Clin: Seizures/Syncope Flashcards
Which drug should be given for initial treatment of Status Epilepticus?
What is the purpose?
- Benzodiazepine (i.e., lorazepam 2-4 mg IV)
- This buys time, but must give longer lasting AED
What is the single most important piece of information alongside EEG in the diagnosis of epilepsy? (this is going to be a test Q)
HISTORY of the event(s) - preferably by witness
What is seen with a tonic-clonic seizure, how long does it last, and how does the patient feel afterwards?
- Bilateral extension followed by symmetrical jerking of extremities
- Loss of consciousness
- Lasts 1-3 mins
- Post-ictal state
What is seen with a Myoclonic Seizure, duration, and how does patient feel after?
- Brief, rapid symmetrical jerking of extremities and/or torso
- Loss of consciousness
- Lasts < few seconds
- Minimal post-ictal state
Which drug is used to treat Absence (petit mal) seizures, if this is the only type of seizure the person has experienced?
Ethosuxamide (absence only)
What continues to be a problem worldwide for patients with epilepsy based on longstanding stigma?
Stricter laws when compared to?
- Unemployment and underemployment of these pt’s continues to be a problem
- Driving restrictions - in most states stricter laws for pt who has had a seizure when compared to persons w/ DUI convictions!
Epilespsy is generally defined as?
2 or more unprovoked seizures
What is the general treatment for Status Epilepticus?
- A, B, C’s; establish IV
- Try to gain history; seizure previously, allergies to seizure meds
- Labs: accucheck, CBC, chemistry panel, drug levels
- Non-contrast CT head
- Give benzodiazepine
What is Transient Global Amnesia?
Typical patient presentation and how long do they episodes last?
Recurrence?
- Sudden, temporary, isolated episode of loss of memory (amnesia)
- No other neurologic symptoms or signs
- Patient knows self and close family friends, but may not recognize others
- Usually lasts a few hours, then resolves
- Usually doesn’t recur
What is seen with an Atonic seizure, duration, and how does patient feel after?
- Sudden loss of muscle tone –> head drops or patient collapses
- Loss of consciousness
- Variable duration
- Post-ictal state
Which type of seizure is nearly always picked up (90%) as a positive finding on a single EEG?
Petit mal (with Hyperventilation)
Which type of seizure is characterized by focal motor or sensory activity, no LOC, lasting only seconds and no post-ictal state?
Simple partial seizure
What is a secondary generalized (partial onset) seizure (symptoms, consciousness, timeline, post-ictal)?
- Starts on one side of brain and then progresses to bilateral tonic-clonic activity
- Loss of consciousness
- Lasts 1-3 mins
- Post-ictal state
What are 3 general principles/considerations in the treatment of patients with epilepsy?
- Try to use monotherapy
- Consider drug interactions, i.e., OC’s w/ carbamazepine
- Consider long-term side effects, i.e., bone loss with carbamazepine or phenytoin
What are 3 types of Parial Seizures and how does each manifest?
- Simple partial: pt is aware (conscious)
- Complex partial: pt loses consciousness
- Secondarily generalized (partial onset): symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions
