Seizure Flashcards
Risk factors for seizure
Stroke Head injury Emotions Medications and toxins Fever
Differential for abnormal movements
Syncope PNES Arrhythmia Tics Restless leg
DDX in infants and toddlers
Arrhythmias Benign monoclonus Dystonia Self gratification Shuddering attacks Belign sleep monoclonus Migraine Head banging
Investigations
EEG MRI Extended ytes Glucose LFTs Renal Culture Drug screen ECG Neuropsych testing
Management general principles
Position properly (LLD if pregnant) ABC MOVIES
1st line for pregnant and non pregnant patients
Benzodiazepine
Can be midazolam Intranasal in peds
Can ve IV or rectal diazepam
First one in pregnant patients is Mag sulf
2nd line in pregnant and on pregnant
Pregnant=Benzo
Adult=Phenytoin or valproate
Children=phenytoin, valproate, or phenobarbital
When do you start a long term antiepileptic
after 2nd unprovoked seizure
Avoid valproic acid in women due to teratogenic effects
What specific differences do you have to consider for a woman who had a seizure
Avoid valproic acid
Take 5 mg/day folic acid
If taking Carbamazapine, pehnytoin, phenobarb, or ropiramate, need to increase dose of estrogen for contraceptives (>50 in OCP, no progesterone only pill, no nexplanon, Depo Provera q 10 weeks)
Best bet is IUD
List seven reversible causes of seizure
Hypoglycemia Hypoxia Hypo CA Hypovolemia Forgot seizure meds Heat Low sodium Opioid overdose
When can you drive after Seizure
Single unprovoked=3 months
After diagosis of disorder can drive after 12 months seizure free
If during alcohol withdrawl need to be etoh free with no seizures for 12 months
If due to medication change need to be 3 months from change
If due to infection just need illness cleared
How to treat febrile seizure
Same as any other seizure
ABC MOVIES
Benzos then phenytoin or phenobarb etc
THEN ACETAMINOPHEN-NNT7 to prevent recurrence during same illness
