Epilepsy Flashcards
what is the etiology of most epilepsy?
unknown
what is the most common location of focal epilepsy?
temporal lobe epilepsy
tumors/lesions that are present throughout the body that are recurrent and will be replaced if removed
tuberous sclerosis (TS)
limited to one side of the cerebral hemisphere or one area, and the patient is aware of the seizure
focal epilepsy
what is the most common type of epilepsy?
focal epilepsy
distributed on both hemispheres of the brain
generalized epilepsy
stage of seizure that is a warning, hours to days, and is not part of the seizure
prodrome
stage of seizure that is within seconds to minutes, part of the seizure, and can show EEG changes
aura
period after the seizure when the patient has headaches, disorientation, confusions, and tiredness
post-ictal
what are 4 DDx of focal seizures?
TIAs
migraine auras
rage/anger attacks
panic attacks
what are 3 DDx of generalized seizures?
syncope
drug/alcohol withdrawal
psychogenic non-epileptic spells (PNES)
resembles seizures but is extremely prolonged, asynchronous thrashing of limbs that worsens with restraints, shouting and cussing, and occurs without prodrome, aura, or post-ictal
psychogenic non-epileptic spells (PNES)
what is the diagnostic for psychogenic non-epileptic spells (PNES)?
video EEG monitoring
what is the treatment for psychogenic non-epileptic spells (PNES)?
CBT
adjustment to antiepileptic drugs
what is the gold standard diagnostic for epilepsy?
EEG - shows the electrical activity of the brain
what imaging can be used in a patient with epilepsy and history of trauma?
CT head
what is the diagnostic imaging of choice for epilepsy?
3T MRI
focal epilepsy that lasts 1-2 mins, no aura, +/- post-ictal
complex partial
what is a focal epilepsy in which awareness is maintained?
simple partial
what is a focal epilepsy in which the patient has impaired awareness?
complex partial
non-purposeful, inappropriate, repetitive movements or behaviors
automatism
epilepsy that originated on one side of the brain and spreads to the other side
focal to bilateral tonic-clonic seizure
in generalized epilepsy, the patient has complete loss of what?
awareness/consciousness
generalized non motor seizure that is staring spells for few seconds, no aura, patient is unaware of seizure, and has immediate recovery
typical absence (petit mal)
what is the classical EEG finding in typical absence seizure (generalized)?
3 Hz spike and wave
what triggers generalized, non motor (typical absence/petit mal)?
hyperventilation
tonic phase of 1 min + clonic phase for 2-3 mins that is a generalized motor epilepsy
tonic-clonic seizures
in which type of seizure does post-ictal (slow return of awareness and consciousness with soreness and sleep) return?
tonic-clonic seizures
when should treatment be initiated?
after 2 or more unprovoked seizures
what is the most common cause of drug failure?
wrong diagnosis leading to wrong drug
when is epilepsy considered medically refractory and must be referred to surgery?
if patient fails 2 correct drugs
what are the first line drugs for focal seizures? (3)
Carbamazepine
Oxacarbazepine
Lamotrigine
what are the 1st line drugs for generalized seizures? (3)
Valproate-Depakote
Lacosamide
Levetiracetam
what is the 1st line drug for absence seizures?
ethosuximide
what are 4 drugs used in pregnancy?
Carbamazepine
Oxcarbazepine
Lamotrigine
Levetiracetam
what should all pregnant women with epilepsy do? (2)
take folic acid
register with epileptic foundation
what drug should be avoided in pregnancy?
valproate
what is the most common cause of status epilepticus?
non-compliance
when can AEDs be d/c? (2)
seizure free
patient has normal EEG + MRI
what treatment is recommended for refractory focal seizures?
brain surgery
seizure lasting over 5 mins OR repeated seizures over 30 mins OR recurrent seizures so close together that the person cannot recover
convulsive status epilepticus
what is the treatment for convulsive status epilepticus?
IV lorazepam/ativan
electrical shutdown of the brain resulting in changes in heart function and breathing; is linked to generalized tonic-clonic seizures
sudden unexpected death in epilepsy (SUDEP)
what is the treatment for SUDEP?
like status epilepticus (IV lorazepam/ativan)
what is the treatment for alcohol/withdrawal seizures?
diazepam or lorazepam
