Clinical Approach to Seizures and Syncope (Hon) Flashcards

1
Q

Epilepsy is generally defined as?

A

2 or more unprovoked seizures

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2
Q

What type of seizure is there a high likelihood (90%) that you will have positive findings for epilepsy on a single EEG?

A

Petit mal seizure (absent seizure)

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3
Q

What type and how many EEGs should be performed for positive findings for all types of epilepsy?

A

3 sleep-deprived EEGs

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4
Q

Although the EEG is an important tool in the diagnosis of epilepsy, what is the single most important information?

A

History of the event (preferably by witnesses)

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5
Q

How can seizures be classified?

A

1) Partial seizures

2) Generalized seizures

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6
Q

What happens in a partial seizure

What types of seizures fall under Partial Seizure?

A

Activity begins on one side of brain

Simple partial
Complex partial
Secondarily generalized (Partial onset)

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7
Q

What falls under Generalized Seizures

A
Absence (Petit mal)
Tonic-Clonic
Myoclonic
Tonic
Clonic
Atonic
Clonic-Tonic-Clonic
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8
Q

Adult onset seizures almost always come from what seizure classification?

A

Partial seizure

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9
Q

How is simple partial seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Focal motor or sensory activity
2) No loss of consciousness
3) Lasts seconds
4) No post-ictal state

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10
Q

How is complex partial seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Nonresponsive staring with possible preceding aura
2) Yes
3) 1-3 minutes
4) Yes

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11
Q

How is secondary generalized seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Bilateral tonic-clinic activity
2) Yes
3) 1-3 minutes
4) Yes

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12
Q

How are absence seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Nonresponsive staring, rapid blinking, chewing, and clonic hand motions
2) Yes
3) 10-30 seconds
4) No

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13
Q

How are tonic-clonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Bilateral extension followed by symmetrical jerking of extremities
2) Yes
3) 1-3 minutes
4) Yes

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14
Q

How are atonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Sudden loss of muscle tone, head drops, or patient collapses
2) Yes
3) Variable
4) Yes

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15
Q

How are myoclonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

A

1) Brief, rapid symmetrical jerking of extremities and/or torso
2) Yes
3) Few seconds
4) Minimal

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16
Q

What antiepileptic drug should be avoided in pregnant women because of its strong teratogenic effects?

What should be used instead?

A

1) Valproic acid

2) Levetiracetam

17
Q

What combination of AED’s has been shown to be synergistic in the treatment of epilepsy (especially for primary generalized seizures)?

A

Valproic acid and lamotrigine

18
Q

Ethosuximide is used for what type of seizure only?

A

Absence seizure

19
Q

Status Epilepticus is a condition characterized by?

A

Prolonged seizure (generally greater than 10 minutes) or repeated seizures without recovery in between

20
Q

In the treatment for status epilepticus, what should you give immediately to buy time before landing on a longer lasting AED?

A

Benzodiazepine

21
Q

In cases where a patient may only respond to one of the oral anticonvulsants (e.g. carbamazepine) what should be done?

A

Place a nasogastric tube

22
Q

What is a general principle in the treatment of patients with epilepsy?

A

Try to use monotherapy

23
Q

While all women of child-bearing age should be taking Folic acid, why is this particularly important in women with epilepsy?

A

AED’s are folate-depleting

24
Q

How can syncope present?

A

1) Pallor
2) Sweating
3) Abnormal head sensation
4) Lightheadedness
5) Slow onset
6) Brief unconsciousness

PB LASS

25
Q

Transient global amnesia is characterized as?

A

Sudden, temporary, isolated episode of loss of memory with no other neurologic symptoms