Seizures

Question 1

What electolyte disturbances can cause Generalized tonic-clonic seizures?

Answer 1

Hyponatremia or hypernatremia
Hypocalcemia
Hypomagnesemia (rare)

Question 2

What toxycological etiologies can lead to Generalized tonic-clonic seizures?

Answer 2

Alcohol, barbiturate, and benzodiazepine withdrawal

Cocaine toxicity

Question 3

What metabolic abnormalities can lead to Generalized tonic-clonic seizures?

Answer 3

Hypoglycemia

Question 4

What organ-specific abnormalities can cause Generalized tonic-clonic seizures?

Answer 4

Any CNS infection (encephalitis, meningitis, abscess)
Any CNS anatomic abnormality (trauma, stroke, tumor)
Hypoxia
Uremia (elevated creatinine)
Hepatic failure

Question 5

when to choose electroencephalogram as the answer?

Answer 5

after all of these

tests (etiologies aforementioned) were done and were normal

Question 6

____ is to coma and seizure as ____is to myocardial infarction

Answer 6

Confusion is to coma and seizure as angina is to myocardial infarction

Question 7

Seizures of unclear etiology are called ___. If there is a clear cause, it is not ____.

Answer 7

Seizures of unclear etiology are called epilepsy. If there is a clear cause, it is not epilepsy.

Question 8

The best initial therapy for a persistent seizure (status epilepticus) is

Answer 8

a benzodiazepine such as lorazepam or diazepam intravenously

Question 9

status epilepticus IF the seizure persists, then give

Answer 9

phenytoin or fosphenytoin.

both have same efficacy, but fosphenytoin has fewer adverse effects compared to phenytoin

Question 10

phenytoin, SE, and why?!

Answer 10

it is a class 1b antiarrhythmic medication. When given intravenously, it is associated with hypotension and AV block.

Question 11

why chose Fosphenytoin over phenytoin?

Answer 11

Fosphenytoin does not have these adverse effects and can therefore be given more rapidly.

Question 12

If benzodiazepines and fosphenytoin do not stop the seizure, then

Answer 12

administer phenobarbital.

Question 13

Finally, the ultimate therapy for unresolving seizure is to use___
to allow you ___
and then _____

Answer 13

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.

Question 14

The patient must be _____ before the administration of _____, which can stop breathing.

Answer 14

placed on a ventilator

propofol

Question 15

T/F Neuromuscular blocking agents (e.g., succinylcholine) do not stop the seizure. Why

Answer 15

they just stop muscular contraction or the external manifestations of the seizure.

Question 16

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_______).

Answer 16

focal - body
an arm - leg

simple - consciousness
complex - or alteration of consciousness

Question 17

space. Absence seizures occur more often in ___

Answer 17

children.

Question 18

Treatment of Status Epilepticus can be summarized with:

Answer 18

1. • Benzodiazepine
2. • Fosphenytoin
3. • Phenobarbital
4. • General anesthesia

Question 19

T/F It is not necessary to begin antiepileptic drugs (AED) for a single seizure

Answer 19

T

Question 20

The exceptions in which you should start after a single seizure are

Answer 20

Presentation in status epilepticus or with focal neurological signs
Abnormal EEG or lesion on CT
Family history of seizures

Question 21

Best AEDs in pregnancy:

Answer 21

Levetiracetam

Lamotrigine

Question 22

T/F The best treatment of epilepsy is

not clear.

Answer 22

T

Question 23

Which AED has less SE?

Answer 23

Levetiracetam

Question 24

.

Answer 24

.

Question 25

______is the best therapy for absence seizures.

Answer 25

Ethosuximide

Question 26

If seizures are not controlled with a single agent, ___________. If seizures are still not controlled __________.
If multiple medications do not control the seizure,____

Answer 26

an alternate medication should be tried.
adding a second drug may help.
surgical correction of a seizure
focus may lead to resolution of recurrences.

Question 27

Alcohol withdrawal seizures are not treated with_________

Answer 27

long-term antiepileptic drugs

Question 28

AED if Highest risk of hyponatremia

Answer 28

Carbamazepine

Question 29

effects of Estrogens (OCPs) if are also being used.

Answer 29

Increase metabolism of lamotrigine to ineffective levels

Question 30

when to do HLA B*1502 testing

Answer 30

Predicts Stevens-Johnson syndrome: carbamazepine

and phenytoin

Question 31

when to Discontinuance of Medication AED?

Answer 31

The standard of care is to wait until the patient has been seizure-free for 2 years.

Question 32

____ is the best way to tell if there is the possibility of

recurrence. This can elicit ____ on an EEG, but the test lacks ___.

Answer 32

A sleep deprivation EEG

abnormal activity
high sensitivity