Lecture 8: Seizures/Syncope Flashcards
Epilespsy is generally defined as?
2 or more unprovoked seizures
What continues to be a problem worldwide for patients with epilepsy based on longstanding stigma?
Stricter laws when compared to?
- Unemployment and underemployment of these pt’s continues to be a problem
- Driving restrictions - in most states stricter laws for pt who has had a seizure when compared to persons w/ DUI convictions!
Which type of seizure is nearly always picked up (90%) as a positive finding on a single EEG?
Petit mal (with Hyperventilation)
How many sleep-deprived EEG’s are necessary for positive findings in 85% of all types of epilepsy?
3 sleep-deprived EEG’s
What is the single most important piece of information alongside EEG in the diagnosis of epilepsy? (this is going to be a test Q)
HISTORY of the event(s) - preferably by witness
Where does the seizure activity begin with Partial Seizures?
Activity begins on one side of the brain
What are 3 types of Parial Seizures and how does each manifest?
- Simple partial: pt is aware (conscious)
- Complex partial: pt loses consciousness
- Secondarily generalized (partial onset): symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions
What parts of the brain involved with generalized seiures?
Both sides of the brain
What are the 7 types of generalized seizures?
- Absence (petit mal)
- Tonic-clonic (grand mal)
- Myoclonic
- Tonic
- Clonic
- Atonic
- Clonic-tonic-clonic
What is the difference between a tonic and a clonic seizure?
- Tonic = Muscle stiffness, rigidity (think increased tone)
- Clonic = Repetitive, jerking movements
Which type of seizure is characterized by focal motor or sensory activity, no LOC, lasting only seconds and no post-ictal state?
Simple partial seizure
What are the characteristic of a complex partial seizure (i.e., signs/symptoms, time-line, consciousness post-ictal)?
- Nonresponsive staring, possible preceding aura
- Automatisms (action performed unconsciously or involuntarily)
- Loss of consciousness
- Last 1-3 mins
- Post-ictal state
What is a secondary generalized (partial onset) seizure (symptoms, consciousness, timeline, post-ictal)?
- Starts on one side of brain and then progresses to bilateral tonic-clonic activity
- Loss of consciousness
- Lasts 1-3 mins
- Post-ictal state
What is seen with an Absence (petit mal) seizure, how long does it last, how does the patient feel after?
- Nonresponsive staring, rapid blinking, chewing, clonic hand motions
- Loss of consciousness
- Lasts 10-30 sec
- No post-ictal state
*Abrupt onset and abrupt end
What is seen with a tonic-clonic seizure, how long does it last, and how does the patient feel afterwards?
- Bilateral extension followed by symmetrical jerking of extremities
- Loss of consciousness
- Lasts 1-3 mins
- Post-ictal state
What is seen with an Atonic seizure, duration, and how does patient feel after?
- Sudden loss of muscle tone –> head drops or patient collapses
- Loss of consciousness
- Variable duration
- Post-ictal state
What is seen with a Myoclonic Seizure, duration, and how does patient feel after?
- Brief, rapid symmetrical jerking of extremities and/or torso
- Loss of consciousness
- Lasts < few seconds
- Minimal post-ictal state
Which drug is used to treat Absence (petit mal) seizures, if this is the only type of seizure the person has experienced?
Ethosuxamide (absence only)
Which combination of AED’s has been shown to be synergistic in treatment of epilepsy (especially for primary generalized seizures)?
Valproic acid and Lamotrigine
What is Status Epilepticus?
Condition characterized by prolonged seizure (generally >10 minutes) or repeated seizures w/o recovery in between
What is the general treatment for Status Epilepticus?
- A, B, C’s; establish IV
- Try to gain history; seizure previously, allergies to seizure meds
- Labs: accucheck, CBC, chemistry panel, drug levels
- Non-contrast CT head
- Give benzodiazepine
What type of imaging should be taken with Status Epilepticus?
Non-contrast CT head
Which drug should be given for initial treatment of Status Epilepticus?
What is the purpose?
- Benzodiazepine (i.e., lorazepam 2-4 mg IV)
- This buys time, but must give longer lasting AED
What are 3 general principles/considerations in the treatment of patients with epilepsy?
- Try to use monotherapy
- Consider drug interactions, i.e., OC’s w/ carbamazepine
- Consider long-term side effects, i.e., bone loss with carbamazepine or phenytoin
All woman of child-bearing age with epilepsy should be on what?
Which drug should be avoided?
- Should be on a multivitamin w/ 1 mg Folic acid; many of the AED’s are folate-depleting
- Avoid valproic acid in pregnancy
What is the drug of choice for a woman with epilepsy?
Whichever drug BEST controls her seizures (no one size fits all)
What are common associated signs with Syncope?
- Pallor
- Sweating
- Abnormal head sensation
- Lightheadedness
- Positionally related
- Slow onset
- Brief unconsciousness
What are 4 common signs/symptoms seen with a seizure that are distinct from syncope?
- Urinary or bowel incontinence
- Tongue injury
- Tonic/clonic movements
- Post-ictal state
What is Transient Global Amnesia?
Typical patient presentation and how long do they episodes last?
Recurrence?
- Sudden, temporary, isolated episode of loss of memory (amnesia)
- No other neurologic symptoms or signs
- Patient knows self and close family friends, but may not recognize others
- Usually lasts a few hours, then resolves
- Usually doesn’t recur
