Diagnosis and Management of Epilepsy

Question 1

Define seizures

Answer 1

abnormal synchronous discharge of neurons in the cortex that produces stereotyped behaviours; usually self limited, lasting seconds to minutes

Question 2

Define Epilepsy

Answer 2

2 or more unprovoked seizures

Question 3

Define Postictal

Answer 3

Time after a seizure- seconds to hours

Characterized by disorientation and confusion

Question 4

Define Interictal

Answer 4

Time between seizures

Question 5

Define an Aura

Answer 5

A warning sign of an impeding seizure

Question 6

Define an EEG

Answer 6

Eelectroencephalograph: recording of gross electrical activity of the cortex via the scalp

Question 7

What are the types and subtypes of seizures?

Answer 7

Generalized
Partial: Simple or complex

Seizures can start partial and become generalized

Question 8

Does a generalized seizure have an aura?

Answer 8

No

Question 9

Does a partial seizure have an aura?

Answer 9

Yes both complex and simple

Question 10

Does a generalized seizure have an altered LOC?

Answer 10

Yes

Question 11

Does a partial seizure have an altered LOC?

Answer 11

Yes for complex, no for simple

Question 12

Does a generalized seizure show postictal confusion?

Answer 12

Yes (except absence)

Question 13

Does a partial seizure show postictal confusion?

Answer 13

No for simple, yes for complex

Question 14

What are the subtypes of a generalized seizure?

Answer 14

Tonic-clonic
Atonic
Myotonic (like twitching while falling asleep)
Absence (though to originate from thalamus)

Question 15

How does a complex partial seizure present?

Answer 15

Starts focally and becomes generalized

Question 16

What would a partial (focal) seizure that includes loss of awareness classify as?

Answer 16

Complex

Question 17

What are the features of an absence seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?

Answer 17

Pediatric
No aura
up to 100s/day
10-15 seconds
no change to tonic-clonic
no postictal confusion
generalized 3 Hz spies and waves
-ve CT/MRI
Ethosuximide

Question 18

What are the features of a complex partial seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?

Answer 18

Older patients
presents with aura
not very frequent
1-2 minutes
changes to tonic-clonic sometimes
presents with postictal confusion
focal epileptiform discharges
positive findings on CT/MRI
Various treatments

Question 19

Define the prevalence of epilepsy in terms of lifetime risk and male/female`

Answer 19

1% of population has epilepsy
5% life time risk
M=F
Risk starts high in life, decreases, then increases again at later age

Question 20

What are the primary and secondary causes of seizures?

Answer 20

Primary: idiopathic epilepsy
Secondary: Metabolic: nonadherence, Diabetic, EtOH withdrawal, Drugs,
Structural: Tumour, puss, bleeding, stroke

Question 21

Do subcortical strokes cause seizures?

Answer 21

No

Question 22

What do we look for in bloodwork to confirm seizures?

Answer 22

Na, Mg, Ca

Question 23

Is EEG helpful in diagnosing seizures?

Answer 23

Yes but
First EEG is 50% sensitive
Three EEG’s are 80% sensitive, one of which is done sleep deprived

Question 24

What are the ontario regulations in terms of driving for patients who present with a seizure?

Answer 24

Must be reported and instructed not to drive
Not able to drive for minimum 6 months
Ex. insulin induced seizure

Question 25

How do antiepileptic drugs work?

Answer 25

increase GABA; ex. benzodiazepines Decrease glutamate Alter ion channels (Na, Ca) Or combination of the above

Question 26

What is the process of managing AED? what is the success rate?

Answer 26

start with monotherapy, titrate up If sz or complications, switch to another monotherapy drug if sz try dual therapy using drugs with different mechanism of action 75% of patients will become seizure free With each failed medication, the chance of becoming seizure free becomes lower

Question 27

1 unprovoked seizure+ abnormal MRI, EEG, or physical. Treat?

Answer 27

Yes

Question 28

1 provoked seizure + reversible cause. Treat?

Answer 28

No

Question 29

1 provoked seizure +irreversible cause. Treat?

Answer 29

Yes

Question 30

2 unprovoked seizures. Treat?

Answer 30

Yes

Question 31

what are the first aid steps for a person seizing?

Answer 31

``` 1- cushion head, remove glasses 2- loosen tight clothing 3- turn to the side to keep airway open 4- time seizure 5- don't put anything in the mouth 6- don't restrain 7- offer help postictally 8- ask about diabetes ```

Question 32

Define status epilepticus

Answer 32

Ongoing seizure lasting >5 min repeated seizures without return to baseline in the inter-ictal period High morbidity and mortality

Question 33

How do you treat a patient with seizure lasting more than 2 min? (status epilepticus)

Answer 33

``` As for capillary glucose (most important) ask for monitors +IV access Attach O2 roll pt on the side if glc 2 give ativan+phenytion IV ```