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Résidence - FM Learner > 86. Seizures (3%) > Flashcards

86. Seizures (3%) Flashcards

1
Q

Describe : Generalized seizures (4)

A
  • Tonic-clonic (grand mal)
  • absence (petit mal)
  • myoclonic
  • Diffuse motor activity and LOC at onset
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2
Q

Describe : Partial seizures (3)

A
  • focal, eg. one extremity
  • Complex = Consciousness affected
  • Partial = No LOC
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3
Q

Describe : Status epilepticus

A
  • if >5-15mins
  • or multiple seizures without full return to consciousness
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4
Q

Describe : Pseudoseizure (5)

A
  • Diffuse motor activity (moving all extremities) with preservation of consciousness (eg. speaking)
  • Eyes squeezed shut (most epileptic patients do not resist eyelid raising)
  • Responsive noxious stimuli (nasal swab)
  • Out-of-phase movement of limbs (usually limbs move synchronously)
  • Unusual movmeents (pelvic thursting, side-to-side head movement)
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5
Q

Describe : Management of Status Epilepticus (6)

A
  • Protect airway, oxygen, intubation if unable to terminate seizure
  • IV access if possible
  • Terminate seizure (prevent brain damage). = 1st line benzos
  • r/o hypoglycemia - Glucose 1-2 amps of D50W (25g-50g) IV (can be given empirically if no glucose test available)
  • r/o hyponatremia - 150mL of 3% NaCl (with repeat bolus if persistent seizure) or 2 amps of NaCO3 (100mEq in 100mL)
  • Anti-epileptic for ALL status epilepticus (seizure >5mins)
  • If seizure persists, prepare for intubation
  • Consult neurology, ICU
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6
Q

Name benzos for 1st line tx to terminate seizures (3)

A
  • Lorazepam 0.1mg/kg IV up to max 8mg IV,
  • Midazolam 10mg IM
  • Diazepam 10mg IV/rectal/ET q5 mins x 3
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7
Q

Name anti-epileptic agents for status epilepticus (4)

A
  • Keppra 60mg/kg IV (up to 4500mg) over 10 minutes. Preferred as safe, no contraindications, and minimal side effects (SIADH)
  • Valproic acid 40mg/kg (up to 3000mg) over 10 minutes
  • Fosphenytoin
  • Phenobarbital (usually in alcohol withdrawal)
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8
Q

What to do if seizures persist ?

A

Prepare for intubation
* Propofol 1.5mg/kg + Ketamine 2mg/kg + Rocuronium 0.6mg/kg (lower dose so that does’t last to long)
* Then propofol infusion at 3-5mg/kg/hour (avoid propofol infusion syndrome, keep <5mg/kg/h)
* Prepare pressors PRN (norepinephrine)
* If severely hypotensive, consider Midazolam 0.2mg/kg loading dose with 0.1mg/kg/h infusion
* If seizure persists, consider re-bolus propofol and ketamine or high-dose ketamine 1-2mg/kg q5mins PRN (up to 10mg/kg cumulative dose)

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9
Q

Describe history of seizures (7)

A
  • Seizure disorder. Careful history for previous seizures
  • Precipitating factors
  • Localized vs. Generalized/symmetrical
  • Duration (usually 60-90 seconds)
  • Loss of bowel and bladder control, tongue biting
  • Apnea, cyanosis
  • Gradual return to consciousness, postictal confusion
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10
Q

Name precipitating factors of seizures (4)

A
  • Sleep deprivation, stress
  • Infection
  • Alcohol use/withdrawal, drug use
  • Change in medications
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11
Q

Differenciate Localized vs. Generalized/symmetrical seizures

A
  • Unilateral movements, eye deviation, head turning to one side
  • Tonic-Clonic - very rigid with extension and then rhythmic jerking
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12
Q

Describe physical exam : Seizures (4)

A
  • Vitals, Temperature, Glucose
  • Complete neuro exam
  • Lateral tongue biting
  • Trauma during episode
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13
Q

Name DDX of seizures (10)

A
  • TIA
  • Eclampsia
  • Syncope
  • Migraine
  • Cardiac disorders (Dysrhythmias, Long QT syndrome, HOCM)
  • Sleep disorders (Narcolepsy)
  • Movement disorder
  • Acute dystonia
  • Rigors
  • Pseudoseizure
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14
Q

Name causes of seizures (9)

A
  • Stroke
  • Metabolic / Electrolyte : Hypo/hyperglycemia, Hypo/hyperNa, Hypophophatemia, HypoCa, Hyperammonemia/hepatic encephalopathy, Uremia
  • Hypoxia
  • Hyperthermia
  • Hypertension (encephalopathy, PRES, eclampsia)
  • CNS trauma, tumor, bleed, stroke (ischemic>hemorrhagic), infection (meningitis, encephalitis, abscess)
  • Drug intoxication (anticonvulsants, antidepressants, antipsychotics, isoniazid, opioids, theophylline, sympathomimetics)
  • Drug withdrawal (alcohol, barbiturates, benzodiazepines)
  • Low dilantin (in known epilepsy
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15
Q

Describe investigations for known seizure

A

Serum anticonvulsant levels

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16
Q

Describe investigations for FIRST seizure (11)

A
  • Glucose
  • Chem (Sodium, Creat, Calcium, Magnesium, Phos, Urea)
  • Consider LFT, ammonia in cirrhosis
  • B-hCG
  • CBC
  • Consider CK for rhabdo
  • Consider anti-epileptic drug levels (for adherence)
  • Consider toxicology (cocaine, methamphetamine)
  • Head CT generally recommeneded unless obvious cause (non-adherence to anti-epileptic)
  • EEG within 24-48h
  • LP if immunosuppressed (r/o meningitis, encephalitis)
17
Q

When to do in head CT in children for seizures ? (5)

A
  • if <1yo
  • and in those with cognitive or motor developmental delay
  • unexplained neurologic abnormalities
  • a history of focal seizures
  • or findings on electroencephalography (EEG) that are incompatible with benign partial epilepsy of childhood or primary generalized epilepsy
18
Q

When to start anticonvulsant ? (4)

A
  • Do not need to start antiepileptic medication in first seizure
  • Consider if risk factor (eg. abnormal EEG results or brain injury/lesion)
  • If no risk factor, counsel on excellent prognosis, and can consider medication if second seizure episode occurs
  • Consider as per patient’s preference or work (eg. pilot)
19
Q

Anticonvulsants should be taken with ?

A

Anticonvulsants (valproic acid, phenytoin) are teratogenic, advise taking folic acid and be on lowest dose

20
Q

Name adverse effects of anticonvulsants (5)

A
  • Osteoporosis
  • hematologic (decreased WBC, pancytopenia)
  • liver failure (phenytoin)
  • GI symptoms
  • fatigue
21
Q

Describe follow-ups : Seizures (2)

A
  • Neurology Consult
  • Dangers of swimming, living alone, operating machinery, chewing gum, heights
22
Q

When can you drive with seizures ?

A

Pas de conduite pour 6 mois après une crise (permis de véhicule promenade)

23
Q

In the ongoing care of a patient with a stable seizure disorder, inquire about what? (5)

A
  • Regularly inquire about compliance (with medication and lifestyle measures).
  • Side effects of anticonvulsant medication
  • Impact of the disorder and its treatment on the patient’s life (e.g., on driving, when seizures occur at work or with friends).
  • Monitor for complications of the anticonvulsant medication (e.g., hematologic complications, osteoporosis).
  • Modify management of other health issues taking into account the anticonvulsant medication (e.g., in prescribing antibiotics, pregnancy).

Résidence - FM Learner (32 decks)

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