Seizures Flashcards
What electolyte disturbances can cause Generalized tonic-clonic seizures?
Hyponatremia or hypernatremia
Hypocalcemia
Hypomagnesemia (rare)
What toxycological etiologies can lead to Generalized tonic-clonic seizures?
Alcohol, barbiturate, and benzodiazepine withdrawal
Cocaine toxicity
What metabolic abnormalities can lead to Generalized tonic-clonic seizures?
Hypoglycemia
What organ-specific abnormalities can cause Generalized tonic-clonic seizures?
Any CNS infection (encephalitis, meningitis, abscess)
Any CNS anatomic abnormality (trauma, stroke, tumor)
Hypoxia
Uremia (elevated creatinine)
Hepatic failure
when to choose electroencephalogram as the answer?
after all of these
tests (etiologies aforementioned) were done and were normal
____ is to coma and seizure as ____is to myocardial infarction
Confusion is to coma and seizure as angina is to myocardial infarction
Seizures of unclear etiology are called ___. If there is a clear cause, it is not ____.
Seizures of unclear etiology are called epilepsy. If there is a clear cause, it is not epilepsy.
The best initial therapy for a persistent seizure (status epilepticus) is
a benzodiazepine such as lorazepam or diazepam intravenously
status epilepticus IF the seizure persists, then give
phenytoin or fosphenytoin.
both have same efficacy, but fosphenytoin has fewer adverse effects compared to phenytoin
phenytoin, SE, and why?!
it is a class 1b antiarrhythmic medication. When given intravenously, it is associated with hypotension and AV block.
why chose Fosphenytoin over phenytoin?
Fosphenytoin does not have these adverse effects and can therefore be given more rapidly.
If benzodiazepines and fosphenytoin do not stop the seizure, then
administer phenobarbital.
Finally, the ultimate therapy for unresolving seizure is to use___
to allow you ___
and then _____
neuromuscular blocking agent such as succinylcholine, vecuronium, or pancuronium to allow you to intubate the patient and then give general anesthesia such as midazolam or propofol.
The patient must be _____ before the administration of _____, which can stop breathing.
placed on a ventilator
propofol
T/F Neuromuscular blocking agents (e.g., succinylcholine) do not stop the seizure. Why
they just stop muscular contraction or the external manifestations of the seizure.
Partial seizure: Like the name implies, this is a seizure that is ___ to one part of the ___. For instance, a patient may have a seizure that is limited just to___or __. Partial seizures can either be __(intact ____) or ___(loss_______).
focal - body
an arm - leg
simple - consciousness
complex - or alteration of consciousness
space. Absence seizures occur more often in ___
children.
Treatment of Status Epilepticus can be summarized with:
- Benzodiazepine
- Fosphenytoin
- Phenobarbital
- General anesthesia
T/F It is not necessary to begin antiepileptic drugs (AED) for a single seizure
T
The exceptions in which you should start after a single seizure are
Presentation in status epilepticus or with focal neurological signs
Abnormal EEG or lesion on CT
Family history of seizures
Best AEDs in pregnancy:
Levetiracetam
Lamotrigine
T/F The best treatment of epilepsy is
not clear.
T
Which AED has less SE?
Levetiracetam
.
.
______is the best therapy for absence seizures.
Ethosuximide
If seizures are not controlled with a single agent, ___________. If seizures are still not controlled __________.
If multiple medications do not control the seizure,____
an alternate medication should be tried.
adding a second drug may help.
surgical correction of a seizure
focus may lead to resolution of recurrences.
Alcohol withdrawal seizures are not treated with_________
long-term antiepileptic drugs
AED if Highest risk of hyponatremia
Carbamazepine
effects of Estrogens (OCPs) if are also being used.
Increase metabolism of lamotrigine to ineffective levels
when to do HLA B*1502 testing
Predicts Stevens-Johnson syndrome: carbamazepine
and phenytoin
when to Discontinuance of Medication AED?
The standard of care is to wait until the patient has been seizure-free for 2 years.
____ is the best way to tell if there is the possibility of
recurrence. This can elicit ____ on an EEG, but the test lacks ___.
A sleep deprivation EEG
abnormal activity
high sensitivity