Clinical Approach to Seizures and Syncope (Hon) Flashcards
Epilepsy is generally defined as?
2 or more unprovoked seizures
What type of seizure is there a high likelihood (90%) that you will have positive findings for epilepsy on a single EEG?
Petit mal seizure (absent seizure)
What type and how many EEGs should be performed for positive findings for all types of epilepsy?
3 sleep-deprived EEGs
Although the EEG is an important tool in the diagnosis of epilepsy, what is the single most important information?
History of the event (preferably by witnesses)
How can seizures be classified?
1) Partial seizures
2) Generalized seizures
Simple partial, complex partial, and secondarily
generalized all fall under what seizure classification?
Partial Seizures
Absence (Petit mal), tonic-clonic, myoclonic, tonic, clonic, atonic, and clonic-tonic-clonic all fall under what seizure classification?
Generalized seizures
Adult onset seizures almost always come from what seizure classification?
Partial seizure
How is simple partial seizure characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Focal motor or sensory activity
2) No loss of consciousness
3) Lasts seconds
4) No post-ictal state
How is complex partial seizure characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Nonresponsive staring with possible preceding aura
2) Yes
3) 1-3 minutes
4) Yes
How is secondary generalized seizure characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Bilateral tonic-clinic activity
2) Yes
3) 1-3 minutes
4) Yes
How are absence seizures characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Nonresponsive staring, rapid blinking, chewing, and clonic hand motions
2) Yes
3) 10-30 seconds
4) No
How are tonic-clonic seizures characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Bilateral extension followed by symmetrical jerking of extremities
2) Yes
3) 1-3 minutes
4) Yes
How are atonic seizures characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Sudden loss of muscle tone, head drops, or patient collapses
2) Yes
3) Variable
4) Yes
How are myoclonic seizures characterized?
Is there loss of consciousness?
How long does it last?
Is there a post-ictal state?
1) Brief, rapid symmetrical jerking of extremities and/or torso
2) Yes
3) Few seconds
4) Minimal
What antiepileptic drug should be avoided in pregnant women because of its strong teratogenic effects?
What should be used instead?
1) Valproic acid
2) Levetiracetam
What combination of AED’s has been shown to be synergistic in the treatment of epilepsy (especially for
primary generalized seizures)?
Valproic acid and lamotrigine
Ethosuximide is used for what type of seizure only?
Absence seizure
Status Epilepticus is a condition characterized by?
Prolonged seizure (generally greater than 10 minutes) or repeated seizures without recovery in between
In the treatment for status epilepticus, what should you give immediately to buy time before landing on a longer lasting AED?
Benzodiazepine
In cases where a patient may only respond to one of the oral anticonvulsants (e.g. carbamazepine) what should be done?
Place a nasogastric tube
What is a general principle in the treatment of patients with epilepsy?
Try to use monotherapy
While all women of child-bearing age should be taking Folic acid, why is this particularly important in women with epilepsy?
AED’s are folate-depleting
How can syncope present?
1) Pallor
2) Sweating
3) Abnormal head sensation
4) Lightheadedness
5) Slow onset
6) Brief unconsciousness
