Seizure and Syncope

Question 1

Name 5 paroxysmal (episodic) disorders in Neurology

Answer 1

1. Migraine
2. Dizziness
3. Syncope
4. Seizure
5. Transient global amnesia

Question 2

Epilespsy is generally defined as?

Answer 2

2 or more unprovoked seizures

Question 3

What continues to be a problem worldwide for patients with epilepsy based on longstanding stigma (ppl think their possessed by demons)?

Stricter laws when compared to?

Answer 3

1. Unemployment and underemployment of these pt’s continues to be a problem (American with Disabilities Act in 1990 helped)
2. Driving restrictions - in most states laws are more strict for ppl who had a seizure than ppl with DUIs

Question 4

Does a NL single EEG rule out epilepsy/seizure?

Answer 4

No: only 40% of seizures are picked up on a SINGLE EEG.

Question 5

Which type of seizure is nearly always picked up (90%) as a positive finding on a single EEG?

Answer 5

Petit mal (with hyperventilation)

Question 6

How many sleep-deprived EEG’s are necessary for positive findings in 85% of all types of epilepsy?

Answer 6

3 sleep-deprived EEG’s

Question 7

If you see minor abnormalities on an EEG, does this indicate a patient will have seizures?

Answer 7

No.

Question 8

What is the single most important piece of information alongside EEG in the diagnosis of epilepsy? (this is going to be a test Q)

Answer 8

History of the event - preferably by witnesses.

Question 9

What is the difference between partial and generalized seizures?

Answer 9

1. Partial seizure = activity begins on ONE side of the brain
2. Generalized seizure = activity begins on BOTH sides of the brain.

Question 10

What are 3 types of Partial Seizures and how does each manifest?

Answer 10

1. Simple partial: No LOC; lasts seconds, focal motor (twitching) activity; sensory activity; NO post-ictal-state.
2. Complex partial: LOC; lasts 1-3 minutes; non-responsive staring and preceding aura, automatisms (lip smaking, chewing, picking at clothes), POST-ICTAL state.
3. Secondarily generalized (partial onset): lasts 1-3 minutes; symptoms that are initially associated with no LOC => LOC, bilateral tonic-clonic activity; POST-ICTAL state.

Question 11

Describe a simple partial seizure

Answer 11

1. No LOC
2. Lasts seconds
3. Focal motor (twitching) activity
4. Focal sensory activity;
5. NO post-ictal-state.

Question 12

Describe a complex partial seizure

Answer 12

1. LOC
2. 1-3 minutes
3. Blank staring
4. Preceding aura
5. Automatisms (lip smaking, chewing, picking at clothes)
6. POST-ICTAL state

Question 13

Describe a secondary generalized seizure (begins as a partial)

Answer 13

1. Symptoms that start out as no LOC => LOC
2. Bilateral tonic-clonic activity
3. 1 - 3 minutes
4. Post-ictal state

Question 14

What are the 7 types of generalized seizures?

Answer 14

• 1. Absence (petit mal)
• 2. Tonic-clonic (grand mal)
• 3. Myoclonic
• 4. Tonic
• 5. Clonic
• 6. Atonic
• 7. Clonic-tonic-clonic

Question 15

What is the difference between a tonic and a clonic seizure?

Answer 15

1. Tonic = Muscle stiffness, rigidity (think increased tone)
2. Clonic = Repetitive, jerking movements

Question 16

What is seen with an Absence (petit mal) seizure, how long does it last, how does the patient feel after?

Answer 16

1. Blank stare, rapid blinking, chewing, clonic hand motions
2. LOC
3. 10 - 30 seconds
4. NO post-ictal state
5. *Abrupt onset and abrupt end

Question 17

What is seen with a tonic-clonic seizure, how long does it last, and how does the patient feel afterwards?

Answer 17

1. Bilateral extension (tonic) followed by symmetrical jerking of extremities
2. LOC
3. Lasts 1-3 mins
4. Post-ictal state

Question 18

What is seen with an Atonic seizure, duration, and how does patient feel after?

Answer 18

1. -“Drop seizure”: fall to the floor; confused for fainting
2. • LOC
3. • Variable duration
4. • Post-ictal state

Question 19

What is seen with a Myoclonic Seizure, duration, and how does patient feel after?

Answer 19

1. Quick, repetitive, symmetrical jerksof extremities and/or torso
2. LOC
3. Lasts < few seconds
4. Minimal post-ictal state

Question 20

MANY PTS WILL NOT BE AWARE OF HOW SIMPLE OR COMPLEX PORTION ; WITNESSS MAY REPORT (PT TURNED HEAD TO RIGHT, EYES DEVIATED TO RIGHT, RIGHT ARM LIFTED UP, STARTED JERKING AND WHERE DOWN ON THE GROUND STIFF AND SHAKING. THIS ICALLED ______. COMING FROM _____ side of BRAIN.

Answer 20

Version

Left

Question 21

Which drug is used to treat absence (petit mal) seizures, if this is the only type of seizure the person has experienced?

Answer 21

Ethosuxamide (absence only)

Question 22

Which combination of AED’s has been shown to be synergistic in treatment of epilepsy (especially for primary generalized seizures)?

Answer 22

Valproic acid and Lamotrigine

Question 23

What drugs can be used for partial and generalized drugs?

Answer 23

1. Valproic acid
2. Lamotrigine
3. Topiramate
4. Leviteracetam
5. Zonisamide
6. Perampanel

Question 24

What is Status Epilepticus?

Answer 24

Seizure >10 minutes or repeated seizures w/o recovery in between

Question 25

What is the general treatment for **Status Epilepticus?**

Answer 25

1. **ABC's;** establish IV 2. **Try to get hx:** seizure previously, allergies to seizure meds 3. **Labs:** accucheck, CBC, chemistry panel, drug levels 4. **Non-contrast CT head** 5. Give **benzodiazepine (buys time),** but _must_ give a longer-lasting anti-epileptic drug (AED)

Question 26

What type of imaging should be taken with **Status Epilepticus?**

Answer 26

**Non-contrast** CT head

Question 27

Which drug should be given for initial treatment of **Status Epilepticus?** What is the purpose?

Answer 27

1. **Benzodiazepine** (i.e., lorazepam 2-4 mg IV) 2. This buys time, but must give longer lasting **AED** 1. ​\***Fosphenytoin** 2. Phenobarbital 3. Valproic acid 4. Lacosamide

Question 28

What is the **last resort** AED to give a patient with **status epilepticus?**

Answer 28

**Pentobarbital coma**

Question 29

What are **3 general principles/**considerations in the treatment of patients with **epilepsy**?

Answer 29

* 1. Try to use **monotherapy** * 2. Consider **drug interactions**, i.e., OC's w/ carbamazepine * 3. Consider **long-term side effects,** i.e., bone loss with carbamazepine or phenytoin

Question 30

All **woman of child-bearing age** with **epilepsy** should be on what? Which drug should be avoided?

Answer 30

1. **Multivitamin + 1mg Folic acid**: many of the AED's are folate-depleting 2. **Valproic acid**

Question 31

What is the **drug of choice** for a woman with epilepsy?

Answer 31

Newer ones are probably safer (lamotrigine, leviteraetam), BUT ## Footnote **Whichever drug BEST controls her seizures (no one size fits all)**

Question 32

What are common associated signs with **Syncope**?

Answer 32

1. - Slow onset 2. - Pallor 3. - Sweating 4. - Lightheadedness 5. - Positionally related 6. - Abnormal head sensation 7. - Brief unconsciousness

Question 33

What are **4 common signs/symptoms** seen with a **seizure** that are distinct from syncope?

Answer 33

1. **Urinary or bowel incontinence** 2. **Tongue injury** 3. **Tonic/clonic movements** 4. **Post-ictal state**

Question 34

What is **Transient Global Amnesia?** Typical patient presentation and how long do they episodes last? Recurrence?

Answer 34

1. - Sudden, temporary, isolated episode of memory loss (amnesia); pt asks the same q over and over 2. **- No other** symptoms or signs 3. - Patient knows self and close family friends, but may not recognize others 4. - Usually lasts a few hours, then resolves 5. - Usually **doesn't recur**

Question 35

MC reason for breathrough seizure in a pt who had it controlled

Answer 35

med non-compliance