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OMS - 2 Neuro Final > Seizure > Flashcards

Seizure Flashcards

1
Q

______ (3) can mimic seizures (must r/o).

A
  1. Syncope
  2. Cardiac disturbances
  3. Psychological (PNES)
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2
Q

Examples of provoked seizures

A
  1. Head trauma
  2. Drugs alcohol intoxication
  3. Metabolic disturbances
  4. Stroke
  5. Fever

(provoked seizures are not considered epilepsy)

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3
Q

Seizure lifetime prevalence

A
  • 9% (1/3 are benign febrile seizures)
  • 30-70% recurrence rate over three years after a single seizure
  • 80/1000,000
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4
Q

Define epilepsy

A
  1. Disease of the brain that predisposes a person to recurrent unprovoked seizures
  2. Must have two or more unprovoked seizures

(TQ)

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5
Q

Non-epileptic seizures

A
  1. Cardiovascular
  2. Drug or substance
  3. Metabolic
  4. Infection
  5. Fever
  6. Sleep disorder
  7. Psychogenic
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6
Q

Seizure precipitants

A
  1. Cocaine
  2. High or low (more common) blood sugar
  3. Low calcium, sodium or magnesium
  4. Stimulant (cocaine)
  5. Sedative withdrawal
  6. Severe sleep deprivation
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7
Q

Third most common neurological disease

A

Epilepsy

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8
Q

Epilepsy prevalence and incidence

A
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9
Q

Seizure classification

A
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10
Q

Common causes of seizure in newborns

A
  1. Malformation
  2. Lack of oxygen during birth
  3. Low levels of blood glucose, calcium, or magnesium
  4. Inborn error of metabolism
  5. Intracranial hemorrhage
  6. Maternal drug use
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11
Q

Common cause of seizures in infants and children

A
  1. Fever
  2. Brain tumor
  3. Infection
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12
Q

Common causes seizures in children and adults

A
  1. Congenital conditions (Angelman’s, Tuberous sclerosis)
  2. Genetic factors
  3. Progressive brain disease
  4. Head trauma
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13
Q

Common causes of seizures in seniors

A
  1. Stroke
  2. Alzheimer’s disease
  3. Trauma
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14
Q

Epilepsy pathophysiology

A
  • Synchronous interaction of large populations of neurons that intermittently discharging abnormal patterns
  • High voltage, long duration depolarization with superimposed high-frequency burst of action potentials
  • Extracellular current flow results in inter-ictal EEG “spike and sharp wave”
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15
Q

Normal waves on EEG (4)

A
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16
Q
A

Normal EEG

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17
Q

EEG abnormalities

A
  1. Background abnormalities
  2. Transient abnormalities
  3. Under all these can be a focal lateral or general
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18
Q

Background abnormalities

A

Significant abnormalities and or degree of slowing inappropriate for clinical state

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19
Q

Transient abnormalities associated with seizures

A
  1. Spike waves
  2. Sharp waves
  3. Spike - wave complex
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20
Q
A

EEG-GTC Seizure

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21
Q

How are focal onset seizures subdivided?

A

aware or unaware

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22
Q

General seizures are subclassified as

A

Motor or non motor

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23
Q

Myoclonic seizure symptoms (3)

A
  1. bilateral
  2. shock-like muscle contractions (head/UE)
  3. consciousness preserved
24
Q

Myoclonic seizures are precipitated by _______ or ______

A
  • waking up
  • falling asleep
25
Q

Myoclonic seizures may progress to _______ or ______.

A
  • clonic or tonic-clonic seizure
  • progressive neurological deterioration
26
Q

Main differentiating factor of simple partial seizure

A

NO loss of awareness

27
Q

Complex partial seizure symptoms (4)

A
  1. impaired consciousness
  2. automatisms (i.e. lip smacking, blinking)
  3. amnesia
  4. aura

(different presentation when it originates in the temporal lobe)

28
Q

Example of aura experienced with complex partial seizures (3)

A
  1. smells
  2. epigastric sensation
  3. deja vu
29
Q

Complex partial seizures last ______.

A

30 sec - 3 min

30
Q

Simple partial seizures may lead to ______.

A

depression of epileptogenic cortical area → focal weakness & numbness

(these are reversible)

31
Q

Todd’s paralysis

A

reversible focal weakness & numbness following simple partial seizure

(caused by post-ictal depression of the epileptogenic cortical area)

32
Q

70-80% of complex partial seizures arise from the _____lobe.

A

temporal

33
Q

uncinate fit

A

olfactory auras that precede complex partial seizures; temporal lobe orign

(associated w/brain tumors)

34
Q

Presentation of complex partial seizure arising from the temporal lobe (5).

(70-80% arise from the temporal lobe)

A
  1. motionless state
  2. altered consciousness
  3. automatisms
  4. dystonic posturing
  5. confusion
35
Q

The majority of seizures can be treated with medication, but _____% of patients will continue to always have seizures.

A

25

36
Q

Valproate is used to treat all, but _____ seizures

A

focal

37
Q

Topiramate treats ______ seizures

A

myoclonic

38
Q

Lamotrigine treats all seizures except ______.

A

generalized absent

39
Q

Levitracetam is used to treat ________ (2 seizure types)

A
  1. Focal
  2. Myoclonic
40
Q

Zonisimide is used to treat _______.

(only one type of seizure)

A

focal

41
Q

2 reasons why anti-epileptic drugs fail?

A
  1. Rx efflux transporters create Rx resistance (P-glycoprotein (Pgp) & MRP1-9)
  2. tolerance to non-benzos (receptor & channel response change)

(also Rx interaction, enzyme induction)

42
Q

Epilepsy work up (4)

A
  1. MRI brain
  2. EEG
  3. Neuropsych eval
  4. labs AED levels
43
Q

What labs would you order for a patient with epilepsy (8)?

A
  1. CBC
  2. HbA1C
  3. LFTs
  4. Na+
  5. BUN/Cr
  6. Blood cultures
  7. LP
  8. Tox screen
44
Q

______% of epilepsy patients who have depression

A

37

(increases medical expenses, decreases quality of life)

45
Q

If an epileptic patient fails 3 mono-therapy trials, the next step is _______.

A

video EEG monitoring

46
Q

After an epileptic patient does video-EEG monitoring, it is determined to be non-epileptic what are the potential causes (5)?

A
  1. sleep disorder
  2. migraine
  3. syncope
  4. movement disorder
  5. psychogenic
47
Q

What are the 3 treatments to choose from after an epileptic patient fails 3 monotherapies and video EEG monitoring confirms epilepsy?

A
  1. poly-therapy
  2. resective surgery
  3. stimulator therapy
48
Q

Brain stimulation for epilepsy (3)

A
  1. TMS
  2. Deep brain/Intracranial stimulation
  3. Vagal Nerve (NVS)
49
Q

Deep brain stimulation (Intracranial stimulation) for epilepsy targets ________ (3).

A
  1. thalamus
  2. cerebellum
  3. hippocampus
50
Q

When a woman with seizures becomes pregnant, refer them to ________.

A

neurology for assessment

(if they have been seizure free for one year prior, they shouldn’t have seizures during pregnancy)

51
Q

Status epilepticus is a seizure lasting longer than ____ or ____ .

A
  • 5 minutes
  • 2 seizures so close together, patient doesn’t recover between
52
Q

Status epilepticus is _______ (convulsive/non-convulsive).

A

can be either

53
Q

status epilepticus: treatment for ongoing seizure

A

lorazepam

or

diazepam

(also check blood glucose)

54
Q

status epilepticus treatment (ongoing seizure 10-30 min) (4)

A
  1. fosphenytoin
  2. levetiracetam
  3. phenobarbital
  4. valproic acid
55
Q

status epilepticus treatment at 30-60 min (5)

A
  1. INTUBATE
  2. EEG monitoring
  3. midazolam or propofol
  4. fluids & pressors
  5. AEDs
56
Q

Status epilepticus treatment at >72 hours (5)

A
  1. burst suppression 24-48 hours
  2. IV magnesium
  3. Ketamin
  4. Pentobarbital (titrate to burst suppression)
  5. pyridoxine

OMS - 2 Neuro Final (36 decks)

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