Epilepsy

Question 1

Key feature of partial seizures?

Answer 1

NO loss of consciousness

Question 2

Features of a simple partial seizure?

Answer 2

Lesion is related to the cortical area involved

Patient remains conscious

No post-ictal confusion or memory loss

Question 3

Features of a complex partial seizure?

Answer 3

Impaired consciousness - awake, but inattentive, unresponsive, emotional changes, hallucinations, distortions of time/reality, automatisms (semipurposeful stereotyped gestures)

Unable to follow commands

No recollection; post-ictal period

Affects the medial temporal or hippocampal areas

Question 4

Features of absence seizures (non-convulsive primarily generalized seizure)

Answer 4

Brief impairment of consciousness

Starring spells, flurry of eye blinking

No post-ictal confusion or recall

EEG with generalized 3Hz spike-and-slow-wave discharge

Question 5

Features of generalized tonic-clonic seizures

Answer 5

Violent jerking of the limbs and body with loss of consciousness, falling to the ground, and frequent injury

Possible aura

Tonic phase: sudden stiffness from contraction of limb and trunk muscles which may cause the patient to fall and forcibly expel air

Apnea leads to a cyanotic, dusky face and consciousness is lost

Clonic phase: rhythmic, forceful, synchronous jerking of the libs and face, tongue biting or other oral trauma, and excessive salivation or drooling

During the post-ictal phase phase, breathing resumes at a rapid rate and bladder incontinence may be noted, sleepy, confused, amnestic

Question 6

Causes of primary generalized seizures?

Answer 6

Global, synchronous cortical discharge from diffuse cortical disinhibition; may be due to diffuse, permanent brain injury, as with anoxia, hereditary metabolic disorders, or congenital brain malformations

Transient metabolic disorders (drugs, alcoho, toxins, electroyte disturbances)

Question 7

Causes of secondarily generalized seizures?

Answer 7

Cortical discharge begins at a focus, the site of an acquired lesion -> head trauma, viral encephlaitis, stroke, tumor

Question 8

Rx epilepsy?

Answer 8

Anticonvulsants (enhance cortical inhibition)

• VPA
• Lamotrigine
• Benzos
• Ethosuximide (absence)

Secondarily generalized or partial seizures: phenytoin, carbamazepine, oxcarbazepine, gabapentin, pregabalin, levetiracetem, topiramate

Question 9

What is status epilepticus?

Answer 9

Continuous unabated seizures or a series of repeated seizures from which the patient does not recover for a period of 30 minutes or longer

Question 10

Rx status epilepticus?

Answer 10

Benzos (diazepam or lorazepam)

Lorazepam 0.1 mg/kg (4-8 mg) as an IV bolus
Repeat in 5-10 minutes if needed
Loading with either fosphenytoin 20 PE/kg IV, no faster than 150 mg/min OR phenytoin 20 mg/kg IV in saline no faster than 50 mg/min