Recent Seizure/Epilepsy Flashcards
what should you always order in patients presenting with first time seizure
Na
glucose
CT head
what is status epilepticus
more than 30 minutes of continuous seizure activity, or recurrent seizures withough full recovery
seizure lasting more than 5 min should be presumed to be status and be treated as such
immediate treatment is the key for reducing mortality
define seizure
abnormal and unregulated electrical neural discharge that interrupts normal brain function and causes altered awareness, abnormal sensations, involuntary movements and/or convulsions
what is the difference between an epileptic and a nonepileptic seizure
epilepsy is a chronic brain disorder involving recurrent (2 or more) seizures without a reversible disorder or stressor
non epileptic seizures can be caused by a temporary disorder or stressor i.e metabolic disorders, CNS infections, CV disorders, drugs, withdrawal
in a child less than 2, what is the most likely seizure etiology
developmental defects
metabolic disorders
in a child ages 2-14, what is the most likely seizure etiology
idiopathic
in adults what is the most likely seizure etiology
trauma etoh withdrawal tumours strokes idiopathic
in the elderly what is the most likely seizure etiology
tumours
strokes
how do you classify seizures
generalized or partial
generalized have no focal onset, and affect both hemispheres simultaneously
partial have a focal or localized onset
how do you classify partial seizures
either simple, which maintains awareness, or complex, which loses awareness
what are the types of generalized seizures
tonic clonic
atonic (sudden loss of tone)
absence (brief lapse of awareness)
tonic
myotonic
what drugs can cause seizures
etoh or benzo withdrawal
cocaine
LSD
methanol
ethylene glycol
TCAs
insulin
prescription drugs
what infections can cause seizures
febrile seizures
meningitis
encephalitis
what are metabolic problems that can cause seizures
hypoglycemia, hyponatremia, hypocalcemia
non ketotic hyperglycemic, hyper osmolar coma
hyperthyroidism
what are structural causes of seizures
mass
stroke
trauma
congenital malformations
list some seizure mimics
migraines syncope stroke/TIA psychogenic movement disorders night terrors panic attacks
*absence of post ictal phase suggests a seizure mimic
what are some complications of seizures
aspiration, hypoxia–> brain injury, lactic acidosis, rhabdomyolysis–> ARF
what triggers to ask about
sleep deprivation flickering lights menses hyperventilation voiding/defecating
what to ask about the pre-ictal phase?
aura? (simple partial)
automatisms? (complex partial)
if triggered by intense emotions/exercise, and occurs along with diaphoresis, lightheadedness, pallor–> likley syncope
what to ask about the ictal period
loss of awareness aura abnormal motor activity muscle tone (rigid vs flaccid) facial involvement (head or eye deviation, tongue biting, excess blinking) symptom lateralization incontinence tongue biting automatisms
numbness
weakness
CV risk factors for TIA
visual aura, N/V, pounding headache suggests migraine
waxing/waning movements, pelvic thrusting, sobbing or moaning during event suggests psychogenic
what is Todds paralysis
hemiplegia post ictally–suggestive of focal onset
transient paralysis lasting less than 48 hours
red flags for seizures
status epilepticus
sudden or “worst ever” headache (SAH)
stiff neck, fever (meningitis)
focal neuro signs
what meds to ask about specifically in seizure history
psychotropics benzos theophylline bupropion meperidine
what do you HAVE to address when someone has a seizure/gets diagnosed with epilepsy
DRIVING
also occupation/risks
