Epilepsy and Seizures Flashcards
EEG character of absence
3-Hz spike-and-wave
Likely nothing on MRI
Symptomatic generalized epilepsy EEG findings
1-2 Hz
What is the Conners Rating Scale
used for evaluation of inattention and hyperactivity (ADHD) given to parents at home and teachers at school
Seizure triggers (5)
bright flashing lights lack of sleep hyperventilation psychological stress *missing AEDs*
Advantage of Lorazepam (as opposed to other benzos) for status epilepticus
rapid acting, cleared more slowly from brain, less fat-soluble
Which AED can cause cardiac arrhythmia
phenytoin, if given at >50 mg/min in adults or 1 mg/kg/min in children
Strategies to decrease side effects of rapid phenytoin infusion
use Fosphenytoin (water-soluble prodrug of phenytoin that cause fewer infusion site rxns) but can give up to 150 mg/min in adults.
- can be intramuscular
Adverse effects of IV phenobarbital
hypotension and respiratory arrest
Adverse effects of diazepam and clonazepam (in high doses)
hypotension & autonomic depression
First step in workup of simple partial seizure in middle-aged adult
Rule out brain lesion (CT & preferably MRI)
Peak time period for alcohol withdrawal seizures
1-2 days after drinking cessation
Peak time period for delirium tremens
2-4 days after drinking cessation
Lennox-Gastaut EEG characteristics
Generalized 1-2 Hz spike-wave discharges
People with Lennox-Gastaut usually has what history?
Infantile spasms
Presentation of Infantile spasms
paroxysmal flexions of body, waist or neck and have disorganized EEG pattern called hypsarrhythmia
Name the seizure: “hypsarrhythmia” on EEG
infantile spasms
Name the seizure: 3 Hz spike-and-wave
absence
Name the seizure: bi/triphasic sharp wave complexes
CJD
kiddo with onset of episodes of loss of body tone, associated falls, generalized tonic-clonic seizures, deterioration of cognitive function
What does s/he have?
Lennox-Gastaut
Landau-Kleffner syndrome
loss of language function & abnl EEG during sleep
Juvenile Myoclonic Epilepsy
onset late adolescence/early adulthood, benign
Presentation of febrile seizures
generalized tonic-clonic seizures associated with fever in child who is otherwise healthy
Where is the lesion in pts with seizures preceded with aura of olfactory hallucination
Mesial temporal lobe, particularly HIPPOCAMPUS and parahippocampal gyrus
Mesial temporal sclerosis is associated with
(also known as hippocampal sclerosis), associated with intractable temporal lobe epilepsy
Purpose of AED use post head trauma
reduce incidence of EARLY posttraumatic seizures, which reduces morbidity and prolonged hospital stays
Preferred AED for posttraumatic seizure ppx
phenytoin
Most common complication of temporal lobectomy and whats the mechanism.
visual field defect from interruption of fibers from optic tracts passing over temporal horn of lateral ventricles
Superior quadrantanopsia
Management of MTS
neurosurgery; resection of right anterior temporal lobe (80% effective)
Jacksonian march presentation
(also known as sequential seizure)
starts as focal seizure activity (commonly in hand) primarily motor and spreads (commonly to face because thumb and mouth are near each other on the motor strip of cerebral cortex), secondarily generalizes, then pt lose consciousness and have generalized tonic-clonic seizures
Benign Juvenile myoclonic epilepsy presentation
happens upon waking up, can be triggered by light flashes or loud sounds.
sleep myoclonus
happens upon falling asleep…duh
Complex-partial seizure presentation
could look like a psychiatric problem, have altered consciousness, but they don’t have any memory of abnormal behavior and can have auras
uncinate fits
abnormal activity in the uncus of ttemporal lobe
Status epilepticus lasts >_____minutes
> 30 minutes
Complications of status epilepticus
respiratory failure, aspiration, acidosis, hypotension, rhabdo, renal failure, cognitive impairment
Epilepsia partialis continua
persistent focal motor seizure activity (most commonly distal hand and foot muscles)
Tx for epilepsia partialis continua
felbamate
Tx of complex-partial seizure
levetiracetam
Tx of seizure associated with West syndrome
ACTH
West syndrome
generalized seizure disorder of infants w/ recurrent spasms, EEG pattern of hypsarrhythmia, mental retardation.
associated with tuberous sclerosis.
Genaralized absence tx
(if non generalized: ethosuxamide)
in this case: divalproex sodium (valproic acid)
Tx for prevention of seizures in preggos with pre-eclampsia or established eclampsia
MgSo4 (4-5 g IV load dose followed by 1g/h IV infusion)
Example of reversible posterior leukoencephalopathy syndrome
eclampsia