Clincial Correlations With Seizures

Question 1

Which seizures are generalized?

Answer 1

Petit mal

Grand mal
- tonic-clonic movements widespread

Absence seizures
- small quick seizures that occur multiple times

Question 2

Which seizures are partial?

Answer 2

Simple
- partial (consolidated to one area) w/out altered mental status and/or loss of consiousness

Complex
- partial (consolidated to one area) w/ altered mental status and/or loss of consiousness

Question 3

What are examples of seizure mimics

Answer 3

Syncope

Cardiogenic causes
- orthostatic hypotension, cardiac arrhythmias

Neurogenic causes:
- movement disorders

Toxicologic causes
- overdose of pain meds, some medications in normal doses

Metabolic causes
- thyrotoxicosis, hyponatremia

Infections causes
- tetanus

Psychiatric causes
- pseudo-seizures, panic attacks, cataplexy

Question 4

What is the most common cause of new onset reactive seizure?

Answer 4

Hypoglycemia

Symptoms:

• sweating
• tachycardia
• anger
• seizures

Question 5

5 classic signs of a classic seizure (rule out pseudo seizure)

Answer 5

Abrupt onset

Brief duration
- (90-120 seconds)

Altered level of consciousness

Purposeless activity

Postictal state
- period where WPW of the brain occurs

Question 6

Treatment for emergency seizures

Answer 6

First-line = Benzos

• lorazapam is 1st line benzo. (longest half life) can also use Diazepam.
• maximize the dose first before adding new drugs

Second-line = General anti-epileptics
- usually phenytoin or levetiracetam are the 1st lines but this is more up to physician disgression

Third-line = (any of the following three)

• induce paralysis and put on intubation and EEG monitoring
• induce a coma via barbitals or propofol
• give midazolam high IV dose

Question 7

What are caveats for treating emergency seizures

Answer 7

must find out what the underlying cause (if any)

if status epileptics is present and the patient is on INH overdose, none of the lines of treatment will work unless the patient gets pyridoxine (vitamin B6)

if patient is on diuretic, must consider hyponatremia and other electrolyte causes

seizure with mass amounts of diarrhea = shigella toxin or hyponatremia most likely

if alcoholic, use high thiamine IV doses also to protect brain

Question 8

Generally, When should you get imaging for seizures and altered mental status?

Answer 8

Any trauma

Any persistent altered mental status

Any focal neurological exam findings are found

New onset seizure in a patient who has never had one

New onset seizure with a completely different pattern in a patient who has had seizures before

Patients with HIV (rule out HIV encephalopathy)

Question 9

Prolonged postictal state is indicative of what?

Answer 9

Possible nonconvulsive status epilepticus

Question 10

Todds paralysis

Answer 10

After a seizure, the patient retains focal hemiparasis somewhere (looks similar to strokes)

• unless there is a history of this, you have to assume its a stroke and work it up as such*

Question 11

When is it okay to not give anti-epileptic meds to a patient who has a seizure?

Answer 11

If it is a first time, isolated seizures

if its recurrent will need meds