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clin med IV > seizure > Flashcards

seizure Flashcards

1
Q

epilepsy

A
  • recurrent (>2) unprovoked seizures

- usually sz stops spontaneously

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2
Q

classification of seizures

A
  • generalized

- partial/ focal -> simple vs. complex

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3
Q

generalized seizure

A
  • hits both hemispheres of brain

- LOC

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4
Q

examples of generalized sz

A
  • tonic clonic
  • absense
  • myoclonic
  • atonic
  • tonic
  • clonic
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5
Q

partial simple sz

A
  • only impacts one part of the brain, stays local
  • no LOC
  • typical, reproducible patterns
  • lasts seconds- minutes
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6
Q

partial complex sz

A
  • starts as a localized sz but then generalizes
  • LOC/ altered consciousness for 60-90 seconds
  • behavioral arrest -> staring, automatisms -> post ictal confusion
  • often have an aura
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7
Q

potential phases of sz

A
  • prodrome
  • preictal/ aura
  • ictal
  • post ictal
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8
Q

prodromal phase of sz

A
  • premonition prior to sz
  • “emotional change”
  • mood change
  • sleep disturbance
  • lightheadedness
  • anxiety
  • can occur hours- days before sz
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9
Q

aura or preictal phase of sz

A
  • occurs prior to sz
  • sensory or experiential warning
  • visual
  • olfactory
  • auditory
  • psychic
  • tactile
  • can be hours- days before
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10
Q

postictal phases

A
  • after the sz
  • simple partial may not have postictal phase
  • memory loss
  • confusion/ agitation
  • difficulty talking
  • exhaustion, weakness
  • HA
  • nausea
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11
Q

things that may provoke a sz

A
  • metabolic/ electrolyte abnormalities
  • stimulants, OD
  • sedative or ethanol withdrawal
  • sleep deprivation
  • AED med reduction or inadequate tx*
  • fever in peds
  • infx
  • CVA, ICH
  • tumor
  • cardiac arrhythmias
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12
Q

what is a PE finding that suggests seizure

A
  • lateral tongue lacerations
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13
Q

what are seizure mimics

A
  • syncope*
  • narcolepsy
  • movement disorders
  • PNES
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14
Q

common parts of work up for first time seizure

A
  • CMC, BMP, HCG, glucose
  • lactate, prolactin
  • blood and urine tox
  • LP if febrile, immunocomp, and CT already done
  • EKG
  • EEG if pt is not improving
  • CT or MRI
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15
Q

dx of seizure

A
  • history*

- EEG/ video EEG

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16
Q

counseling for new dx of seizure

A
  • avoid precipitants
  • avoid driving for at least 6 mo and until EEG/ imaging
  • caution with bathing, swimming, working at heights
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17
Q

partial motor seizures

A
  • jerky, rhythmic movement
  • remain restricted to one body segment or spread by jacksonian march
  • 25% of childhood epilepsy and remits by 16
  • no specific DOC
  • surgery for medically refractory sz
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18
Q

jacksonian march

A
  • abnormal electrical activity that travels up the homunculus
  • thumbs -> hands -> arms
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19
Q

sensory/ experiential partial seizures

A
  • positive sensations
  • negative sensations
  • deja vu or jamais vu
  • affective fear, depression, joy, anger
  • hallucination: visual or auditory
  • illusory: altered perception
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20
Q

autonomic partial sz

A
  • less common

- abdominal, cardiac, respiratory, urogenital sx

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21
Q

what is an automatism

A
  • non-purposeful, stereotyped and repetitive behavior
  • chewing, lip smacking
    fumbling with hands
  • picking
  • mumbling
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22
Q

frontal lobe sz

A
  • complex partial sz

- bizzare motor behavior like bicycling

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23
Q

temporal lobe sz

A
  • may be just an aura and/or complex partial sz
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24
Q

absense sz

A
  • brief generalized sz
  • impaired consciousness
  • no aura, post ictal phase, loss of postural tone
  • staring episodes, confused, detached, withdrawn
  • aka petit mal
  • no or few automatisms
25
Q

who do absence sz usually affect

A
  • children/ adolescence
  • may continue on into adulthood but usu resolves
  • suspect in child with sudden drop in school performance
26
Q

triggers of absence sz

A
  • hyperventilation
  • phonic stimulations
  • bright lights
27
Q

tx of absence sz

A
  • depends on if other sz present
  • only absence: ethosuximide
  • others: valproic acid, topiramate, lamotrigine
28
Q

myoclonic sz

A
  • brief arrhythmic jerking movement
  • generalized sz
  • less than 1 sec, often cluster
29
Q

tonic sz

A
  • generalized sz
  • sudden onset
  • ext or flex of head, neck trunk and/or extremities
  • typically occurs in relation to drowsiness
30
Q

clonic sz

A
  • rhythmic jerking motor mvmt
  • +/- LOC
  • typically involves UE and LE at same time
  • rare and typically in babies
  • generalized sz
31
Q

atonic sz

A
  • “drop attack”
  • generalized sz
  • brief loss of postural tone
  • multiple falls/ injuries- often wear helmets
  • < 15 seconds
  • congenital, do not grow out of these
32
Q

tx options for generalized sz

A
  • valproic acid
  • lamotrigine
  • topiramate
  • levetiracetam
  • try mono, max of monotx before adding on second agent
33
Q

tonic clonic sz

A
  • aka grand mal sz
  • several motor behaviors lasting 1-2 minutes
  • prodromal ictal cry
  • tonic pase
  • clonic phase
  • post ictal phase
  • no aura, may have prodrome
34
Q

tonic phase of tonic clonic sz

A
  • 10-20 sec
  • ext of extremities
  • flex of neck and trunk
  • apnea -> cyanosis
35
Q

clonic phase of tonic clonic sz

A
  • convulsive rhythmic symmetric mvmt
  • may bite tongue or lateral cheek
  • end of clonic phase -> relaxation -> incontinence
36
Q

post ictal phase of tonic clonic sz

A
  • often prolonged
  • variable pd of consciousness
  • initially stuporous or sleeps, gradually awakens confused/ agitated/ combative
37
Q

tx of tonic clonic sz

A
  • valproic acid
  • lamotrigine
  • topirimate
  • phenytoin
  • carbamazepine
38
Q

status epilepticus

A
  • sz > 5-10 min or 2 sz without lucid interval
  • assumes ongoing sz activity during time of diminished responsiveness
  • can involve any type of sz
39
Q

why is status epilepticus dangerous

A
  • high mortality rates if > 60 min

- brain uses more energy than can be supplied -> neurons become exhausted and dont function

40
Q

when should you suspect status epilepticus

A
  • if AMS does not improve in 20-40 min s/p sz

- consider stat EEG

41
Q

which type of status epilepticus is most dangerous

A
  • tonic clonic
  • cause:
  • ventilatory insufficiency, hypoxemia
  • cardiac arrhythmias
  • hyperthermia
  • systemic lactic acidosis
42
Q

common causes of status epilepticus

A
  • med withdrawal or non-compliance
  • most common in very young or old
  • stroke most common cause in elderly
43
Q

medication options for acute sz

A
  • lorazepam IV or diazepam IV
  • midazolam IM if no IV access
  • phenytoin IV
  • fosphenytin IV (faster infusion rate but $$)
  • valproate IV
  • induce coma with midazolam, propofol, phenobarbitol
44
Q

lorazepam vs. diazepam for acute sz tx

A
  • lorazepam has no upper limit of dosing
  • lorazepam lasts longer than diazepam
  • diazepam has faster onset
  • diazepam has risk of respiratory depression and hypotension
45
Q

etoh induced seizure

A
  • usu occurs 6-48 hours after last drink/ cutting back
  • may have multiple sz
  • consider admission for 1-2 days
46
Q

tx for etoh induced sz

A
  • BZDs
  • phenobarbitol
  • detox
  • CIWA scale for lorazepam admin
47
Q

sz in pregnancy

A
  • think eclampsia**
  • urgent OB consult
  • mag sulfate then lorazepam/ diazepam
48
Q

febrile sz

A
  • common benign condition in pds
  • brief generalized sz in otherwise healthy kid
  • d/t bacterial or viral illness + fever
49
Q

simple febrile sz

A
  • < 15 min
  • fever 100.4+
  • 6 mo- 5 years
  • only 1 sz in 24 hours
50
Q

complex febrile sz

A
  • > 1 in 24 hours
  • any focality to sz
  • outside of 6mo-5 yrs
  • duration > 15 min
51
Q

work up for simple sz in well appearing child

A
  • underlying illness work up only*

- no imaging/ LP/ consults

52
Q

work up for complex sz and/or ill appearing child

A
  • CBC
  • UA/UC
  • blood cx
  • cxr
  • LP
  • abx immediately
53
Q

treatment of febrile sz

A
  • does NOT require AED
  • antipyretics do not rduce risk of sz
  • 50% likely to have repeated febrile sz
54
Q

psychogenic non-epileptic seizure (PNES)

A
  • aka pseudoseizure
  • resembles seizure but psych causes
  • assoc with PTSD, personality disorder, depression
  • 40% of pts with sz disorder also have PNES
55
Q

conversion disorder

A
  • psychiatric somatoform disease
  • functional neuro sz disorder
  • psychological stress is displayed in physical ways
56
Q

dx of PNES

A
  • resistant to AEDs
  • EEG video monitoring for definitive dx
  • time to sx is usu 7-10 years
57
Q

si/sx of PNES

A
  • side to side head shaking
  • asynchronous, nonrythmic or sterotypical motor mvmt
  • stuttering
  • weeping
  • preserved awareness, no post ictal phase
  • eye flutter, eyes held shut
  • back arching
  • pelvic thrusting
  • episodes impacted by bsystanders
58
Q

management of PNES

A
  • generally tx if irreversible precipitant
  • if unprovoked may recur
  • no evidence for need to treat with AED after 1st unprovoked sz
  • consult neuro
  • admin AEDs with lower ADR profiles

clin med IV (23 decks)

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