Seizure disorders

Question 1

Absence (petit mal)- Eti

Answer 1

• Generalized, entire brain
• Begins in childhood, cease by age 20
• May be induced with hyperventilation

Question 2

Absence (petit mal)- Sx

Answer 2

• Brief consciousness impairment- seconds with abrupt recovery
• 3 hz spike and wave pattern
• Pt unaware
• Clonic, tonic, atonic
• Enuresis or automatisms

Question 3

Tonic-clonic (Grand mal)- Eti

Answer 3

• Generalized seizure

- Both sides of brian

Question 4

Tonic-clonic (Grand mal)- Sx

Answer 4

• Cessation of resp
• Sudden LOC
• Tonic first- stiffening with moan, flexion and pronation, incontinence, cyanosis
• Clonic follows- tongue biting, rhythmic shaking, decreased freq and increased amplitude

Question 5

Status elipticus- Sx

Answer 5

• Repeated seizures without recovery of consciousness
• lasts > 30 min
• 2 without clearing in-between
• > 5 min (new def)

Question 6

Generalized seizures- Dx

Answer 6

• EEG

Question 7

Generalized seizures- Tx

Answer 7

• Phenytoin
• Carbamazepine
• Valproic acid
• Phenobarbital
• Trial diff drugs until seizure free for 2 yrs, withdrawl

Question 8

Generalized seizures- - Eti

Answer 8

• May have prodrome

- Occur with postural changes

Question 9

Generalized seizures- Outcome

Answer 9

• Report to DMV

- Dont do dangerous activities

Question 10

Febrile seizure- Eti

Answer 10

• 3 mo to 6 years
• 3-5% children
• > 38.8 C
• Generalized
• Assoc with infection, can’t have with CNS infection
• 1/3 have additional
• developmental delay with normal neuro exam

Question 11

Febrile seizure- Dx

Answer 11

• Eval source of fever, CNS infection

Question 12

Febrile seizure-Tx

Answer 12

• Symptomatic
• Don’t need to tx
• Progress to epilepsy in 15-20%

Question 13

Simple partial seizure- Sx

Answer 13

• Motor, sensory and autonomic aura
• Clonic mvmt single musc group
• Pallor, sweating, fulgins, piloerection, pupillary dilatation, borborygmi
• Psychic sx
• Consciousness preserved
• Postictal hemiparesis

Question 14

Complex partial seizure- Sx

Answer 14

• Altered consciousness
• Impaired responsiveness
• Automatism- coordinated involuntary mvmt
• Arises from temporal node
• Lip smaking, grabbing bed sheets, turning hands
• Aura, epigastric sensations, fear, deja vu
• 1-3 min

Question 15

Partial seizures- Tx

Answer 15

• Phenytoin
• Carbamazepine
• Oxcarbazepine

Question 16

Seizures- Eti

Answer 16

• Trauma
• Mass lesion
• Stroke
• Lytes imbalance
• Drugs
• Eclampsia
• CNS dysfunction

Question 17

Alcohol withdrawal seizures- Eti

Answer 17

• Within 48 hrs of alcohol withdrawal

- Period of high or prolonged intake

Question 18

Alcohol withdrawal seizures- Sx

Answer 18

• Generalized tonic- clonic seizures
• Tremors first then hallucinations, formiacation
• More dangerous in days 4-5 - Autonomic instability: arrhythmia, HTN
• Self limited

Question 19

Alcohol withdrawal seizures- Dx

Answer 19

• Hx

- CT or MRI

Question 20

Alcohol withdrawal seizures- Tx

Answer 20

• Benzodiazepines

- Lorezepam, diazepam, phenobarbital

Question 21

Postictal state

Answer 21

• Drowsy, lethargy
• Resp resumes
• HA
• Todd’s paralysis

Question 22

Febrile seizure- Sx

Answer 22

• Simple: generalize, last 15 min, focal features, recur within 24 hrs, postictal neuro signs, likely 2/2 underlying infection