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LMCC Part II > Recent Seizure/Epilepsy > Flashcards

Recent Seizure/Epilepsy Flashcards

1
Q

what should you always order in patients presenting with first time seizure

A

Na
glucose
CT head

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2
Q

what is status epilepticus

A

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

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3
Q

define seizure

A

abnormal and unregulated electrical neural discharge that interrupts normal brain function and causes altered awareness, abnormal sensations, involuntary movements and/or convulsions

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4
Q

what is the difference between an epileptic and a nonepileptic seizure

A

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

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5
Q

in a child less than 2, what is the most likely seizure etiology

A

developmental defects

metabolic disorders

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6
Q

in a child ages 2-14, what is the most likely seizure etiology

A

idiopathic

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7
Q

in adults what is the most likely seizure etiology

A 
trauma
etoh withdrawal 
tumours
strokes
idiopathic
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8
Q

in the elderly what is the most likely seizure etiology

A

tumours

strokes

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9
Q

how do you classify seizures

A

generalized or partial

generalized have no focal onset, and affect both hemispheres simultaneously

partial have a focal or localized onset

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10
Q

how do you classify partial seizures

A

either simple, which maintains awareness, or complex, which loses awareness

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11
Q

what are the types of generalized seizures

A

tonic clonic

atonic (sudden loss of tone)

absence (brief lapse of awareness)

tonic

myotonic

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12
Q

what drugs can cause seizures

A

etoh or benzo withdrawal

cocaine

LSD

methanol

ethylene glycol

TCAs

insulin

prescription drugs

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13
Q

what infections can cause seizures

A

febrile seizures
meningitis
encephalitis

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14
Q

what are metabolic problems that can cause seizures

A

hypoglycemia, hyponatremia, hypocalcemia

non ketotic hyperglycemic, hyper osmolar coma

hyperthyroidism

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15
Q

what are structural causes of seizures

A

mass
stroke
trauma
congenital malformations

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16
Q

list some seizure mimics

A 
migraines
syncope
stroke/TIA
psychogenic
movement disorders
night terrors
panic attacks

*absence of post ictal phase suggests a seizure mimic

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17
Q

what are some complications of seizures

A

aspiration, hypoxia–> brain injury, lactic acidosis, rhabdomyolysis–> ARF

18
Q

what triggers to ask about

A 
sleep deprivation
flickering lights
menses
hyperventilation
voiding/defecating
19
Q

what to ask about the pre-ictal phase?

A

aura? (simple partial)
automatisms? (complex partial)

if triggered by intense emotions/exercise, and occurs along with diaphoresis, lightheadedness, pallor–> likley syncope

20
Q

what to ask about the ictal period

A 
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

21
Q

what is Todds paralysis

A

hemiplegia post ictally–suggestive of focal onset

transient paralysis lasting less than 48 hours

22
Q

red flags for seizures

A

status epilepticus
sudden or “worst ever” headache (SAH)
stiff neck, fever (meningitis)
focal neuro signs

23
Q

what meds to ask about specifically in seizure history

A 
psychotropics
benzos
theophylline
bupropion
meperidine
24
Q

what do you HAVE to address when someone has a seizure/gets diagnosed with epilepsy

A

DRIVING

also occupation/risks

25
Q

what exam should be done in seizure evaluation

A

full neuro, including CN, tone, strength, DTRs, sensory and cerebellar/gait

also vitals

26
Q

what blood tests should you order in seizure evaluation

A 
CK
beta hcg--eclampsia?
tox
lytes
troponin 
PROLACTIN
27
Q

why do you order prolactin when evaluating seizures

A

if measured 10-20 min after event, and it is elevated, it can be helpful in distinguishing generatlized tonic clonic seizure or complex partial from psychogenic seizures

*cannot be used to distinguish between seizures and syncope

28
Q

who should get an EEG

A

urgent for status

recommended for all patients with new seizure

29
Q

how to manage acute seizure

A

ABCs, VS, prevent injury and aspiration

ensure safe environment

put patient in recovery position

give O2

antiepileptics–> phenytoin, phenobarbital, VPA

30
Q

what are the seizure precautions to discuss

A

no swimming or bathing alone

avoid heights

avoid baths

no fire

no driving until evaluated by a neurologist (should have normal CT head and EEG)

31
Q

what are automatisms

A

lip smacking
chewing
sucking

32
Q

what is jacksonian march

A

one body part is initially affected, followed by spreading to other body parts

33
Q

how to screen for seizures

A 
lost time
unresponsive even if someone touches you
smell burning or other auras
automatisms 
periods of confusion/post ictal 
simple partial seizures with dysphagia, fear, deja vu
34
Q

how do you discuss epilepsy with a patient with questions

A

relatively common
treatable though not curable
most people can lead safely normal lives especially if taking meds and following basic precautions

35
Q

things to be careful doing when you have epilepsy

A 
heights
swimming
operating heavy machinery
boating
locked bathrooms/bedrooms
36
Q

how do you counsel around epilepsy meds

A

need to take even when seizure free

establish a routine

discuss SEs

close f/up to monitor drug levels

many drug interactions–when buying OTC drugs, check with pharmacists to ensure no interactions because can increase or decrease levels in blood

anti epileptics can also interfere with other drugs like the OCP

37
Q

what particular type of med do anti epileptics interfere with

A

OCP

38
Q

when can you try being off meds

A

when youve been seizure free for a few years

39
Q

how should you counsel female epilepsy patients

A

phenytoin, carbamazepine and phenobarbital all increase metabolism of OCP

risk of birth defects (take folate 4-6 mg daily during child bearing years)

evaluate fetal neural tube defects if pregnant

40
Q

effect of alcohol on epilepsy

A

lowers seizure threshold

LMCC Part II (52 decks)

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