Chapter 15: Seizures

Question 1

Diagnosis of epilepsy requires

Answer 1

Two unprovoked seizures

Question 2

Partial

Answer 2

One portion of the brain

Question 3

Generalized

Answer 3

Entire brain at once

Question 4

Secondarily generalized

Answer 4

Starts from one portion of the brain and spread to the rest of the brain

Question 5

Complex

Answer 5

Awareness is impaired

Question 6

Simple

Answer 6

Awareness is preserved

Question 7

Partial seizures…

Answer 7

Complex or Simple

Question 8

Simple Partial Seizures

Answer 8

Positive>Negative signs (tingling>numbness, hallucinations>blindness)
Jacksonian march
Can cause all kinds of sensory phenomena including deja vu, jamais vu, or sensations of depersonalization or derealization

Question 9

Complex Partial Seizures

Answer 9

Commonly arise from temporal lobe, may be frontal
Automatisms like lip-smacking, picking at clothing.
Speech arrest or nonsensical speech
Patients may complete activities like driving and folding clothes or bizarre activities like running in a circle

Question 10

Generalized Tonic-Clonic Seizures

Answer 10

Grand Mal Seizures
Starts off tonic, then becomes clonic
May become incontinent of urine and bite tongue

Question 11

Absence Seizures

Answer 11

Generalized Seizure
Staring for several seconds with immediate recovery
Classic 3-Hz spike-and-wave
Hyperventilation is a common trigger

Question 12

Other seizure types

Answer 12

Atonic, tonic, and myoclonic: all generalized

Question 13

Seizures age groups

Answer 13

Very young and very old

Question 14

A seizure is a…

Answer 14

Abnormal hypersynchronous electrical discharge involving neurons in the brain

Question 15

Most common cause of seizures in the elderly

Answer 15

Strokes

Other frequent cause is metabolic disturbances from hepatic or renal failure

Question 16

Todd paralysis is a…

Answer 16

Postictal hemiparesis, following a secondarily generalized seizure. Indicates partial onset.

Question 17

Infectious cause of seizures that must be ruled out

Answer 17

Meningitis

Question 18

What percent of epileptics have unusual EEGs

Answer 18

50%

Question 19

When to start therapy

Answer 19

After 2 seizures that are not symptomatic or provoked

Question 20

Monotherapy or polytherapy tx

Answer 20

Monotherapy is the rule unless adverse effects become intolerable. Monotherapy works in 70% of patients

Question 21

Vagus nerve stimulation indication

Answer 21

Partial seizures

Question 22

Status epilepticus

Answer 22

Seizure activity continuous for a prolonged period or seizures are so frequent that there is no recovery of consciousness between them. Must tx emergently.

Question 23

Status progression of therapy

Answer 23

1. Thiamine+Glucose+Lorazepam
2. Lorazepam
3. Phenytoin
4. Phenobarbital
5. Coma with barbiturates, midazolam, or propofol

Question 24

Valproic acid and pregnancy

Answer 24

Neural tube defects

Question 25

Epilepsy and pregnancy

Answer 25

Folice acid >1mg/day

Question 26

Pyschogenic Nonepileptic seizures

Answer 26

10-30% of patients evaluated