Epilepsy

Question 1

What is a seizure?

Answer 1

Abnormal electrical discharge of the brain

Question 2

How do you classify seizures?

Answer 2

Generalized: multiple areas of brain
-Gran mal - LOC with clonic/tonic actiivty
-Petit Mal - transient lapse of consiciousness
Partial (Focal): one specific area of the brain
-Complex partial - impairment but no LOC
-Simple partial - minor impairment but no LOC

Question 3

What can cause seizures?

Answer 3

A - alcohol
B - brain tumor
C - ?
D - drugs and degenerative disorders
E - electrolytes

Question 4

What are common meds for seizure patients?

Answer 4

Phenytoin aka "Dilantin
-Stabilize Na+ channels
-Causes blood dyscrasias so get CBC and LFTs
Keppra aka "Levitiracetem
-Inhibits Ca++ channels
-Produces somnolence
Valproic Acid aka "Depakote"
-Works on both Na+ and Ca++ channels
-Produces thrombocytopenia an GI symptoms
Topiramate aka "Topamax)
-GABA, Na, Ca++ channels
-Used for migraines also
Tegretol, "Carbamazepine"
-Produces n/v/ and somnolence
-Works on Na+ channels

Question 5

How do you manage a seizure in your office?

Answer 5

-ABC’s (call 911 if new onsent or nonresponsive to normal tx)
-Open/secure airway if needed
-Benzos, Ativan 2mg IV
…doesn’t break
-Repeat dose of Ativan
-Check sugars and electrolytes
-Thiamine 100mg
-AMP of D50 or electrolytes if deficient from labs
-Dilantin 10mg/Kg IV
-Prop or barbituate drip

Question 6

What are anesthetic treatment plan modifications for epileptic patient?

Answer 6

• Continue meds
• Use benzos
• Get a CBC as some meds cause bone marrow suppression
• Avoid ketamine as it is elliptogenic
• Be aware of any hepatically metabolized meds you use as their effected could be prolonged due to use of anti-epilleptic drugs