SEIZURES

Question 1

Causes of nonepileptic seizures

Answer 1

Extreme metabolic disruption from systemic disease
A deficiency state
Local effects of a brain tumor
Withdrawal from sedative/hypnotic drugs including ethanol
Infection
Renal failure
Hypoxic encephalopathy
Febrile convulsions

Question 2

How do epileptic seizures happen?

Answer 2

A group of abnormal neurons in the epileptogenic foci spontaneously depolarize and the foci will recruit normal neurons –> seizure

Question 3

Details about seizure activity patterns

Answer 3

Consists of a set of sensory, mental, and/or motor activities that are fairly consistent for a given individual

Question 4

Partial seizures begin at…

Answer 4

…discrete and relatively limited focus

Question 5

The pattern of partial seizures depends on what?

Answer 5

The area stimulated

Question 6

Focal motor without march definition

Answer 6

Twitching limited in one area and doesn’t spread

Question 7

Focal motor with march definition

Answer 7

Twitching starts in one area and spreads

Question 8

Characteristics of a simple partial seizure

Answer 8

Has limited spread. Uncomplicated, affects only limited aspects of neural function, has motor or sensory symptoms

(The example Gengo gave in lecture where the patient said the room smelled weird but Gengo said it was fine, the patient realized they had a simple partial seizure)

Question 9

Are consciousness and memory disturbed in a simple partial seizure?

Answer 9

No

Question 10

Characteristics of complex partial seizures

Answer 10

Alteration of consciousness follows initial simple seizure. May appear alert and aware but consciousness impaired
Typically appears confused or preoccupied
May exhibit automatisims: purposeless and automatic behaviors (lip smacking, sucking, fumbling with clothing, etc.)

Question 11

Where do complex partial seizures usually arise?

Answer 11

Temporal lobe

Question 12

Feature of a generalized seizure (in regard to how much of the brain is involved)

Answer 12

Can’t be linked to a single foci, involves entire cerebrum. Includes seizures that vary immensely in terms of severity and amount of brain tissue recruited

Question 13

Absence seizure features

Answer 13

Minor impairment of neural function because of short duration
Blank stare or other facial expression indicates impaired consciousness
2-10 seconds later- resumes pre-seizure activity
Disruption in intentional behavior, consciousness, and memory but not posture, muscle tone, or ongoing automatic behavior (walking)
May include lip smacking, pouting, eye blinking
Can occur 100s of times/day

Question 14

When do simple absence seizures occur?

Answer 14

Childhood and adolescence, begins in childhood and peaks at 6-7 y/o

Question 15

Do simple absence seizures resolve?

Answer 15

Yes, they usually go away when the CNS matures but may progress to generalized tonic-clonic seizures

Question 16

Feature of a tonic-clonic seizure (in regard to how much of the brain is involved)

Answer 16

All brain systems can be recruited into paroxysmal discharge

Question 17

3 phases of a tonic-clonic seizure

Answer 17

Tonic phase
Clonic phase
Terminal phase

Question 18

Tonic phase features

Answer 18

Brief period of muscle flexing followed by 10-15 seconds of pronounced extension, bladder may empty, breathing stops, pupils unresponsive to light
End indicated by short period of muscle tremor

Question 19

Clonic phase features

Answer 19

Onset indicated by initial muscle relaxation
Violent spasms of contraction and relaxation
Strongest muscles dominate- elbow flexion, leg extension, torso hyperextension
Respiration resumes but ineffective- cyanosis
Heavy saliva secretion and blood from bitten tongue → froth of blood in mouth

Question 20

Terminal phase

Answer 20

Limp and quiet with normal breathing
May be followed by several hours of deep sleep or may become conscious with no recollection of seizure

Question 21

Seizure definition

Answer 21

uncontrolled electrical activity in the brain, that can produce a physical convulsion, minor physical signs, thought disturbances, or a combination of these symptoms

Question 22

Epilepsy definition

Answer 22

condition characterized by a relatively long-term disturbance of brain structures and/or function that produces an increased susceptibility to seizures

Question 23

Difference between a person who has epilepsy vs. seizures

Answer 23

Everyone who has epilepsy has seizures, but not everyone who has a seizure has epilepsy

Question 24

Common causes of seizures in adults 20-50 y/o

Answer 24

Possible it could be from underlying causes like metabolic imbalances, toxicity, hemodynamic instability, psychogenic (patient thinks they’re having a seizure but they’re really not)

Question 25

Common causes of seizures in adults >50 y/o

Answer 25

Usually from a tumor, bleeding, infection, fibrosis secondary to a stroke that occurred 6-12 months earlier…usually don’t have a good prognosis

Question 26

Seizure history

Answer 26

When was your first seizure?
How often do you have seizures?
When was your most recent seizure?
What did you do, or eat, or take the day of your most recent seizure?
What anticonvulsant medications have you used in the past?
What medications are you currently taking in addition to the anticonvulsant?
Medication-specific questions regarding toxicity
Determine relevant counseling points for this patient and their specific medications
Be sure patient understands the goal of therapy

Question 27

Management of epilepsy

Answer 27

Control with one drug, only go to polytherapy only after several drugs have failed

Question 28

Goal of epilepsy therapy

Answer 28

Reduce the number of seizures (NOT GET RID OF THEM ENTIRELY) and have the patient experience the least amount of side effects

Question 29

Favorable outcomes of seizure therapy

Answer 29

Seizure free >3 years
Monotherapy
Background EEG normal
No psychomotor retardation
No juvenile myoclonic epilepsy

Question 30

Who should diagnose epilepsy?

Answer 30

A NEUROLOGIST

Question 31

What to do if a pregnant patient has seizures and needs therapy

Answer 31

Use AED monotherapy if necessary at the lowest dose

Question 32

AEDs to avoid in pregnancy

Answer 32

Lamotrigine
VPA+CBZ+PB polytherapy
Avoid VPA and CBZ but if not, use lower divided doses

Question 33

Patients taking OCs but also have seizures

Answer 33

Divalproex has no effect on OC efficacy

Question 34

What medications decrease OC effectiveness and why?

Answer 34

phenobarbital, phenytoin, primidone, carbamazepine all decrease it because they increase the CL of estrogen

Question 35

AEDs that are CI’ed in breastfeeding

Answer 35

Ethosuximide, zonisamide, clonazepam, diazepam