Seizure Flashcards
A febrile seizure that is recurrent is ___
NOT epilepsy
Def. of epilepsy (2):
- More than 1 seizure
2. Enduring alteration of brain that increases risk for seizure
An acute symptomatic seizure is called:
Provoked
What are the two causes of a provoked seizure?
- Electrolyte imbalance
- ETOH withdraws (first 48 hours)
Cause for an unprovoked seizure?
CVA, brain tumor, TBI
What is a Jacksonian March?
Seizure activity that starts unilateral in 1 muscle group and spreads systemically
What is Todd’s Paresis/paralysis?
Todd = T; Transient hemiplegia after a seizure
Incidence for seizures is highest in what age groups?
Under 5 and over 65
Two main historic features suggestive of a seizure:
- Aura associated with onset
- Post-ictal confusion state
Febrile seizure in kids common between 3 mo - 5 years on:
1st day of febrile illness (d/t speed of fever)
Treatment of febrile seizure
Tylenol - Control the fever
After a TBI, may start experiencing seizures within 1 week - treat with:
Phenytoin or levetiracetam
Seizures in AIDS patients may indicate:
Toxoplasmosis, cryptococcal meningitis, AIDS complex dementia
Seizure from hypoglycemia at:
20 - 30 mg/dL
Seizure from hyponatremia at:
< 120 mEq/L - CHANGE is what causes seizure
Low levels of Calcium and Magnesium at:
<0.8 mEq/L of Mg
Seizure from hyperosmolar state at:
> 330 mOsm/L
Seizure from drug/ETOH withdrawal:
Within a few days of withdrawal
Seizure from Eclampsia - woman with:
HTN, proteinuria and edema
Seizure from THYROID:
Hyper-thryoidism
Seizure from drug __
Overdose: Abx, antidepressants, narcotics, lithium and more.
Most common type of seizure:
Generalized
Two types of focal seizures:
Simple partial: Retained awareness
Complex partial: Impaired awareness
Three types of a generalized seizure:
- Motor
- Non-motor (absence)
- Other: Tonic, clonic, myoclonic, atonic
When does the patient urinate/start breathing again with a generalized motor seizure?
Clonic phase
What is status epilepticus?
Seizures over 30 minutes without ceasing spontaneously - FULL CONSCIOUSNESS IS NOT RESTORED BETWEEN SEIZURES
Why is status epilepticus a medical emergency?
Can cause brain damage
How do you abort status epilepticus?
Lorazepam + maintenance therapy too
Maintenance medication for status epilepticus?
Fosphenytoin or phenytoin
What type of seizure is a “drop seizure”? (common with what syndrome?)
Atonic - loss of postural tone
*Syndrome: Lennox-Gastaut
Most common pediatric epilepsy syndrome:
Absence (non-motor) - Simple (just staring)
Common age for pediatric absence seizures:
4-8
Most common symptom of a complex partial seizure (focal)?
Epigastric sensation (dysphagia)
Which type of seizure has orobuccolingual automatisms?
Complex partial seizures (focal)
What test should you order in determining syncope vs. tonic-clonic?
Pregnancy test
Three characteristics of EEG for seizures?
- Abnormal spikes
- Polyspike Discharge
- Spike-wave complexes
To diagnosis epilepsy, should you trial AEDs?
NO
When can you initiate a second drug for seizure prevention?
- After drug max has been reached with drug #1
Should you use two drugs for seizures?
Monotherapy is best. Start the second drug and wean off drug #1 that was not working. Using two drugs together is last resort.
When can you withdraw from AEDs?
After 2-5 years of being seizure free
Diet proven to reduce all seizures by 50%
Keto - Body burns fat instead of glucose for energy
Alternative diet to keto that is more flexible:
Low Glycemic index treatment (GIT)
Two stimulation devices for seizures:
- Vagus nerve stimulator
- RNS therapy
Only try surgery for epilepsy if:
At least two single drugs and a combination of 2 or more drugs has been tried
Treatment for absence seizure:
Ethosuximide
Treatment for partial seizures:
Lamotrigine
Treatment for Tonic-Clonic seizures:
Valproate/Lamotrigine
