Seizures

Question 1

What are Generalized (Grand Mal) Tonic-Clonic Seizures?

Answer 1

• Rigid (Tonic phase) -> Pt falls -> Tonic phase subsides -> Incr coarse movements -> symmetric jerking (clonic phase)
• Last 60-90sec
• Always lose consciousness if generalized

Question 2

Absence seizures are MC in which age group?

Answer 2

Childhood (4-10yo)

usu resolved by early puberty (20yo)

Question 3

Simple partial vs Complex partial seizures?

Answer 3

• Simple partial = NO altered cosciousness
• Complex partial = impaired consciousness
• BOTH = local/focal seizures

Question 4

______ Seizures are sometimes referred to as “temporal lobe seizures” bc they often caused by focal discharge in temporal lobe

Answer 4

Complex partial seizures

Question 5

_____ seizures often cause unilateral tonic muscle stiffness limited to one extremity. NO altered consciousness

Answer 5

partial seizures

Question 6

What autoimmune condition has incr risk for seizures?

Answer 6

Lupus

Question 7

Is Hyper or Hypo Thyroidism a risk factor for seizures?

Answer 7

HYPERTHYROID (HIGH Thyroxine T4)

Question 8

What tyoe of trauma is most likely to cause a seizure?

Answer 8

Epidural or subdural HEMATOMA

Question 9

MC epilepsy syndrome in children?

Answer 9

Childhood ABSENCE epilepsy

Question 10

MC tumor to cause seizures?

Answer 10

GLIOBLASTOMA

Question 11

Which drugs have a seizure risk?

“METABOLICS” acronym -_-

Answer 11

• Metronidazole
• ETOH W/D
• TCAs
• Amphetamines (Ritalin, Aderall)
• Benzos W/D & Bupropion (Welbutrin)
• Opiates (tramadol)
• Lithium
• Isoniazid
• Cocaine
• Salicylate
• Everything else = Eclampsia & Elevated Temp -> febrile Sz in kids

Question 12

Pt with sussy encephalitis is having multiple seizures. Before you send them for a Lumbar Puncture, get a _____

Answer 12

HEAD CT W/O Contrast to r/o bleed

Question 13

Tx for active Seizure

Answer 13

PICK 1
- Lorazepam
- Diazepam

PICK 1
- Fosphenytoin
- #1 Phenytoin (Dilantin) -> monitor for poss cardiac arrhythmias
- Levetiracetam

Question 14

WU for 1st seizure

Answer 14

• POC Gluc, CMP, Lactate, PRL, Mg, HCG, Tox, Anticonvulsant drug levels
• PT/INR/PTT if on anticoagulants
• LP if febrile, immunocomp, sussy bleed (get CT first)
• MRI if sussy tumor
• EEG (absence = polyspike)

Question 15

Refractory Siezure Tx

Answer 15

• Midazolam (Nayzilam)
• Propofol (Diprrivan) -> MUST INTUBATE

Question 16

Tx for ABSENCE Seizures?

Answer 16

Ethosuximide (Zarontin) -> Monitor CBC, LFTs (Thrombocytopenia)

Question 17

What is Todd’s Paralysis?

Answer 17

A transient focal deficit (usu unilateral) following a simple or complex focal seizure that should be resolved in 48Hrs

Question 18

Febrile seizures are MC in which age group? What is the #1 ET?

Answer 18

Kids (6mo - 6yo)
Roseola (HPV 6)

Question 19

9mo old boy has febrile seizure with no ET found. No immunization Hx. Order a ______

Answer 19

lumbar puncture

Question 20

Seizure Tx: Lifestyle modifications

Answer 20

Avoid triggers (ETOH, Sleep deprivation)