Convulsions

Question 1

Definitions

Answer 1

Convulsion

Seizure

Question 2

Types of seizures

Answer 2

Epilepsy
Acute symptomatic / provoked seizure
Status epilepticus

Question 3

Focal seizure - 2 categories

Answer 3

Focal with intact awareness (simple partial)

Focal with impaired awareness (complex partial)

Question 4

Simple partial seizures

Answer 4

Motor
Sensory
Autonomic
Psychiatric

Question 5

Complex partial seizures

Answer 5

Classic complex seizure

Other forms

Question 6

Generalized seizures - 6 main types

Answer 6

Abscence (petit mal) 
Tonic
Clonic
Tonic-clonic (grand mal) 
Myoclonic 
Atonic

Question 7

Grand mal seizure

Answer 7

May have prodrome
Loss of consciousness, patient falls
Tonic ictal phase
Clonic ictal phase
Post-ictal phase

Question 8

Generalized seizures commonly occuring in infants:

Answer 8

Tonic
Clonic
Atonic

Question 9

Febrile seizure

Answer 9

Rapid temp. increase >39  
14 - 18 month old most common age
Positive family history
Typical vs atypical presentation
Tx: antipyretics, NOT anticonvulsants

Question 10

Neonates most common seizure cause

Answer 10

Provoked seizures! ;
Neonatal encephalopathy
CNS or systemic infection
Metabolic disturbance

Question 11

Infants, children - most common cause of seizures

Answer 11

Febrile seizures

Question 12

Seizure history

Answer 12

SOCRATES;
Before seizure - any prodrome, triggers
Description of the seizure(s)
Any post-ictal state 
History, physical exam, labs, imaging for cause of a provoked seizure 
EEG

Question 13

Seizure inital management

Answer 13

Provoked seizure - treat underlying cause

Unprovoked - 1st seizure observation for recurrence

Question 14

1st unprovoked seizure - increased risks for recurrence:

Answer 14

Abnormal EEG
Prior neurological insult
Significant MRI findings

Question 15

Focal epilepsy pharmacotherapy

Answer 15

Carbamazepine

Oxcarbazepine

Question 16

Generalized epilepsy pharmacotherapy

Answer 16

Valproate
Lamotrigine
Ethosuximide

Question 17

Infantile spasms - specific Tx

Answer 17

ACTH

Question 18

Childhood absence seizures specific Tx

Answer 18

Valproate

Ethosuximide

Question 19

Juvenile myoclonic epilepsy specific Tx

Answer 19

Valproate

Question 20

Side effects all antiepileptics

Answer 20

Drowsiness
Dizziness
Diplopia
Loss of balance

Question 21

Valproate dose dependent side effects

Answer 21

Thrombocytopenia

Teratogenic

Question 22

Drug dosing

Answer 22

Start low - increase gradually

Increase until 1) seizure stop, 2) SE unbearable or 3) serum levels reach therapeutic range

Question 23

Stopping drugs

Answer 23

Should be done after 2 years no seizures
Taper off slowly
Recurrence of seizures 30-40%

Question 24

Causes of provoked / acute symptomatic seizure

Answer 24

Hyponatremia
Hypocalcemia
Fever
Toxin
Intracranial bleeding
Intracrania infection - meningitis, etc..

Question 25

Epilepsy definition

Answer 25

2+ unprovoked seizures occuring >24h apart OR

1 unproked seizure and a probability of further seizures over the next 10 years

Question 26

Partial seizure commonly occuring in infants:

Answer 26

Simple partial - motor type

Specifically ‘versive seizure’ - deviation of the eyes + ipsilateral deviation of the head and turning of the trunk

Question 27

Infantile spasms (West syndrome)

Answer 27

Very specific type of seizure - 2 types of spasm. Occur in clusters.