Seizures

Question 1

Seizures

Question 2

Simple Partial Seizure

Answer 2

Common with cerebral lesions
No loss of consciousness
Rarely last greater than one minute
Motor symptoms often start and single muscle group instead to entire side of body
Paresthesia, flashing lights, vocalizations, hallucinations common

Question 3

Complex Partial Seizures

Answer 3

Any simple partial seizure followed by impaired level of Consciousness
May have aura, staring, or automatisms such as lip smacking and picking at clothes

Question 4

Generalized Absence (petit mal)

Answer 4

Set an arrest of motor activity with blank stare

Common discovered in children/adolescents; begin and end suddenly

Question 5

Generalized tonic- clonic (grand mal)

Answer 5

May have aura
Begins with tonic contractions (repetitive involuntary contraction of muscle), loss of consciousness, then chronic contractions (maintained involuntary contraction of muscle)
Usually last 2–5 minutes
Incontinence may occur
Followed by postictal period

Question 6

Status Epilepticus

Answer 6

Series of grand mal seizures of greater than 10 minutes duration
Medical emergency
May occur when the patient is awake or asleep, but the patient never gains consciousness between attacks
Most uncommon, but most life-threatening

Question 7

Seizure Lab/Diagnostic

Answer 7

E.g.: the most important test in determining seizure classification
CT of the head is indicated for all new onset seizures
Seizure assessment:
Presence of aura, onset, spread, type of movement, body parts involved, pupil changes and react Tivitt he, duration, loss of consciousness, incontinence, behavioral and neurological changes after cessation of seizure activity

Question 8

Seizure Management Stabilization phase

Answer 8

0–5 minutes
Stabilize patient
Time seizure from onset; ongoing vital signs assessment
Assess oxygenation: 02 pour nasal cannula or mask; consider intubation
Continuous EKG monitoring
Fingerstick blood glucose: less than 60 give 100 mg thiamine IV then 50 ML‘s of D50 IV
IV access plus collecting routine labs, Tóxicology screen, anticonvulsant levels

Question 9

Seizure Management Initial therapy phase

Answer 9

5-20 minutes
Choose one
I am midazolam 10 mg >40 kg; 5 mg 13 –40 kg OR
Lorazepam 0.1 mg/kg/dose Max 4 mg/dose may repeat once or
diazepam 0.15–0.2 mg/kg/dose Max 10 mg/dose may repeat once

If none of these are available
IV phenobarbital 15mg/kg single dose OR
Rectal diazepam 0.2-0.5mg/kg single dose; max 20mg OR
Intranasal midazolam, buccal midazolam

Question 10

Seizure Management Second Therapy Phase

Answer 10

20-40 minutes
There is no evidence base with bird choice
Choose one of the following as a single dose:
IV fosphenytoin 20PE/kg max 1500 PE/dose OR
IV valporoic acid 40mg/kg Max 3000/dose OR
IV levetiracetam 60mg/kg; max 4500mg/dose

Question 11

Seizure Management Third Therapy Phase

Answer 11

40-60 minutes
There is no evidence-based preferred choice
Repeat second line therapy or
Anesthetic doses with continuous EEG monitoring of either
Thiopental OR
Midazolam OR
Pentobarbital OR
Propofol

Question 12

Subsequent Seizure Prevention

Answer 12

Maintenance dose of long term anti-convulsant
Tegretol (carbamazepine)
Ethosuximide (zarontin)
Phenobarbital (Luminal)
Dilantin (phenytoin)
Primidone (Mysoline )
Valproic Acid (Depakote)

Dosages should be titrated
Discontinuance should be tapered and never abruptly withdrawn