Chapter 445 Seizures Flashcards by Jatter Angelo I. Duran

Proxysmal event due to abnormla excessive or synchronous neuronal activity in the brain

Seizure

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Highest incidence of seizures

Early childhood and late adulthood

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Condition of recurrent seizures due to a chronic, underlying process

Epilepsy

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Seizure that originates within a limited network located in one cerebral hemisphere

Focal seizure

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Seizure that engages both cerebral hemispheres

Generalized seizures

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EEG pattern of focal seizure

Often normal may show epileptiform spikes or sharp waves

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Repetitive flexionm extension movements

Clonic movements

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Spread of a seizure over a progressively larger region of motor cortex

Jacksonian March

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Localized paresis in the area involved following a seizure

Todd’s paralysis

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Focal seizure that may continue for hours to days, refractory to medical therapy

Epilepsia partialis continua

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Subjective internal feelings not observed by someone else

Aura

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Two types of focal seizures in terms of cognitive features

Focal with dyscognative features

2. Focal without dyscognative features

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Seizure characterized by sudden, brief lapses of consciousness without loss of postural control
No postictal confusion

Typical absence

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Hallmark EEG of typical absence

Generalized, symmetric, 3-Hz spike and wave discharge, begins and ends suddenly

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Type of seizure that presents like absence seizure with longer duration, less abrupt onset and cessation

Atypical absence

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EEG pattern of atypical absence

Slow spike and wave pattern with frequency = 2.5

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Most common seizure type resulting from metabolic derangement

GTC seizure

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State of unresponsiveness, muscular flaccidity, excessive salivation, stridourous breathing, bladder and bowel incontinence

Postictal phase

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EEG showing progressive increases in generalized low-voltage fast activity, followed by high amplitude, polyspike discharge

Spike and wave pattern that is generalized

Tonic phase

Clonic phase

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Tyoe of seizure characterized by sudden loss of postural muscle tone for 1-2 seconds

Atonic seizure

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Sudden brief muscle contraction involving one part of the body or the entire body.

Myoclonic seizure

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EMG pattern showing rhomboid pattern

Epileptic spasm

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Generalized seizure disorder of unknown origin appears during early adolescence, usually characterized by bilateral myoclonic jerks single or repetitive

Juvenile myoclonic epilepsy

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triad of 1. multiple seizure types 2. EEG showing slow spike-and-wave discharge (<3HZ) 3. impaired cognitive function

Lennox- Gastaut syndrome

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most common syndrome associated with focal seizure with dyscognitive features.

Mesial temporal lobe epilepsy syndrome (MTLE)

Area of the brain that undergoes sclerosis in MTLE

Hipocampal area

severe penetrating head trauma is associated with how many percent risk of epilepsy?

45%

it is the process where a normal neural network is transformed into an abnormally hyperexcitable one

epileptogenesis

factors leading to a lowered seizure threshold

epileptogenic factors

recurrent seizure occurs how many years after head trauma?

within one year

Acute seizure is seen most commonly in what type of stroke?

embolic

hallmark of established seizure

electrographic spike

This medication lowers seizure threshold in humans, it reduces inhibition by antagonizing GABA at its receptor

Penicillin

In the examination of a patient with seizure, history should focus on?

Determining if the event was truly a seizure

Indications to do lumbar puncture in patients who presented with seizure

suspicion of meningitis/ encephalitis | ALL HIV patients

TRUE or FALSE | all patients who have a possible seizure disorder should be evaluated with an EEG ASAP

TRUE

this finding establishes the epilepsy diagnosis:

presence of electrographic seizure activity during a clinically evident event

all patients with new onset seizure activity should have brain imaging. TRUE or FALSE

TRUE | *except in children with unambiguous history and examination

Preferred Imaging for patients with new onset seizures

MRI

nonepileptic behaviors that resemble a seizure

psychogenic seizure

serum indicator used to distinguish between organic and psychogenic type seizure

serum prolactin expected to rise in seizures, best taken 30 minutes postictal

overall goal of seizure treatment

complete prevention of seizure without any side effects

when can antiepileptic drug therapy be started?

any patient with recurrent seizures of unknown etiology or a known cause that cannot be reversed patients with identified lesion known to be epileptogenic

risk factors for recurrent seizures

1. abnormal neuro exam 2. presents as status epilepticus 3. Todd's paralysis 4. family history 5. abnormal EEG

First line treatment for GTC seizure

Lamotrigine, Valproic Acid

First line for Focal seizures

Lamotrigine, Carbamazepine, Oxcarbazepine, Phenytois, Levetiracetam Mnemonic: PhOCaLL (Phenytoin, Oxcarbazepine, Carbamazepine, Lamotrigine, Levetiracetam)

First line for Typical Absence

Valproic Acid, Ethosiximide, Lamotrigine

First line for Atypical Absence, Myoclonic, Atonic

Valproic Acid, Lamotrigine, Topiramate

Drug that can cause leukopenia, aplastic anemia, or hepatotoxicity

Carbamazepine

Drug that can cause SJS

Lamotrigine | mnemonic Lamoktrigine or mosquito bite = SJS :)

long-term use of this drug can cause cosmetic effects like hirsutism, coarsened facial features, and gingival hypertrophy)

Phenytoin

This drug is avoided in patients who will develop glaucoma or renal stones

Topiramate

Drug of choice for patients with generalized epilepsy syndromes having a mixed seizure type

Valproic Acid

Profile of patients who remain seizure free after drug withdrawal

1. complete medical control of seizures for 1-5 years 2. single seizure type 3. normal neurologic findings including intelligence 4. normal EEG

when does recurrence of seizure occur after drug withdrawal?

in the first 3 months after withdrawal

refers to continuous seizure or repetitive, discrete seizures with impaired consciousness in the interictal period.

Status Epilepticus

duration of seizure activity used to define status epilepticus

15-30 minutes

for Generalized Convulsive Status Epilepticus the duration of seizure to label it as such is?

beyond 5 minutes

Management of early or impending status epilepticus?

IV benzodiazepine 1. Lorazepam 0.1 mg/kg 2. Midazolam 0.2 mg/kg 3. Clonazepam 0.015 mg/kg IV antiepileptic drug 1. Phenytoin 20 mg/kg 2. Valproic acid 20-30 mg/kg 3. Levetiracetam 20-30 mg/kg

Management of established GCSE early and refractory period | 30 minutes to 48 hours

1. IV midazolam 0.2 mg/kg then drip to 0.2-0.6 mg/kg/hr And/or 2. IV propofol 2mg/kg then drip to 2-10 mg/lg/hr

Management of established early refractory status epilepticus of the focal-complex, myoclonic or absence type

Further IV/PO antiepileptic drug if still refractory proceed to management of GCSE

Management of late refractory SE | >48 hours

Phenobarbital / thiopental | 5mg/kg/1 mg/kg then drip to 1-5 mg/kg/hr

Occurs in women where there is an increase in seizure frequency around the time of menses.

Catamenial epilepsy

Seizure frequency in pregnancy

50% unchanged 30% increase 20% decrease

Most common malformations in children of pregnant women taking antiepileptic drug occurs in what system?

Cardiovascular and musculoskeletal

Floate is recommended for pregnant women taking antiepileptic drug at what dose?

1-4 mg/day

Anticonvulsant known to decrease efficacy of oral contraceptives

Carbamazepine Phenytoin Phenobarbital Topiramate