Obj. 11/12: Seizures - LL

Question 1

What’s the difference between seizures and epilepsy?

Answer 1

Epilepsy IS recurrent and unprovoked seizures

Question 2

How can you tell if a seizure is focal or generalized?

Answer 2

Clinical and EEG findings

Question 3

Would you expect focal seizures to have bilateral or unilateral findings?

Answer 3

Unilateral, only a RESTRICTED part of ONE cerebral hemisphere is activated.

Question 4

What is the most common seizure type in adults?

Answer 4

Focal seizure with IMPAIRED consciousness + automatisms (blinking, lip smacking, staring off into space)

Question 5

T/F. Generalized seizures always begin bilaterally simultaneously.

Answer 5

False. Most generalized seizures are primarily bilateral, but some focal seizures can progress to generalized (called secondarily generalized)

Question 6

Parent brings in their 4 y/o daughter with the CC, “she frequently stops talking mid sentence and begins smacking her lips”. These episodes last 5-10 seconds and patient is unaware. What are we thinking?

Answer 6

Absence seizure

Question 7

Drug of Choice for Absence Seizure?

Answer 7

Ethosuximide

said with a lisp: “it sucks oh my”

Question 8

What seizure type generally has onset in the teenage years?

Answer 8

Myoclonic

Question 9

Drug of Choice for Myoclonic seizures?

Answer 9

Valproic Acid

valley-girls (Teenagers) take acid

Question 10

What are the 3 phases of Grand mal (tonic-clonic) seizures?

Answer 10

1. Tonic –> LOC, rigid and falls, respiration stops
2. Clonic –> jerking
3. Flaccid Coma

Question 11

What are the main categories of causes of grand-mal seizures?

Answer 11

1. Metabolic –> hypoglycemia, uremia, hypoparathyroidism
2. Infectious –> meningitis, neurosyphilis, herpes, HIV/AIDs
3. Substances –> alcohol withdrawal, cocaine, heroin, SSRI

Question 12

After a patient suffers from a grand-mal seizure how long do you tell them they need to take their anti-epileptic med?

Answer 12

until no seizures for 2 years!

Question 13

A patient continuously having convulsions for more than 5 minutes is called:

Answer 13

STATUS EPILEPTICUS –> is a Medical Emergency!

Question 14

What is the most common cause of status epilepticus?

Answer 14

Poor compliance to their anticonvulsant medication

Question 15

What is the initial emergency management of status epilepticus?

Answer 15

1. Maintain Airway
2. IV 50% dextrose (hypoglycemia may be the cause)
3. Terminate seizure if lasts for >5 minutes with Lorazepam
4. Prevent further seizures with Phenytoin with EKG monitoring

THEN investigate cause.

Question 16

What is the time frame associated with Alcohol Withdrawal seizures?

Answer 16

Needs to be <48 hours of withdrawal after a period of high or prolonged intake

Question 17

Are anticonvulsant drugs required to treat an alcohol withdrawal seizure?

Answer 17

Not usually, they are self-limiting

Question 18

What can you give a patient to help reduce their withdrawal symptoms?

Answer 18

Benzos (lorazepam or diazepam)

Question 19

Does a patient need to drink to avoid having another Alcohol Withdrawal Seizure?

Answer 19

NO! DEFINITELY NOT!