diagnosis and mgmt of epilepsy Flashcards
def of seizure
abnormal syncronous discharge of neurons in the cortex that produce sterotyped movements
what is epilepsy
2 or more unprovoked seizures
2 main seizure categories
- generalized
2. partial (focal)
2 main types of partials
simple - only in hand(or other) and otherwise fine
complex - changes in consciousness
describe generalized in terms of aura, LOC, post-ictal confusions
aura - none
LOC - altered
confusion - yes
describe complex partial in terms of aura, LOC, post-ictal confusions
aura - yes
LOC - altered
confusion - yes
describe simple partial in terms of aura, LOC, post-ictal confusions
aura - yes
LOC - no
confusion - no
4 types of generalized
- tonic-clonic - the one we think of
- atonic - full flaccid tone
- myoclonic - irreg. jerky movement of limbs
- absence - just zone out
describe absence in terms of age, aura, freq, duration, change to tonic-clonic, confustion
age - young aura - no freq - 100s/day duration -10-15 sec tonic clonic change - never confusion - none
describe partial complex in terms of age, aura, freq, duration, change to tonic-clonic, confustion
age - adult aura - sometimes freq - infreq duration -1-2min tonic clonic change - sometimes confusion - yes
lifetime risk of epilepsy and seizure
epi - 1%
seizure 5%
what is a primary cause of seizure
epilepsy
2 types of secondary causes of seizure and their causes
- structural - tumor, pus, blood, stroke
2. metabolic - non-adherance, hypoglycemia, EtOH withdrawl, drugs
where must a seizure originate
cortex - subcortical is not a seizure
what is sensitivity of EEG for detecting seizure
first EEG - 50%3
3 - 80%
when would lumbar puncture be appropriate
only to rule out meningitis or encephalitis
reporting of seizures?
must be reported no matter what
6 safety precautions for seizure
- no swimming alone
- no worksites
- no baths alone
- no alc
- medic alert
what are main mechs of various seizure drugs
- increase GABA - inhibitory
- decrease glutamate - excitatory
- alter ion channels
- combinations
3 ways one chooses seizure meds
- type of seizure
- side effects
- patient factors
what are chances of seizure cure as we add drugs
1st - 50%
2nd - 70%
3rd - 75%
should one give drugs if one unprovoked seizure
if PT wants it
what is status epilepticus
seizure over 5mins or repeated seizure with no return to baseline
what to test for in stat epi
capillary glucose
what to give for stat epi
if glucose 2 - ativan + phenytoin
