Seizures

Question 1

What is a seizure

Answer 1

Electrical storm in the brain

Question 2

What is epilepsy

Answer 2

recurrent unprovoked seizures associated with abnormal electrical activity in the brain

Question 3

What is the criteria for being diagnosed with epilepsy

Answer 3

2 or more unprovoked seizures separated by AT LEAST 24 hours

Question 4

When will you start someone on anti-seizure medication

Answer 4

after second unprovoked seizure

Question 5

What are examples of a provoked seizure

Answer 5

infections
alcohol withdrawal
low blood sugar
surgery

Question 6

What are the 3 main classifications of seizures

Answer 6

Focal onset
generalized onset
unknown onset

Question 7

What are focal onset seizures

Answer 7

seizures that start in and affect one part of the brain

generally originates paroxysmal discharge in the temporal lobe

Question 8

What is a primary generalized seizure

Answer 8

abnormal electrical discharge that originates from the diencephalic activating system and spread simultaneously through the brain

Question 9

What are the stages of a seizure

Answer 9

prodrome
aura
ictal phase
post-ictal phase

Question 10

What type of seizures do auras occur in

Answer 10

focal epilepsy

Question 11

What is the ictal phase

Answer 11

Time from the first symptom (including aura) until the end of the seizure activity

Question 12

What is an example of automatisms

Answer 12

lip smacking

Question 13

What progression may you see in seizures as the activity spreads to other parts of the brain

Answer 13

Aura->focal aware-> focal unaware-> bilateral tonic clonic

Question 14

What is the post-ictal phase

Answer 14

Time between the end of a seizure and return to baseline

Question 15

What is a focal seizure with impaired awareness

Answer 15

Starts in one area of the brain
duration 1-3 minutes

Question 16

What are signs someone is having a focal seizure with impaired awareness

Answer 16

picking at clothes
bicycling of legs
utilization behavior
Smacking lips

Question 17

What is a bilateral tonic clonic seizure

Answer 17

may see head or eye deviation (pt. looking away from seizure)

will show figure 4 or fencing posture

Question 18

If a patient demonstrates fencing posture, where is their seizure located

Answer 18

frontal lobe

Question 19

If a patients hand goes up to their face, what does it tell you about the seizure

Answer 19

Tells you which side of the brain the seizure is happening in

hand=side of seizure

Question 20

What are generalized seizures

Answer 20

absence
myoclonic
clonic
tonic
tonic-clonic
atonic

Question 21

What is an absence seizure

Answer 21

sudden behavioral arrest

Question 22

What is a clonic seizure

Answer 22

rhythmic contraction of arms and legs

Question 23

What is an atonic seizure

Answer 23

loss of muscle tone “drop attack”

Question 24

What type of seizures do children typically have

Answer 24

absence seizures
*generally happen in clusters

Question 25

If a myoclonic seizure disorder starts with childhood, what will happen as they grow

Answer 25

They should grow out of it

Question 26

If myoclonic seizures starts in juvenile ages, will they grow out of it

Answer 26

no

Question 27

When are myoclonic seizures most common

Answer 27

morning time upon waking up

Question 28

What happens if a seizure lasts longer than 5 minutes

Answer 28

They probably won't stop on own-> call 911

Question 29

What side is best to turn a person on to and why

Answer 29

left better venous return

Question 30

What is the difference between provocation and triggers

Answer 30

Provoked= things out of the ordinary that cause seizures Trigger= known causes for seizure

Question 31

What is an example of provocation

Answer 31

severe hypoglycemia

Question 32

Which patients will have febrile seizures

Answer 32

children under age 5 -should be primary/general in onset...No prodrome

Question 33

What are medication side effects for anti seizure medications

Answer 33

Balance issues double vision prolonged nystagmus

Question 34

If someone has a "wine stain" on their face, what is it indicative of

Answer 34

brain was effected with seizure and the patient probably needs surgery

Question 35

What is a storage weber sign

Answer 35

a wine stain on the face

Question 36

How would you differentiate between confusion and aphasia

Answer 36

when a patient is aphasic, they can act out a word but cannot think of what it is

Question 37

What is PNES

Answer 37

psychogenic non-epileptic seizures

Question 38

can someone with epilepsy have non-epileptic seizures

Answer 38

Yes

Question 39

What is the most common correlation for PNES

Answer 39

sexual abuse

Question 40

If someone has a prolonged seizure that breaks on its own and they go into status, is this a sign of epilepsy or PNES

Answer 40

PNES

Question 41

What test do you need to truly confirm whether a seizure is epileptic or not

Answer 41

EEG

Question 42

What is the standard of care for seizures if a patient has only had one

Answer 42

avoid typical precipitants if unprovoked Correct imbalance if provoked

Question 43

When should anti-convulsants be used for patients

Answer 43

if they have had 2+ unprovoked seizures

Question 44

What do broad spectrum ASMs treat

Answer 44

generalized and focused epilepsies

Question 45

What do narrow spectrum ASMs treat

Answer 45

only focal epilepsy *may make generalized worse

Question 46

What is the drug of choice for idiopathic generalized epilepsy

Answer 46

Valproic acid *avoid in women of child bearing age

Question 47

When can/should you consider stopping seizure medication

Answer 47

when a patient is seizure free for 2 years

Question 48

What type of birth control should a female be on while taking AEDs

Answer 48

IUD

Question 49

If the risk of seizures outweighs the risk of fetotoxicity, what drug should the mother be put on

Answer 49

Keppra folic acid supplement

Question 50

What are acute repetitive seizures

Answer 50

closely group seizures over minutes to 2 days that increase in frequency

Question 51

What are the 3 types of status epilepticus

Answer 51

tonic clonic focal with impaired consciousness absence

Question 52

What is status epilepticus

Answer 52

continuous seizure activity for at least 5 minutes OR 2+ seizure attacks without recovery of consciousness in between

Question 53

What makes status epilepticus complex

Answer 53

usually a combo of seizure types The longer it goes, the less noticeable it is

Question 54

What is the first like agent for status

Answer 54

4mg IV lorazepam x 2