diagnosis and mgmt of epilepsy

Question 1

def of seizure

Answer 1

abnormal syncronous discharge of neurons in the cortex that produce sterotyped movements

Question 2

what is epilepsy

Answer 2

2 or more unprovoked seizures

Question 3

2 main seizure categories

Answer 3

1. generalized

2. partial (focal)

Question 4

2 main types of partials

Answer 4

simple - only in hand(or other) and otherwise fine

complex - changes in consciousness

Question 5

describe generalized in terms of aura, LOC, post-ictal confusions

Answer 5

aura - none
LOC - altered
confusion - yes

Question 6

describe complex partial in terms of aura, LOC, post-ictal confusions

Answer 6

aura - yes
LOC - altered
confusion - yes

Question 7

describe simple partial in terms of aura, LOC, post-ictal confusions

Answer 7

aura - yes
LOC - no
confusion - no

Question 8

4 types of generalized

Answer 8

1. tonic-clonic - the one we think of
2. atonic - full flaccid tone
3. myoclonic - irreg. jerky movement of limbs
4. absence - just zone out

Question 9

describe absence in terms of age, aura, freq, duration, change to tonic-clonic, confustion

Answer 9

age - young
aura - no
freq - 100s/day
duration -10-15 sec
tonic clonic change - never
confusion - none

Question 10

describe partial complex in terms of age, aura, freq, duration, change to tonic-clonic, confustion

Answer 10

age - adult
aura - sometimes
freq - infreq
duration -1-2min
tonic clonic change - sometimes
confusion - yes

Question 11

lifetime risk of epilepsy and seizure

Answer 11

epi - 1%

seizure 5%

Question 12

what is a primary cause of seizure

Answer 12

epilepsy

Question 13

2 types of secondary causes of seizure and their causes

Answer 13

1. structural - tumor, pus, blood, stroke

2. metabolic - non-adherance, hypoglycemia, EtOH withdrawl, drugs

Question 14

where must a seizure originate

Answer 14

cortex - subcortical is not a seizure

Question 15

what is sensitivity of EEG for detecting seizure

Answer 15

first EEG - 50%3

3 - 80%

Question 16

when would lumbar puncture be appropriate

Answer 16

only to rule out meningitis or encephalitis

Question 17

reporting of seizures?

Answer 17

must be reported no matter what

Question 18

6 safety precautions for seizure

Answer 18

1. no swimming alone
2. no worksites
3. no baths alone
4. no alc
5. medic alert

Question 19

what are main mechs of various seizure drugs

Answer 19

1. increase GABA - inhibitory
2. decrease glutamate - excitatory
3. alter ion channels
4. combinations

Question 20

3 ways one chooses seizure meds

Answer 20

1. type of seizure
2. side effects
3. patient factors

Question 21

what are chances of seizure cure as we add drugs

Answer 21

1st - 50%
2nd - 70%
3rd - 75%

Question 22

should one give drugs if one unprovoked seizure

Answer 22

if PT wants it

Question 23

what is status epilepticus

Answer 23

seizure over 5mins or repeated seizure with no return to baseline

Question 24

what to test for in stat epi

Answer 24

capillary glucose

Question 25

what to give for stat epi

Answer 25

if glucose 2 - ativan + phenytoin