Seizures

Question 1

seizure

Answer 1

• sudden abnormal, excessive, electrical discharge of neurons
• multiple neurons fire at a rate much faster than normal

Question 2

seizure disorder/epilepsy

Answer 2

• group of neurologic diseases marked by recurring seizures
• does not include seizures from systemic/metabolic problems if they stop when underlying problem is corrected

Question 3

idiopathic generalized epilepsy

Answer 3

seizure disorder with unknown cause

Question 4

metabolic causes of seizure

Answer 4

• acidosis
• electrolyte imbalances
• hypoglycemia
• hypoxemia
• alcohol/barbiturate withdrawal
• dehydration/water intoxication

Question 5

disorders that may cause seizures

Answer 5

• lupus
• diabetes
• hypertension
• sepsis
• heart, lung, liver, kidney diseases

Question 6

3 major classes of seizures

Answer 6

• generalized onset
• focal onset
• unknown onset

Question 7

4 phases of seizure

Answer 7

• prodromal
• aural
• ictal
• postictal

Question 8

5 types of generalized seizures

Answer 8

• tonic-clonic
• tonic
• clonic
• atonic
• absence

Question 9

tonic-clonic seizures

Answer 9

• most common generalized seizure
• pt loses consciousness, falls
• tonic phase: body stiffens
• clonic phase: extremities jerk
• cyanosis, salivation, tongue biting, incontinence

Question 10

tonic seizure

Answer 10

• sudden onset of increased tone in extensor muscles
• occur most often during sleep
• pt will fall if standing
• pt usually stays aware

Question 11

clonic seizure

Answer 11

• loss of awareness and sudden loss of muscle tone, followed by rhythmic limb jerking

Question 12

atonic seizure

Answer 12

• drop attack
• sudden loss of tone, brief LOC
• great risk for head injury

Question 13

absence seizure

Answer 13

• occurs most often in children, rarely beyond adolescence
• occurs most often in girls
• typical: brief staring spell and sudden recovery
• atypical: staring spell accompanied by blinking, jerking movements of lips, repetitive finger movements, may continue into adulthood

Question 14

focal-onset seizures

Answer 14

• begin in 1 hemisphere of the brain in a localized region of the cortex
• cause sensory, motor, cognitive, or emotional manifestations based on the involved area of the brain
• can be motor or nonmotor
• can have awareness or impaired awareness

Question 15

focal seizures: motor

Answer 15

• atonic
• tonic
• clonic
• myoclonic (rapid, irregular, brief jerking)
• automatisms

Question 16

focal seizures: nonmotor

Answer 16

• emotional manifestations
• autonomic symptoms

Question 17

focal awareness seizures - simple

Answer 17

• conscious and alert
• unusual feelings or sensations
• sudden feelings of joy, anger, sadness, nausea
• may taste, hear, smell, see, feel things that aren’t real
• localized twitching

Question 18

focal impaired awareness seizure - complex

Answer 18

• LOC or change in awareness producing dreamlike state
• eyes open, make movement that seem purposeful but cannot interact with others
• may do dangerous/embarrassing things
• after seizure, no memory of actions

Question 19

Psychogenic nonepileptic seizures (PNES)

Answer 19

• triggered by emotional events, not neuronal activity
• requires video-EEG monitoring to diagnose
• Hx of emotional/physical abuse, specific traumatic event common
• Tx: CBT, SSRIs

Question 20

status epilepticus

Answer 20

• state of continuous seizure activity
• any seizure lasting >5 min or occurring so close together that pt cannot recover in between
• neurological emergency
• can occur with any type of seizure
• requires rapid-acting antiseizure drug, usually benzodiazepines (IV lorazepam preferred)

Question 21

complications of convulsive SE (CSE)

Answer 21

• respiratory insufficiency
• hypoxemia
• dysrhythmias
• hyperthermia
• systemic acidosis

Question 22

Refractory SE (RSE)

Answer 22

• continuous seizure activity despite admin of 1st and 2nd line therapy
• high risk for mortality, neuro damage

Question 23

sudden unexpected death in epilepsy (SUDEP)

Answer 23

• most often from tonic-clonic seizures
• more common at night, in those taking multiple seizure meds, in pts with poorly managed seizures

Question 23

diagnostics for seizure disorder

Answer 23

• EEG
• CT
• MRI
  -MRA
• PET scan
• lumbar puncture
• urinalysis
• CBC, metabolic panel

Question 24

Gabapentin (Neurontin)

Answer 24

GABA analog

S/E: ataxia, dizziness, drowsiness, vision changes, weight gain

avoid pregnancy, avoid alcohol

Question 25

pregabalin (Lyrica)

Answer 25

GABA analog

S/E: dizziness, drowsiness, edema, vision problems, weight gain

avoid pregnancy, avoid alcohol

Question 26

phenytoin (Dilantin)

Answer 26

S/E: ataxia, drowsiness, gingival hyperplasia, liver toxicity

avoid alcohol
monitor drug levels, LFTs
maintain good oral hygiene

Question 27

carbamazepine (Tegretol)
oxcarbamazepine (Trileptal)

Answer 27

S/E: bleeding, dizziness, vision problems

avoid grapefruit juice, pregnancy, alcohol

monitor drug levels, LFTs

Question 28

clonazepam

Answer 28

benzodiazepine

S/E: confusion, dizziness, drowsiness

do not d/c abruptly, can develop tolerance, monitor LFTs

Question 29

divalproex (Depakote)

Answer 29

S/E: bleeding, liver toxicity, suicidal thoughts, vision changes

monitor for depression, CBC, LFTs

Question 30

valproic acid (Depakene)

Answer 30

S/E: bleeding, drowsiness

avoid pregnancy

monitor bleeding times, drug levels, LFTs

Question 31

lacosamide (Vimpat)

Answer 31

S/E: dizziness, drowsiness, dysrhythmias, GI distress

avoid alcohol, pregnancy

Question 32

levetiracetam (Keppra)

Answer 32

S/E: dizziness, GI distress, SI

avoid alcohol, monitor for depression

Question 33

topiramate (Topamax)

Answer 33

S/E: ataxia, drowsiness, vision changes

stop if vision changes occur, avoid alcohol, pregnancy