Seizure Disorders

Question 1

Focal (partial seizures)

Answer 1

Initial discharge arises from a focal, unilateral area of the brain:
Consciousness usually NOT impaired
Olfactory area: “aura” of unusual smell
Motor strip (frontal lobe): face, hand or leg twitching/shaking
Parietal lobe: odd sensations
Temporal lobe: “aura of fear”, automatisms

Question 2

Generalized seizures

Answer 2

Those that involve the cerebral cortex diffusely from the beginning
Absence (petit mal), Atypical, Myoclonic, Tonic-Clonic (grand mal), Febrile seizure, Post-traumatic epilepsy

Question 3

Simple partial seizures:

Answer 3

Clonic (Rhythmic jerking) or tonic (Stiffening) movements of a discrete body part
Muscles of the face/hand are often involved
Clonic movements may progress in an orderly sequence “Jacksonian March”
May be followed by transient neurological abnormality reflecting postictal depression of the cortical area

Question 4

Todd’s paralysis

Answer 4

Blindness – occipital lobe
Numbness – sensory seizures
Weakness – motor seizure
temporary, unilateral, 30min-48hours

Question 5

Complex partial seizures:

Answer 5

Impair consciousness
Produce unresponsiveness
70-80% arise from the temporal lobe
Many evolve from simple partial seizures
Simple partial onset followed by impaired consciousness

Question 6

Absence Seizures (petit mal seizures)

Answer 6

Typically occur only in childhood and cease in adulthood
Can evolve into generalized motor seizures
Onset and termination of attacks are abrupt
Impairment is so brief patient is unaware of it
Last about 10 seconds
Examples: Blank stare, Motionless, Stop talking in mid sentence, can have mild clonic, tonic or atonic components

Question 7

Myoclonic Seizures

Answer 7

Rapid recurrent brief muscle jerks

Often cluster shortly after waking or while falling asleep

Question 8

Atonic Seizures

Answer 8

Drop attacks
Occur most often in children with diffuse encephalopathies
Are characterized by sudden loss of muscle tone that may result in falls with self-injury

Question 9

Tonic-clonic Seizures “Grand Mal”

Answer 9

is a major motor seizure which involves all extremities
Tonic: Characterized by sudden loss of consciousness Becomes rigid and falls to ground,Respiration is arrested
Clonic: Jerking of the body musculature, May last for 2-3 minutes, Followed by a stage of altered level of consciousness

Question 10

Carbamazepine (Tegretol)

Answer 10

Partial seizures 1st line
Pregnancy D
Bone marrow suppression, liver toxicity, rash
Monitor CBC & LFT’s
Warnings: serious and sometimes fatal dermatologic reactions to include toxic epidermal necrolysis and Stevens-Johnson

Question 11

Phenytoin (Dilantin)

Answer 11

Pregnancy D
Gingival hypertrophy, hirsutism, coarsened facial features, megaloblastic anemia, lupus-like syndrome
Monitor CBC & LFT’s
Warning:
Cardiovascular risk associated with rapid infusion
Used in partial seizures

Question 12

Lamotrigine (Lamictal)

Answer 12

Pregnancy C
Dizziness, HA, nausea, somnolence, skin rash (Black Box Warning for SJS)
Effective in treatment of children with newly diagnosed absence seizures