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Chapter 445 Seizures > Chapter 445 Seizures > Flashcards

Chapter 445 Seizures Flashcards

1
Q

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

A

Seizure

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2
Q

Highest incidence of seizures

A

Early childhood and late adulthood

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3
Q

Condition of recurrent seizures due to a chronic, underlying process

A

Epilepsy

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4
Q

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

A

Focal seizure

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5
Q

Seizure that engages both cerebral hemispheres

A

Generalized seizures

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6
Q

EEG pattern of focal seizure

A

Often normal may show epileptiform spikes or sharp waves

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7
Q

Repetitive flexionm extension movements

A

Clonic movements

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8
Q

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

A

Jacksonian March

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9
Q

Localized paresis in the area involved following a seizure

A

Todd’s paralysis

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10
Q

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

A

Epilepsia partialis continua

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11
Q

Subjective internal feelings not observed by someone else

A

Aura

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12
Q

Two types of focal seizures in terms of cognitive features

A
  1. Focal with dyscognative features

2. Focal without dyscognative features

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13
Q

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

A

Typical absence

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14
Q

Hallmark EEG of typical absence

A

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

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15
Q

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

A

Atypical absence

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16
Q

EEG pattern of atypical absence

A

Slow spike and wave pattern with frequency = 2.5

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17
Q

Most common seizure type resulting from metabolic derangement

A

GTC seizure

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18
Q

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

A

Postictal phase

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19
Q

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

Spike and wave pattern that is generalized

A

Tonic phase

Clonic phase

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20
Q

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

A

Atonic seizure

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21
Q

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

A

Myoclonic seizure

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22
Q

EMG pattern showing rhomboid pattern

A

Epileptic spasm

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23
Q

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

A

Juvenile myoclonic epilepsy

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24
Q

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

A

Lennox- Gastaut syndrome

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25
Q

most common syndrome associated with focal seizure with dyscognitive features.

A

Mesial temporal lobe epilepsy syndrome (MTLE)

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26
Q

Area of the brain that undergoes sclerosis in MTLE

A

Hipocampal area

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27
Q

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

A

45%

28
Q

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

A

epileptogenesis

29
Q

factors leading to a lowered seizure threshold

A

epileptogenic factors

30
Q

recurrent seizure occurs how many years after head trauma?

A

within one year

31
Q

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

A

embolic

32
Q

hallmark of established seizure

A

electrographic spike

33
Q

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

A

Penicillin

34
Q

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

A

Determining if the event was truly a seizure

35
Q

Indications to do lumbar puncture in patients who presented with seizure

A

suspicion of meningitis/ encephalitis

ALL HIV patients

36
Q

TRUE or FALSE

all patients who have a possible seizure disorder should be evaluated with an EEG ASAP

A

TRUE

37
Q

this finding establishes the epilepsy diagnosis:

A

presence of electrographic seizure activity during a clinically evident event

38
Q

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

A

TRUE

*except in children with unambiguous history and examination

39
Q

Preferred Imaging for patients with new onset seizures

A

MRI

40
Q

nonepileptic behaviors that resemble a seizure

A

psychogenic seizure

41
Q

serum indicator used to distinguish between organic and psychogenic type seizure

A

serum prolactin

expected to rise in seizures, best taken 30 minutes postictal

42
Q

overall goal of seizure treatment

A

complete prevention of seizure without any side effects

43
Q

when can antiepileptic drug therapy be started?

A

any patient with recurrent seizures of unknown etiology or a known cause that cannot be reversed

patients with identified lesion known to be epileptogenic

44
Q

risk factors for recurrent seizures

A
  1. abnormal neuro exam
  2. presents as status epilepticus
  3. Todd’s paralysis
  4. family history
  5. abnormal EEG
45
Q

First line treatment for GTC seizure

A

Lamotrigine, Valproic Acid

46
Q

First line for Focal seizures

A

Lamotrigine, Carbamazepine, Oxcarbazepine, Phenytois, Levetiracetam

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

47
Q

First line for Typical Absence

A

Valproic Acid, Ethosiximide, Lamotrigine

48
Q

First line for Atypical Absence, Myoclonic, Atonic

A

Valproic Acid, Lamotrigine, Topiramate

49
Q

Drug that can cause leukopenia, aplastic anemia, or hepatotoxicity

A

Carbamazepine

50
Q

Drug that can cause SJS

A

Lamotrigine

mnemonic Lamoktrigine or mosquito bite = SJS :)

51
Q

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

A

Phenytoin

52
Q

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

A

Topiramate

53
Q

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

A

Valproic Acid

54
Q

Profile of patients who remain seizure free after drug withdrawal

A
  1. complete medical control of seizures for 1-5 years
  2. single seizure type
  3. normal neurologic findings including intelligence
  4. normal EEG
55
Q

when does recurrence of seizure occur after drug withdrawal?

A

in the first 3 months after withdrawal

56
Q

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

A

Status Epilepticus

57
Q

duration of seizure activity used to define status epilepticus

A

15-30 minutes

58
Q

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

A

beyond 5 minutes

59
Q

Management of early or impending status epilepticus?

A

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
60
Q

Management of established GCSE early and refractory period

30 minutes to 48 hours

A
  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
61
Q

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

A

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

62
Q

Management of late refractory SE

>48 hours

A

Phenobarbital / thiopental

5mg/kg/1 mg/kg then drip to 1-5 mg/kg/hr

63
Q

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

A

Catamenial epilepsy

64
Q

Seizure frequency in pregnancy

A

50% unchanged
30% increase
20% decrease

65
Q

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

A

Cardiovascular and musculoskeletal

66
Q

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

A

1-4 mg/day

67
Q

Anticonvulsant known to decrease efficacy of oral contraceptives

A

Carbamazepine
Phenytoin
Phenobarbital
Topiramate

Chapter 445 Seizures (1 decks)

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