Epilepsy 2

Question 1

epilepsy characterized by

Answer 1

recurrent spontaneous seizures not caused by fever, trauma, etoh

Question 2

diagnosis of epilepsy requires

Answer 2

at least 2 unprovoked seizures separated by at least 24 hrs

Question 3

epilepsy can be the result of

Answer 3

structural abnormality

genetic predisposition

Question 4

seizures classified by ___

partial seizures (simple vs complex)

Answer 4

how they start

partial = start in focal brain region 
generalized = start diffusely

simple partial = sensory or motor phenomena but no alterations of consciousness

complex partial = changes to consciousness

Question 5

seizures involve
jerking

staring and blinking

falling or dropping

shaking and stiffness

Answer 5

myoclonus

absence

atonic

tonic-clonic

Question 6

partial vs diffuse epilepsy

Answer 6

partial epilepsy = symptomatic, idiopathic or special syndromes (neonatal and febrile)

diffuse = symptomatic, idiopathic (genetic), or cyrptogenic

Question 7

intractable seizures define

Answer 7

don’t respond to trial of at least 3 anticonvulsants

approx 30% of new seizure = intractable

Question 8

define status epilepticus

more in children or adults?

can be what types

Answer 8

continuous clinical or EEG seizures for at least 30 min (includes serial seizures when consciousness not regained)

more in children

convulsive = tonic-clonic, myoclonic, tonic, or epilepsia partialis continua

non-convulsive = absence or atypical complex partial w/o motor

Question 9

in children most common cause of status epilpeticus

Answer 9

children = febrile or acute symptomatic seizure due to infection trauma or stroke

Question 10

in adult most common cause of status epilepticus

Answer 10

acute symptomatic = infection, trauma, seizures

Question 11

treatment for status epilepticus

within 5 min

btwn 6-10 min

10-20 min

21-40 min

more than 40 min

Answer 11

ABCs, secure IV access, ABG

within 5 min = lorazepam/diazepam

btwn 6-10 min = repeat benzo

10-20 min = phenytoin

21-40 min = phenobarb

more than 40 min = refractory = midazolam, propofol, valproic acid, keppra

Question 12

definition of febrile seizure

Answer 12

brought on by fever (can be without brain or cord infection or neuro cause)

not epilepsy

may have other febrile seizures but not epilepsy

Question 13

risk factors for febrile eizure

Answer 13

if first seizure before 12 months

fhx of febrile seizures

or if seizure @ temp below 102F

Question 14

define lennox gastaut symptom

Answer 14

intractable seizure disorder

pediatric epilepsy before age 4
multiple types = tonic, atonic, atypical absence, myoclonic

some degree of intellectual impairment, developmental delay, behavioral disturb

slow spike and wave

Question 15

lennox gastraut can be caused by

Answer 15

tuberous sclerosis
hypoxic ischemic injury
encephalitis
meningitis

infantile spasms

Question 16

treatment for lennox gastraut

Answer 16

multiple anti-epileptic meds

Question 17

describe alternatives for intractable seizure

Answer 17

1) ketogenic diet
2) vagal nerve stim
3) epilepsy surgery

Question 18

describe ketogenic diet

Answer 18

diet induces ketosis
ketones prevent seizures in tonic, atonic, atypical

more in children mostly fat

adverse = kidney stones, prolong QT, pancreatitis, immunosuppression

acute adverse = hunger, hypoglycemia, n/v, dehydration, acidosis

Question 19

describe vagal nerve stim

Answer 19

used in chornic intractable seizures

stim vagus nerve to stop seizures for pre-ictal aura

side effect = temporary change in voice, cough, SOB,

Question 20

describe epilepsy surgery

Answer 20

partial epilepsy
msut fail 3+ anti epileptic drugs

lesionectomy
lobectomy
corticoectomy
sub-pial transaction

Question 21

epilepsy surgery for atonic seizure

for catastrophic seizure

Answer 21

atonic use corpus callostomy

for catastrophic use multilobar or hemispherectomy