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Neurology Module > Seizure Disorders > Flashcards

Seizure Disorders Flashcards

1
Q

Seizure Types

A

Not all seizures = epilepsy

Symptomatic Seizure
Cryptogenic Seizure

Acute vs Remote

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2
Q

Prevalence of Seizures

A

1 in 10 adults will have had a seizure

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3
Q

Seizure where cause is identified

A

Symptomatic Seizure

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4
Q

No cause of seizure is identified

A

Cryptogenic Seizure

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5
Q

Pathophysiology of Seizure

A

Basis for neuronal excitation is the action potential

Seizure results from increased frequency burst of action potentials- spikes

Glutamate- excitatory neurotransmitter- allows Ca++ influx which keeps Na+ voltage gated channels open (perpetuates depolarization)

Depolarization activates NMDA channels open which allows further Ca++ influx

GABA- inhibitory neurotransmitter

Old theory: loss of inhibitory neurons (GABA)

New theories:

  • loss of excitatory neurons (that stimulate the inhibitory neurons)
  • Injury leads to axonal “sprouting” to other excitatory neurons
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6
Q

Causes of Non-epileptic Seizure

A

> 70-80% Idiopathic

Neurogenic: Brain tumor, CVA, trauma

Electrolyte/Metabolic imbalances

Hypoglycemia, hyponatremia, hypocalcemia

Hyperthyroidism

Acute renal or hepatic failure

Medication overdoses

Antidepressants, antipsychotics, cyclosporine, interferon, INH, Lithium, Demerol, tramadol (Ultram), quinolone atbs

Drug withdrawal

Drugs: Cocain, m-amphetamine, nitrous oxide, IV contrast dye, lead or mercury poisoning, acetylcholinesterase inhibitors

Infection and/or fever

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7
Q

Common seizure causes <10 yo

A

Idiopathic
congenital
birth injury
metabolic disorders

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8
Q

Common seizure causes 10-40 yo

A

Idiopathic, congenital, birth injury, metabolic disorders

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9
Q

Common seizure causes 40-60 yo

A

Brain Tumor

Head Trauma

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10
Q

Common seizure causes >60 yo

A 
CVA
brain tumor
subdural hematoma
CNS infection
Alzheimers
metabolic disturbance
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11
Q

Age of Febrile Seizure Occurance

A

6 mo - 5 yo

Peak age 2 yo

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12
Q

Prevalence of Febrile Seizures

A

66% male

3-5% children <5

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13
Q

First Febrile Seizure Risk Factors

A

Fever >38 (100.4)
Day care attendance
Developmental delay
Neonatal nursery >30 days
FH (sibling- 10% risk)
Viral infections (HHV6, influenza, others)
Vaccinations (influenza, DTP, MMR (fever))

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14
Q

Common Viral pathogen for Febrile Seizures

A

HH6

Influenza

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15
Q

Recurrent Febrile Seizure Risk Factors

A

30-50% will experience subsequent szs

Age <104F)
First degree relative with febrile

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16
Q

Simple Febrile Seizure

A

last less than 15 min; no underlying neuro problems, ie. Cerebral palsy

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17
Q

Evaluation of Febrile Seizure

A 
History & Physical:
FH
PMH
HPI
Recent vaccines
Meningeal irritation - If yes, LP

Imaging?
Most do not require. MRI preferred (due to less radiation)

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18
Q

Management of Febrile Seizures

A 
Antipyretics Tylenol/ibuprofen
   -For comfort 
   -Do NOT prevent seizure
Recurrence likely
No increased morbidity/mortality
No behavioral/developmental disorders
No prophylaxis required- adverse effects, lack of efficacy
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19
Q

Febrile Seizure Prognosis

A

By age 5 - 98% seizure free

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20
Q

Risk of developing later seizures after febrile seizure:

A

Underlying neuro disease (cerebral palsy)
FH epilepsy
Complex seizures

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21
Q

Types of Seizures

A

Partial

Generalized

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22
Q

Partial Seizures

A

Simple

Complex

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23
Q

Generalized Seizures

A

Absence (“Petit Mal”)
Generalized tonic-clonic (“Grand Mal”)
Myoclonic
Atonic

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24
Q

Causes of Absence Seizures

A

Inherited idiopathic disorder

Secondary disorder: AVM, neoplasm, ID

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25
Q

Absence seizures vs Partial-complex seizures

A

AGE is critical.

In adult, with similar symptoms, think partial-complex seizures.

Tx different!

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26
Q

Age of onset of Absence Seizures

A

age 5-18

Rare under age 2 or beyond adolescense

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27
Q

Signs and Symptoms of Absence Seizures

A

NO AURA!!!

Vacant, dazed expression
Staring
Pallor
Timing: 10 seconds max
Multiple times throughout day (50-100x)
Other: eye blinking, head movements, autonomic movements (incontinent stool or urine)
Post-ictal: brief recovery, picking clothes, pursing lips
EEG: diffuse 3Hz spike pattern (see later)

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28
Q

What are absence seizures mistaken for?

A

Often escape detection.

Mistaken for ADHD, daydreaming.

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29
Q

Treatment of Absence Seizures

A

Usually cease by age 20

Progress (if untreated) to generalized tonic-clonic seizures in 33%

Treatment:
Ethosuximide (Zarontin)
Valproic acid (Depakote)
+/- clonazepam (historically)

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30
Q

Pharmacologic Treatment of Absence Seizures

A

Ethosuximide (Zarontin)
Valproic acid (Depakote)
+/- clonazepam (historically)

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31
Q

Tonic Clonic Seizures AKA

A

Grand Mal

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32
Q

What often proceeds Tonic Clonic seizures?

A

Aura

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33
Q

Aura symptoms

A 
Irritability
Apathy
HA
Scintillating scotoma
nausea
choking sensation
paresthesias
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34
Q

Signs of Tonic Clonic seizures

A 
Aura (often precedes
Sudden LOC
Tonic- muscular rigidity (adduction and flexion of arms; extension of legs)
Clonic- jerking
Incontinence
Tongue biting
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35
Q

Treatment of Tonic Clonic Seizures

A

Valproic acid (Depakote) (first line)
Phenytoin (Dilantin)
Carbamazepine (Tegretol)
+/- phenobarbital

Others:
Primidone (Mysoline)
Lamotrigine (Lamictal)
Topiramate (Topamax)
Zonsisamide (Zonegran)
Levetiracetam (Keppra)
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36
Q

Myoclonic Seizures feel like

A

Sudden, single or multiple jerks

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37
Q

Myoclonic seizures and chidren manfest as

A

“Infantile spasms”

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38
Q

S/S Atonic Seizures

A

LOC
Head drops, loss of posture
“drop attack”
Falls cause Injury

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39
Q

Treatment for Atonic Seizures

A

Resistant to drug therapy

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40
Q

Simple Partial Seizure occurs in a

A

focal area (may spread to other areas)

41
Q

Sensory manifestations of Simple Partial seizures

A

visual
auditory
olfactory
gustatory

42
Q

Autonomic manifestations of Simple Partial seizures

A

GI sxs

flushing

43
Q

Motor manifestations of Simple Partial Seizure

A

Jerking limbs

Paresthesias

44
Q

Other manifestations of Simple Partial Seizurs

A

Hallucinations
Deja vu
Jamais vu

45
Q

Treatment of Simple Partial Seizures

A

Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Valproic acid (Depakote)

+/- others… (phenobarbital, primidone, zonisamide)

46
Q

Most common type of seizure

A

Complex Partial

47
Q

S/S Complex Partial Seizures

A

LOC

“Temporal lobe” may travel to frontal

Aura: GI symptoms, Sense of fear

Stare, automatisms-picking/fumbling, facial movements

Last 30 sec – 2min

May progress to generalized tonic-clonic

Resemble petit mal

48
Q

Treatment of a Complex Partial Seizure

A

Carbamazepine (Tegretol)

Phenytoin (Dilantin)

Surgery: temporal lobe resection

Failed medical treatment after 1-2 years

49
Q

Rolandic Epilepsy are a type of

A

partial seizure.

50
Q

Rolandic epilepsy only occurs in

A

children.

51
Q

Rolandic epilepsy originates in

A

rolandic area of brain but may generalize to tonic-clonic

52
Q

Symptoms of Rolandic epilepsy

A

Face/cheek twitching
Drooling
Difficulty speaking

53
Q

Rolandic epilepsy EEG pattern

A

Centrotemporal Spikes

54
Q

Rolandic seizures often occur

A

during sleep

55
Q

Treatment of Rolandic Seizures

A

Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Gabapentin (Neurontin)

56
Q

Gelastic or Dacrocystic seizures only occur in

A

children.

Often occur when falling asleep or under emotional stress.

May generalize.

57
Q

Gelastic seizures manifest as

A

laughing.

58
Q

Dacrocystic seizures manifest as

A

crying.

59
Q

Treatment of Lennox pts

A

Difficult

60
Q

Lennox seizures occur from…

A

Lennox-Gastraut

61
Q

Also seen with Lennox seizures

A

Developmental delay

62
Q

Lennox seizures occure secondarily to:

A

Encephalopathy
Meningitis
Birth injuries- hypoxia

63
Q

Lennox Seizure Timing

A

Nocturnal
Frequent seizures daily

Often wear helmet because seizures are SO frequent.

64
Q

Lennox EEG pattern

A

interictal spikes

65
Q

Management of Status Epilepticus

A

Check glucose

Lorazepam or diazepam… +/- midalzolam

Lorazepam 0.1mg/kg IV max 4 mg (duration 12-24h)

Diazepam 0.1-0.3mg/kg IV max 10mg (short acting)

66
Q

Biggest risk factor for status epilepticus

A

Medication Withdrawal!

67
Q

Status epilepticus is…

A

LIFE THREATENING!!!

68
Q

Status epilepticus seizures last

A

> 30 minutes

2 or more seizures without recovery period.

69
Q

Risk factors for status epilepticus

A 
MEDICATION!
Alcohol withdrawal
Drug overdose
Intracranial infections (meningitis, encephalitis)
Neoplasms
70
Q

What occurs after seizure?

A

Post Ictal Period

71
Q

How long is the post ictal period?

A

5-30 minutes

72
Q

S/S Post Ictal period

A

Headache
Exhaustion
Confusion
Drownsiness

73
Q

Rare manifestations of the Post Ictal Period

A

Todd’s paresis: (6% of grand mal)-paralysis 15h-36h

Postictal psychosis: lucid phase 2-6h, psychosis 9-10d

Postictal bliss: euphoric

74
Q

Medication Treatment for Seizures

A

LOOK IN CURRENT

LOOK OVER SIDE EFFECTS - fatigue, drowsiness, sedation, ataxia

KNOW A FEW FOR EACH DRUG

75
Q

Medications to avoid during pregnancy

A

Valproate

Carbamazepine

76
Q

Supplementation for pregnancy

A

Folic Acid

Vitamin K

77
Q

Lactation for women with seizures

A

Breast feeding still recommended

78
Q

What to monitor for breast feeding women

A

Irritation
Altered Sleep
Poor weight gain

79
Q

Anovulatory Cycles

A

Have to do with seizures and pregnancy - look up.

80
Q

Anti-seizure medications may effect

A

Hormones.

May increase risk of miscarriage

Birth defects 2-3% risk v 4-8%

81
Q

How should medications be prescribed for pregnant women?

A

Lowest possible dose but dilution factor.

82
Q

Seizures onset due to progesterone withdrawal

A

Catemenial Seizures

83
Q

Pathophysiology of Catemenial Seizures

A

Mid-cycle ovulation due to estrogen surge.

84
Q

Common occurence in women with seizures

A

Polycystic Ovary Disease
40% women with epilepsy

Subset related to valproate - Depakote

85
Q

Drugs that do not affect the eficacy of OCs

A 
Gabapentin (Neurontin)
Levetiracetam (Keppra)
Lamotrigine (Lamictal)
Valproate (Depakote)
Zonisamide (Zonegran)
86
Q

Atypical Seizure Activity

A

Nonfocal: opposite arm/leg

Pelvic thrusting

Head turning side to side

Eyes closed, tight

Tongue biting limited tip

Postictal crying

Memory of the event

May be triggered by emotional/stressful situations

87
Q

Causes of Psychogenic Nonepileptic Seizures

A

Anxiety attacks/ PTSD

Conversion Disorder

88
Q

Pseudoseizures

A

Psychogenic Nonepileptic Seizures

89
Q

Who may experience pseudoseizures?

A

Epilepsy patients

Women

90
Q

Labs to order for new onset seizures

A 
CBC
CMP
Ammonia (cirrhosis)
Tox screen
\+/- ESR
\+/- prolactin- 40-60% within 20min sz

LP if you suspect infection.

91
Q

Imaging for Seizures

A

Head CT if acute bleed suspected

MRI preferred

92
Q

Favorable Factors for pts with seizures

A

Provocative condition
EEG NL
No seizure within first year

93
Q

Negative Factors for pts with seizures

A

Abnormal EEG
Underlying neuro condition
Remote condition- CVA

94
Q

Approach to pt with seizures:

A

Recurrent?
Favorable factors?
Negative factors?

95
Q

Seizure Prophylaxis

A 
Structural abnormality:  neoplasm, AVM, infection
Head trauma, CVA
Sibling with epilepsy
Hx prior seizure
Abnormal EEG
Status epilepticus
Todd’s paresis
\+/- Unprovoked seizure
96
Q

Do not attempt prophylaxis for pateints with

A 
Febrile
Electrolyte abnormality
Secondary to stimulant abuse
Sleep deprivation
Alcohol/drug withdrawal
97
Q

Stop/Tapering Medication

A

Seizure Free x 2 Years

AND

Normal EEG

98
Q

Patient Education: Driving

A

No driving 6 months from last seizure.

Neurology Module (7 decks)

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