Epilepsy and Seizures

Question 1

why should you be careful when infusing phenytoin?

Answer 1

rapid infusion of phenytoin may produce cardiac arrhythmia or hypotension

Question 2

after a pt presents with what sounds like a seizure what is your next step in management?

Answer 2

after clinical diagnosis you should do MRI to look for underlying etiology. an EEG would not be the best first choice

Question 3

when is pt at greatest risk for alcohol withdrawal seizure?

Answer 3

within the first day

delirium tremens in 2-4 days

Question 4

What is Lennox-Gastaut and what do you see on EEG?

Answer 4

juvenile syndrome with mental retardation and multiple seizure types.

will see 1-2 Hz spike-wave on EEG

Question 5

what is West Syndrome

Answer 5

infantile spasms: paroxysmal flexions of the body, waist, or neck and usually have a profoundly disorganized EEG pattern called hypsarrhythmia

Question 6

loss of language and abnormal EEG during sleep makes you think what syndrome?

Answer 6

Landau-Fleffner

Question 7

Would you say Juvenile myoclonic epilepsy is very serious or relatively benign?

Answer 7

relatively benign. onset late adolescence to early adulthood

Question 8

which seizures are associated with aura?

Answer 8

complex-partial

Question 9

what would you give in setting of head trauma for prophylactic seizure prevention?

Answer 9

phenytoin to prevent early posttraumatic seizure

Question 10

mesial temporal sclerosis is associated with what symptoms? How would you treat it?

Answer 10

Most common cause of intractable complex-partial seizures in adults

medication and surgical resection - results in seizure free in 80% of cases

Question 11

What do you see with jacksonian march?

Answer 11

sequential seizure, pt develops focal seizure that is primarily motor that then spreads.

pt may lose consciousness as it secondarily generalizes into tonic clonic

hand is common start site as it mouth (close on homunculus)

Question 12

which seizure can be mistaken for a psych problem?

Answer 12

complex-partial

sometimes no motor/tonic clonic aspect

typically start with aura of unpleasant smell or taste

Question 13

define status epilepticus

Answer 13

seizure that lasts continuously for 30 minutes or series of seizures over a 30 min period without regain full consciousness between

Question 14

what is epilepsia partialis continua?

Answer 14

basically focal motor status epilepticus. usually hand/foot, can last hours to months

Question 15

given the following choices which would you choose as first line for young female with complex partial’s and why?:

• felbamate
• phenobarbital
• primidone
• divalproex sodium
• levetiracetam

Answer 15

Levatiracetam (keppra) because has good efficacy with lowest side effect profile

Question 16

What medication would you choose to treat infantile spasms?

Answer 16

ACTH containing med has good efficacy in treating infantile spasms (like those in west syndrome)

Question 17

If a child cannot tolerate ethosuxamide for absence seizures (usually GI upset) what would be your next choice for treatment?

Answer 17

Divalproex sodium

especially if the absence seizures are associated with generalized tonic clonic then DS is a better choice