epilepsy Flashcards
def. epileptic seizure
- transient occurance of signs and Sx
- due to abnormal excessive syncronous neuronal brain activity
def.epilepsy
- disorder of the brain with an enduring predisposition to seizures
- patient has had at least one seizure
def. focal seizure
originating within networks limited to one hemisphere
- can be discretely localized or more widely distributed
def. generalized seizures
originating at some point in the brain and rapidly engaging bilaterally distributed networks
*** 3 types of focal seizures
- no impairment of consciousness
- simple partial
- subjective Sx only, or observable motor features only - with impairment of consciousness or awarness
- complex partial - eveolving to bilateral convulsive seizure
- secondary generalized
6 types of generalized
- tonic-clonic
- abscence
- clonic - full body
- tonic - seize up
- atonic
- myoclonic - very short
what does 3Hz spike and slow wave indicate
absence epilepsy
DDx for a “spell” (7)
- seizure
- cardiac
- migraine
- stroke/TIA
- decerebration
- movement disorder
- psychogenic non-epileptic event
3 patient Hx questions
- warning with siezure
- preciptating factors
- health at seizure onset
what to ask for to see if there is a previous seizure
many PTs unaware
- positive phenomenology
- flashin lights
- aura
- post-ictal confusion
- tonguq biting
- bed wetting
5 possible predisposing factors
- birth insult
- febrile seizures
- meningitis
- traumatic brain injury
- fam Hx of epi
why is close questioning important
50% of “1st” seizures will have had one before
what are acute precipitants
- drugs
- withdrawal
- metabolic
- meninggitis
- brain abscess
- vascular
5 investigations
- general and neuro exam
- labs
- EKG - long QT, brugada
- EEG
- neuroimaging
why EEG? 2
- helps diagnose - tells if consistent with Sx
2. help prognosticate - if +ve, 50% chance risk of seizure in next 5 years
what is sens of interictal epiletiform changes
intial EEG - seen in 20-55%
repeat - seen in 80-90%
negative EEg doesn’t rule out
use of imaging
- significant problem in 10%
- should always do unless known primary epilepsy
5 predictors of recurrent sizure
- epiletiform on EEg
- know etiology is symptomatic
- post-ictal todd’s paralysis
- prior seizure
- multiple seizure in first 24 hours NOT predictove
what to be cautious about with meds
triggering a seizure
what are cautions for GTC, partial, myclonic, absence, atonic/clonic
GTC - ETX
partial - ETX
myclonic - ETX, PHT, CBZ, OXC, LTG
absence - PHT, CBZ, OXC
what are good drug for fast dosing
- pheytoin
- valproate
- gabapentin
- levetircetem
what is phenytoin use for
emerg. and maintance
AE of phenytoin
CNS - mystagmus, cognition, encephalopathy, movement disorders
GI - give with meals
chronic - cerebellar, peripheral neuopathy, cosmetic
when to use and not use carbemazepine
good - partial onset, generalized tonic/clonic
bad - JME
