Neurol - MedEd - Seizure

Question 1

Seizure - definition

Answer 1

Synchronous firing in awake brain

Question 2

Seizure disorder - 2 main questions

Answer 2

1) Does patient have epilepsy?

2) Is this a first time seizure in someone who is not supposed to seize?

Question 3

Epilepsy patients - types of seizures

Answer 3

1) General - whole body
2) Partial

1) Complex - LOC
2) Simple - no LOC

1) Atonic
2) Myoclonic
3) Absence

Question 4

Causes of first time seizure - mneumonic?

Answer 4

Vascular
Infection
Trauma
Autoimmune (lupus)
Metabolic (blood glucose, perfusion, shock)
Ingestion/withdrawal (benzo/EtOH withdrawal seizure)
Neoplasm
Sych (Psych), pseudoseizures (faking)

Question 5

Common symptoms of seizures: (similar to syncope except for…)

Answer 5

LOC
Jerking
Bowel/bladder incontinence
Tongue biting
Post-ictal state! = seizure
If there is no post-ictal state - could still be syncope!

Question 6

People with epilepsy seize regularly - why are they presenting? what to do?

Answer 6

Last longer
More severe
Taking meds - check levels
If symptoms are worsening - increase drug, add drug, change to different drug
-Look for reason why their seizure symptoms are worsening! i.e. maybe there is a UTI
-R/O Vitamins

Question 7

Patient with first time seizure… what to consider?

Answer 7

Everyone is allowed to have 1 seizure
No need to treat for epilepsy
Esp if there is a cause known (VITAMINS)
Esp if normal MRI/EEG

Question 8

If patient is currently seizing (>5min, failure to return to baseline over 20min)… what is this?

Answer 8

This is status epilepticus

Question 9

If patient is in status epilepticus… what to do?

Answer 9

Snow them with benzos
Lorazepam
May put them into coma
-If doesn’t work, give fosphenytoin –> midazolam –> propofol –> phenybarbital
-This will snow them, then work up why they had the seizure

Question 10

After patient is snowed from status epilepticus… what to investigate

Answer 10

EEG - useful during seizure
CT scan, MRI better
Work-up vitamins mneumonic - fix it

Question 11

If patient is at risk for further seizures, what to give?

Answer 11

Anti-epileptic drugs

• Valproic acid
• Lamotrigine
• Levetiracetam - Keppra

Question 12

Atonic seizure - what is it and how to treat

Answer 12

No LOC
Loss of tone, suddenly fall
-Valproic acid

Question 13

Myoclonic seizure - what is it and how to treat

Answer 13

No LOC
+Unnecessary useless extra tone
-Valproic acid

Question 14

Absence seizure - what is it and how to treat ?

Answer 14

No loss of tone
+LOC
Usually in kids, looks like ADHD and looks like not paying attention in class
Ethosuximide

Question 15

Trigeminal neuralgia - what to give?

Answer 15

• Lance-like pain down face

- Use carbamazepine

Question 16

Nonconvulsive status - what is it

Answer 16

In full on seizure
General LOC
No reason
-Don't even look like  they are seizing
-Need to get EEG

Question 17

If cannot find epilepsy on EEG, what to do?

Answer 17

Need to induce seizure

-i.e. no sleep x 24 hours