal thoughts
-Patient Education: use analgesics for flu-like symptoms; report mood changes or jaundice

Examples: natalizumab, ocrelizumab
-Indication: moderate to severe relapsing or progressive MS
-MOA: Inhibits immune cell trafficking or activity in the CNS

Examples: natalizumab, ocrelizumab
-Common Side Effects: infusion reactions, increased infection risk, PML
-Contraindications: active infections, history of PML

Examples: natalizumab, ocrelizumab
-Nursing care: monitor for signs of infection and hypersensitivity; screen for JC virus before starting
-Patient education: report new neurological symptoms; stay current on vaccines, avoid live vaccines during treatment

Example: pyridostigmine
-Indication: symptomatic treatment of MG
-MOA: inhibits breakdown of acetylcholine at neuromuscular junction

Example: pyridostigmine
-Common side effects: bradycardia, diarrhea, muscle cramps, excessive salivation
-Contraindications: asthma, bradycardia, urinary obstruction

Example: pyridostigmine
-Nursing Care: assess timing and response to doses; monitor for cholinergic crisis (SLUDGE symptoms)
-Patient Education: take at same time daily to avoid weakness; space activities to avoid fatigue; wear medical alert bracelet

Examples: alendronate, zoledronic acid, risedronate
-Inhibits osteoclast-mediated bone breakdown

Examples: alendronate, zoledronic acid, risedronate
-Common Side Effects: GI upset, esophagitis, hypocalcemia, jaw osteonecrosis (rare)
-Contraindications: esophageal disorders, hypocalcemia, renal impairment

Examples: alendronate, zoledronic acid, risedronate
-Nursing Care: monitor renal function and calcium levels; notify dentist before procedures
-Patient Education: ensure calcium and vitamin D intake; take in the AM with full glass of water, remain upright for 30-60 minutes; report thigh or jaw pain