17. Clincal Approach to Seizures and Syncope

Question 1

There are many paroxysmal (episodic) disorders in neurology, including migraine, syncope, dizziness, seizure and transient global ischemia. What is defined as 2+ unprovoked seizures and is the 4th MC neuro disorder behind migrain, alzheimers dz and stroke, 1/26 will develop during their lifetime?

Answer 1

Epilepsy

Question 2

Percent positive findings for epilepsy on a SINGLE EEG: all types is 40%, generalized tonic-clonic 20%, percent positive for epilepsy (all types) with 3 sleep deprived EEGs is 85%, partial is 30% and petit mal with HV is?

Answer 2

90%***

Question 3

Although EEG is an important tool in the dx of epilepsy, the single most important information is what, which is preferably by witnesses because a normal EEG does no exclude presence of epilepsy?

Answer 3

history of the event**

Question 4

Generalized seizures include absence (petit mal), tonic-clonic, myoclonic, tonic, clonic, atonic, clonic-tonic-clonic, what type of seizures are seizure activity begining on one side of the brain and include simple, complex and secondarily generalized?

Answer 4

Partial Seizures

Question 5

What kind of partial seizure is asso with focal motor or sensory activity, no LOC, lasts seconds and has no post ictal state?

Answer 5

Simple partial

Question 6

What kind of partial seizure is assoc with nonresponsive staring, possible preceding aura, automatisms, LOC*, lasts 1-3 mins, and there is a post ictal state?

Answer 6

Complex partial

Question 7

What kind of partial seizure is bilateral tonic-clonic activity with LOC, lasts 1-3 mins with post ictal state?

Answer 7

Secondary generalized partial

Question 8

What generalized seizures is assoc with nonresponsive staring, rapid blinking, chewing, clonic hand motions, LOC, lasts 10-30 sec, no post ictal state?

Answer 8

Absence or Petit Mal Seizure

Question 9

What generalized seizures is assoc with bilateral extension followed by symmetrical jerking of extremeties, LOC lasts 1-3 min with post ictal state?

Answer 9

Tonic Clonic

Question 10

What generalized seizures is assoc with sudden loss of muscle tone, head drops, or patient collapses, LOC, variable duration and a post ictal state?

Answer 10

Atonic

Question 11

What generalized seizures is assoc with brief, rapid symmetrical jerking of extremities and or toso, LOC, lasts LESS THAN a few seconds, minimal post ictal state?

Answer 11

Myoclonic

Question 12

Partial and Secondary generalized seizures are treated with antiepileptic drugs, such as valproic acid, lamotrigine, tropiramate, leviteracetam, zonisamide and ?

Answer 12

perampanel

Question 13

Primary generalized seizures are treated with valproic acid, lamotrigine, leviteracetam, zonisamide, perampanel, and?

Answer 13

Topiramate

Question 14

One single combination of Antiepilepsy drugs that has been shown to be synergistic in the treatment of epilepsy (mainly for primary generalized seizures) is valproic acid and?

Answer 14

Lamotrigine

Question 15

What is a condition characterized by prolonged seizure (generally longer than 10 minutes) or repeated seizures without recovery in between?

Answer 15

Status Epilepticus

Question 16

treatment for Status Epilepticus is first ABCs, establish IV, gain history, allergies to meds?, labs- accuchek, CBC, chem panel, drug levels, non-contrast CT head, and what can be given to ‘buy time’ ?

Answer 16

Benzodiazepine or lorazepam, then give long lasting AED like fosphenytoin, phenobarbital, valproic acid, lacosamide, if unsuccessful try midazolam/propofol IV drip (must be intubated) - pentobarbital coma is last resort

Question 17

for Status Epilepticus, some patients may only respond to one of the oral anticonvulsants such as carbamazepine– consider establishing a nasogastric tube for ?

Answer 17

administration

Question 18

Principles for tx of epilepsy include using *monotherapy, consider drug interactions such as OCP with carbamazepine, and consider long term side effects such as what associated with carbamazepine or phenytoin?

Answer 18

Bone Loss

Question 19

Women w epilepsy of child bearing age should be on a MVI (multivitamin injection) with 1 mg folic acid, this is important in women with epilepsy as many of the AEDs are?

Answer 19

folate depleting

Question 20

Women of childbearing age with epilepsy should avoid valproic acid, in general, newer anti epiletic drugs (lamotrigine/leviteracetam) are safer during pregnancy than older ones (phenytoin/valproic), BUT the drug of choice is the drug which best?

Answer 20

controls the woman’s seizures

Question 21

What is associated with pallor, sweating, abnormal head sensation, lightheadedness, positionall related, slow onset and breif unconsciousness?

Answer 21

Syncope

Question 22

What is associated with urinary/bowel incontinence, tongue injury, tonic/clonic movements, and a postictal state?

Answer 22

Seizures

Question 23

What is sudden, temporary isolated episode of memory loss (amnesia), no other neuro signs/sx present, patient knows self and close family/friends but may not recognized others, usually lasts a few hours and resolves, usually doesnt recur?

Answer 23

Transient Global Amnesia