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Clin Med B 2 > Lecture 9: Seizure Disorders > Flashcards

Lecture 9: Seizure Disorders Flashcards

1
Q

What is required to diagnose a seizure disorder?

A

At least 2 unprovoked/natural seizures.

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2
Q

What is a non-epileptic seizure?

A

Provoked seizure, such as via fever.

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3
Q

What are the high-risk features that increase seizure recurrence after an unprovoked seizure?

A
  1. Epileptiform abnormality on EEG
  2. Remote symptomatic cause
  3. Abnormal neurologic examination
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4
Q

What are the primary risk factors for epilepsy?

A
  • Age (esp >60)
  • Brain infections/tumors
  • Dementia
  • Family history
  • Vascular disease
  • Hypoxic brain injury
  • Cerebral edema
  • Caucasians
  • metabolic disorders
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5
Q

What are the precipitating factors that may induce seizure?

A
  • Fatigue
  • Decreased physical health
  • Alcohol ingestion
  • Emotional stress
  • Flashing lights
  • Menstrual cycle
  • HYpoyglycemia
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6
Q

Withdrawal from what medication class might provoke a seizure?

A

BZD withdrawal

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7
Q

What are the 4 stages of a seizure?

A
  1. Prodromal (sometimes)
  2. Pre-ictal/aura (technically phase 1 of a seizure)
  3. Ictal (What people witness)
  4. Post-ictal
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8
Q

What is the aura/pre-ictal part of a seizure?

A

A focal onset seizure

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9
Q

What is jamais vu?

A

Memory disorder that something familiar is being encountered for the first time

Opposite of deja vu

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10
Q

What typically characterizes a post-ictal phase?

A
  • Confusion
  • Agitation
  • LOC
  • Unresponsiveness

also experience numbness, HA, fatigue, focal weakness, stupor, b/b loss

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11
Q

What are the two types of seizures?

A
  1. Focal onset
  2. Generalized onset
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12
Q

What are the two primary types of focal onset seizures?

A
  • With retained awareness (NO LOC, NO MEMORY LOSS)
  • Impaired awareness (ALOC)
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13
Q

What is the only generalized seizure that does not involve a LOC?

A

Myoclonic seizures

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14
Q

What generally does not precipitate a generalized seizure?

A

Aura

They don’t know its coming

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15
Q

What is the only non-motor onset generalized seizure?

A

Absence seizure (staring spells, lip smacking)

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16
Q

What characterizes an absence seizure?

A
  • Abrupt onset and offset.
  • Lip smacking, staring
  • MC in children
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17
Q

What might make us consider that an absence seizure is a focal seizure instead?

A

If it is longer than 45s or if there is a post ictal phase

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18
Q

What characterizes a myoclonic seizure?

A
  • Sudden/myoclonic jerks of movement for >30mins
  • Partial awareness
  • Can occur upon waking or prior to falling asleep
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19
Q

What is benign myoclonus of infancy and what makes it unique from a myoclonic seizure?

A
  • Normal EEG
  • No delay of neurologic development
  • Often occurs prior to age 1 and is self-limiting
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20
Q

What characterizes atonic seizures/drop attacks?

A
  • Sudden loss of muscle control for < 2s
  • Often associated with intellectual impairment
  • Patient is usually unaware.
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21
Q

What characterizes tonic seizures?

A
  • Tightening and stiffening of muscles
  • People often fall due to the rigidity
  • Usually associated with intellectual impairment

Tonic = tightening

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22
Q

What characterizes clonic seizures?

A
  • Bilateral, jerking movements (rhythmic jerking)
  • ALOC

Clonic is consistent jerking

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23
Q

What characterizres a tonic clonic seizure?

A
  • LOC, violent shaking, and body siffening
  • Bilateral, symmetrical generalized motor involvement
  • Foaming of the mouth, loss of b/b, tongue biting
  • canlast up to 20 min, post ictal phase is 10-30 min

The classic seizure we see on TV

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24
Q

When are most cases of infantile spasms/West Syndrome seen?

A

4-7 months

Usually gone by age 4

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25
Q

What is the suspected underlying etiology for West syndrome?

A

Immature CNS

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26
Q

What are the common features of West Syndrome?

A
  • Hypsaarhythmia on EEG
  • Symmetric, synchronous
  • Brief contractions of muscle groups
  • Clusters
  • 4-6s

Hypsarrhythmia is very high voltage, randomly slow waves with spikes in all cortical areas on EEG.

27
Q

How do we treat West syndrome?

A
28
Q

What is a pseudo seizure?

A
  • Resembles an actual seizure but nothing physically wrong
  • Treat with psychotherapy
  • They will protect their hands from hitting their face
  • Tongue biting still occurs
29
Q

which seizure type is MC in women

A

psuedoseizures

30
Q

What lab might help us see if a patient is faking a seizure?

A

Draw a PRL 10-20 mins after and check from baseline.

31
Q

What lab may be elevated post tonic-clonic activity?

A

PRL a few hours after (but not specific or sensitive)

32
Q

When is a sleep-deprivation EEG ordered?

A

To check if seizures are being induced by a lack of sleep

33
Q

What are the main purposes of EEG?

A
  • Distinguishing true epileptic seizures from other causes.
  • Classifying seizures, because certain meds treat certain types better
  • A localized area might be a candidate for surgery
  • Prognosis
34
Q

When is MRI indicated for seizure?

A

A progressive disorder or new onset seizure over age 20.

35
Q

What are the Antiepileptic drugs (AEDs) that need drug level monitoring?

A
  • Phenytoin
  • Carbamazepine
  • Valproic Acid (VPA)
  • Barbs (phenobarbital)

“Cause very potent pharmicuticles”

36
Q

When do you treat epileptic seizures?

A

Should start after >2 unprovoked seizures or for abnormal EEGs

37
Q

What are the AED therapy guidelines?

A
  1. Monotherapy is preferred
  2. Only add a second drug if we have SE or uncontrolled seizures still. You will slowly withdraw the first drug while titrating up the second drug.
38
Q

What are the common SE among the AEDs?

A
  • Drowsiness
  • IMbalance
  • N/V
  • Diplopia
  • Dizziness
39
Q

OCDs can increase the metabolism of which drug?

A

lamotrigine

40
Q

What kind of AEDs tend to interact with other drugs like warfarin or OCPs?

A

Enzyme-inducing AEDs

phenytoin
carbamazepine
phenobarb
oxcarbazepine
topiramate

41
Q

What AED is associated with gingival hyperplasia?

A

Phenytoin

42
Q

How are AEDs often dosed?

A

BID due to variable halflives

43
Q

What AEDs have QD dosing?

A
  • ESL
  • Phenytoin
  • Phenobarbital
  • VPA
44
Q

What AEDs should be avoided in pregnant women?

A
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • VPA

gabapentin and lamotrigine and topirimate are class C

45
Q

How often should we check drug levels for patients on a stable AED regimen?

A

Annually

46
Q

For focal seizures, what is the first-line therapy?

A

Lamotrigine

47
Q

For generalized seizure, what is the first-line therapy? What is the alternative?

A
  1. Valproate (unless pregnant)
  2. Levetiracetam for pregnant

LP

48
Q

When can AEDs be considered for discontinuation?

A

After 2 years of no seizures.

49
Q

What two medications must be tapered slowly?

A
  • BZDz
  • Barbs
50
Q

For a patient on combo therapy for seizures, how is tapering achieved?

A

Taper 1 drug at a time.

51
Q

how slow should you taper

A

over 2-3 months for most drugs

6+ months for benzos and barbs

52
Q

what studies should be drawn on a person with new epilepsy or starting a new drug

A

CBC
CMP
Albumin

yearly depression screening and labs.
labs every time new drug

53
Q

What are the guidelines regarding driving restriction during AED withdrawal?

A

State guidelines. usually 6 months of driving cessation after last unprovoked seizure

54
Q

what risk needs to be voiced with EVERY AED

A

suicide and mental health effects

55
Q

when is surgery indicated in epilepsy

A

when they have failed 2+ AEDs or if they cannot tolerate the SE

56
Q

What are the two ways surgery is performed in patients with uncontrolled seizures?

A
  • Focal seizures use excision of that area.
  • Generalized will ablate the possible connection points that allow the seizure to spread.
  • Generalized may involve cutting the corpus callosum if the spread can’t be contained easily.
57
Q

What is a new therapy for suboptimal surgical candidates for epilepsy?

A

Chronic vagal nerve stimulation

58
Q

What diet may help with seizures and why?

A

Keto, probably due to the acidic nature of it.

Requires ketone monitoring, can reduce seizures as much as 50%

59
Q

When is a seizure an emergency?

A
  1. Continuous seizure activity > 5 mins
  2. Unable to fully regain consciousness between 2+ seizures
  3. Several seizures within 30 mins.
60
Q

How do you treat status epilepticus?

A
  1. 2 large bore IVs, 1 w/ ativan and 1 w/ cerebryx

Ativan = acute treatment
Cerebyx/fosphenytoin = prevention

61
Q

What topical treatment might help with status epilepticus?

A

Diazepam rectal gel

All pts dxd with epilepsy should get a rx for this.

62
Q

If someone presents with first-time seizure, what are our initial steps?

A
  1. Protect their airway
  2. Protect their head
  3. Remove any obstacles near them
  4. DO NOT try to restrain them
  5. Call 911 if > 5 mins
  6. Try to surround them with padding
63
Q
A

Clin Med B 2 (44 decks)

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