Seizures

Question 1

When is the highest incidence of seizures?

Answer 1

Childhood and late adulthood

Question 2

What is epilepsy?

Answer 2

recurrent unprovoked seizsures

Question 3

What is the pathophys of seizures?

Answer 3

Abnormal, excessive, hypersynchronous discharge from CNS neurons

Question 4

Etiology of seizures for young adults (18-35)?

Answer 4

• Trauma
• Metabolic disorders (alcohol withdrawal, uremia)
• CNS infection

Question 5

Etiology of seizures for older adults (>35 yrs)

Answer 5

• Cerebrovascular disease
• Brain tumor
• Metabolic issues
• Degenerative disorders (alzheimer)
• CNS infection

Question 6

What is a focal seizure with retained awareness?

Answer 6

PARTIAL SEIZURE

• one part of brain affected
• presentation depends on focal area involved

Question 7

What is a focal seizure with impaired awareness?

Answer 7

PARTIAL SEIZURE

• One part of brain affected
• Pt appears to be awake but no normal responses
• No memory of what occured
• automatisms

Question 8

What are automatisms?

Answer 8

• Facial grimacing
• Gesturing
• Lip smacking
• Chewing

Question 9

What part of the brain is involved with generalized seizures?

Answer 9

Entire brain

Question 10

What is the most common type of generalized seizure?

Answer 10

Tonic-Clonic

Question 11

What is happening during the tonic phase?

Answer 11

Sudden muscle stiffening

Question 12

What is happening during the clonic phase?

Answer 12

Rhythmic jerking and tongue biting

Question 13

How long to tonic-clonic phases last?

Answer 13

1-2 minutes

Question 14

What are the other types of seizures?

Answer 14

• Absence
• Clonic
• Atonic

Question 15

What happens during the postictal phase?

Answer 15

• Somnolence
• Confusion
• HA
• No recollection
• Weakness

Question 16

How can you diagnose a seizure?

Answer 16

Video EEG monitor

Question 17

General first aid for seizure?

Answer 17

• Maintain airway
• Start IV
• Blood work

Question 18

What blood work do we obtain for seizures?

Answer 18

1. Electrolytes, LFT, CBC

2. Finger stick glucose

Question 19

Treatment for active seizure?

Answer 19

• Diazepam 5mg IV/IM q5-10 max 30mg

* MEDEVAC

Question 20

What is an emergent seizure?

Answer 20

Status Eplilepticus

Question 21

What are the traits of a status epilepticus?

Answer 21

• Lasts >/= to 5 minutes

* 2 or more seizures without complete recovery between

Question 22

What is the treatment for status epilepticus?

Answer 22

• Diazepam 5mg IV/IM q5-10 min
• Valporic acid
• Airway

Question 23

What is different about a psychogenic noneplileptic seizure

Answer 23

• Eyes are closed
• Incontinence not an issue
• Tonic-Clonic longer than 2 minutes
• No postictal phase
• Not associated with abnormal excessive neuronal activity

Question 24

Diagnosis of psychogenic nonepileptic seizure?

Answer 24

EEG shows no electrical activity

Question 25

Treatment for psychogenic nonepileptic seizure?

Answer 25

Psychotherapy

Question 26

What is a partial seizure?

Answer 26

Only involves part of the brain. * The part of the brain involved will have associated symptoms * Focal

Question 27

What is the most common seizure?

Answer 27

Partial seizure

Question 28

What are the two types of partial seizures?

Answer 28

Focal with awareness | Focal without awareness

Question 29

What is the difference between the two types of partial seizures?

Answer 29

Without awareness is without awareness * There's also automatism such as; - facial grimace - gesturing - lip smacking - chewing - repeating words or phrases

Question 30

How are seizures treated?

Answer 30

* First aid * Airway and maintain O2 sats * IV catheter * Diazepam 5mg IV/IM Max 30mg

Question 31

What is the mechanism of diazepam on seizures?

Answer 31

Assists with GABA neurotransmission to increase inhibition (Remember GABA is an amino acid neurotransmitter inhibits activity in the nervous system)

Question 32

What labs and imaging should be done for seizures?

Answer 32

Blood * CBC, LFT, Electrolytes Imaging * EEG for Dx

Question 33

What area of the brain does a generalized seizure involve?

Answer 33

All of it

Question 34

What is the most common type of generalized seizure and what happens in it?

Answer 34

(Tonic - Clonic) / (Grand Mal) Tonic * Muscle Stiffening Clonic * Twitching/jerking **1 -2 minutes

Question 35

What are some other types of generalized seizures>

Answer 35

* Absence * Clonic * Atonic

Question 36

What happens during the postictal phase of seizures?

Answer 36

* Confusion * Somnolence * No recollection typical * Weakness

Question 37

Treatment for status epilepticus?

Answer 37

* Diazepam 5mg IV/IM * Valporic Acid * Correct underlying issue * Intubate

Question 38

How can you tell someone is faking and having a psychogenic nonepileptic seizure?

Answer 38

* Episodes longer than 2 minutes * Can remember and recover immediately (no postictal phase) * Eyes closed ** EEG shows no changes in electrical activity