Diagnosis And Treatment

Question 1

When is a head CT or MRI needed in seizures

Answer 1

Focal Neurologic s/s and focal seizures
Abnormal EEG
Progressive disorder
New onset seizures <20 y/o

Question 2

What does an EEG provide in regards to seizure diagnosis

Answer 2

Determines epilepsy
Paroxysmal abnormalities with spikes or sharp waves
Guide prognosis
Classify seizure

Question 3

What lab tests are useful for seizures

Answer 3

CBC
CMP
LP

Question 4

What is the first line pharmacological treatment in seizures

Answer 4

Keppra 1g then Keppra 500mg BID
Ativan for breakthrough

Question 5

What are the four surgery options for seizures

Answer 5

Laser interstitial thermal therapy
Deep brain stimulation
Responsive cortical stimulation
Vagus nerve stimulation

Question 6

Describe the initial management of status epilepticus

Answer 6

Secure airway
D50 IV in case of hypoglycemia
Ativan 4mg 2 doses 10mins apart PRN
Versed or Valium can be used instead of Ativan
Fosphenyoin or Phenytoin
If persistent use phenobarbital (will need to be intubated)