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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
who do absence sz usually affect
- children/ adolescence - may continue on into adulthood but usu resolves - suspect in child with sudden drop in school performance
26
triggers of absence sz
- hyperventilation - phonic stimulations - bright lights
27
tx of absence sz
- depends on if other sz present - only absence: ethosuximide - others: valproic acid, topiramate, lamotrigine
28
myoclonic sz
- brief arrhythmic jerking movement - generalized sz - less than 1 sec, often cluster
29
tonic sz
- generalized sz - sudden onset - ext or flex of head, neck trunk and/or extremities - typically occurs in relation to drowsiness
30
clonic sz
- rhythmic jerking motor mvmt - +/- LOC - typically involves UE and LE at same time - rare and typically in babies - generalized sz
31
atonic sz
- "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
tx options for generalized sz
- valproic acid - lamotrigine - topiramate - levetiracetam - try mono, max of monotx before adding on second agent
33
tonic clonic sz
- 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
tonic phase of tonic clonic sz
- 10-20 sec - ext of extremities - flex of neck and trunk - apnea -> cyanosis
35
clonic phase of tonic clonic sz
- convulsive rhythmic symmetric mvmt - may bite tongue or lateral cheek - end of clonic phase -> relaxation -> incontinence
36
post ictal phase of tonic clonic sz
- often prolonged - variable pd of consciousness - initially stuporous or sleeps, gradually awakens confused/ agitated/ combative
37
tx of tonic clonic sz
- valproic acid - lamotrigine - topirimate - phenytoin - carbamazepine
38
status epilepticus
- 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
why is status epilepticus dangerous
- high mortality rates if > 60 min | - brain uses more energy than can be supplied -> neurons become exhausted and dont function
40
when should you suspect status epilepticus
- if AMS does not improve in 20-40 min s/p sz | - consider stat EEG
41
which type of status epilepticus is most dangerous
- tonic clonic - cause: - ventilatory insufficiency, hypoxemia - cardiac arrhythmias - hyperthermia - systemic lactic acidosis
42
common causes of status epilepticus
- med withdrawal or non-compliance - most common in very young or old - stroke most common cause in elderly
43
medication options for acute sz
- 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
lorazepam vs. diazepam for acute sz tx
- 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
etoh induced seizure
- usu occurs 6-48 hours after last drink/ cutting back - may have multiple sz - consider admission for 1-2 days
46
tx for etoh induced sz
- BZDs - phenobarbitol - detox - CIWA scale for lorazepam admin
47
sz in pregnancy
- think eclampsia** - urgent OB consult - mag sulfate then lorazepam/ diazepam
48
febrile sz
- common benign condition in pds - brief generalized sz in otherwise healthy kid - d/t bacterial or viral illness + fever
49
simple febrile sz
- < 15 min - fever 100.4+ - 6 mo- 5 years - only 1 sz in 24 hours
50
complex febrile sz
- >1 in 24 hours - any focality to sz - outside of 6mo-5 yrs - duration > 15 min
51
work up for simple sz in well appearing child
- underlying illness work up only* | - no imaging/ LP/ consults
52
work up for complex sz and/or ill appearing child
- CBC - UA/UC - blood cx - cxr - LP - abx immediately
53
treatment of febrile sz
- does NOT require AED - antipyretics do not rduce risk of sz - 50% likely to have repeated febrile sz
54
psychogenic non-epileptic seizure (PNES)
- aka pseudoseizure - resembles seizure but psych causes - assoc with PTSD, personality disorder, depression - 40% of pts with sz disorder also have PNES
55
conversion disorder
- psychiatric somatoform disease - functional neuro sz disorder - psychological stress is displayed in physical ways
56
dx of PNES
- resistant to AEDs - EEG video monitoring for definitive dx - time to sx is usu 7-10 years
57
si/sx of PNES
- 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
management of PNES
- 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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