Epilepsy Dx and Tx-Clark Flashcards
Describe a focal seizure.
- Simple: Level of consciousness is unchanged during seizure
- Complex: less alert, impaired consciousness
- Starts at one spot in brain
- Can become generalized
Describe a generalized seizure.
- Entire brain affected
- Absence
- Myoclonic
- Atonic: slump to ground
- Clonic: rhythmic movements
- Tonic: stiffening
- Tonic-clonic: fall to ground then shake
Describe a febrile seizure.
- Usually benign and happens just once
- If complex more likely to recur or develop into epilepsy
What is Childhood Absence Epilepsy (CAE)?
- 3 hz spike wave on EEG
- Impaired consciousness w/o loss of muscle tone
- Often resolves in adolescence
What is Juvenile Myoclonic Epilepsy?
- Myoclonic jerks
- Does not resolve with age
What are generalized tonic-clonic seizures?
- Aka grand mal
- Can follow focal seizure
What is an aura?
- Ex: deja vu, fear, smell something funny
- It is a seizure and should be treated as a breakthrough seizure
What is Todd’s paralysis?
Post-ictal weakness following focal seizure (weakness, numbness, visual field defect, aphasia)
In focal seizures what direction does the pt’s eye field focus?
Direction opposite seizure
What is Jacksonian March?
- Focal seizure affecting motor strip
- Starts in hand and progresses upward into arm
What are post-traumatic seizures?
- Seizures after trauma
- If early higher risk of ICH
- If late, higher chance of post-traumatic epilepsy
People who have had 0 or 1 seizures are at a high risk for recurrence if:
- Remote symptomatic etiology
- Neurological exam abnormalities present
- 1st seizure occurred out of sleep
- Abnormal EEG
What are some causes of Breakthrough seizures?
- Missed doses of meds
- Alcohol
- Sleep loss
- Ilness
What are some teratogenic effects of seizure meds?
- Cardiac septal defects
- Nerve tube defects
- Cleft lip/palate
- Urogenital defects
- MIDLINE DEFECTS
What is eclampsia and its tx?
- HTN, proteinuria, seziure
- Tx: magnesium & deliver baby ASAP
What is Delerium Tremens (DT) and its tx?
- Withdrawal from chronic alcohol use
- Sx: tremor, agitation, insomnia, tachycardia, seizure
- Tx: Thiamine & benzos
What is Status Epilepticus?
- Seizure lasting > 30 minutes or 2 seizures w/o return to baseline in b/n
- Can look like any of the seizure types
- Sx: gaze preference, blinking, posturing
- No clear cause for decreased consciousness
Which etiologies of Status Epilepticus have the highest mortality rates?
Anoxia, hypoxia & acute stroke
If a pt comes in w/Status Epilepticus, should you paralyze them?
Generally not
What is the order of tx for Status Epilepticus?
- ABC
- Give Thamine, Dextrose & Diazepam (or Lorazepam)
- If still seizing, do therapeutic loading dose of AED (ex: Fosphenytoin)
- If still seizing, intubate & Phenobarbital
