Seizures Flashcards
What distinguishes a simple partial seizure from a complex partial seizure?
complex involves alteration in consciousness
simple - often involves positive neurologic signs (e.g. tingling, hallucinations, aura)
Describe the progression of a generalized tonic clonic seizure
tonic phase - rigidity in entire body, followed by a clonic phase in which extremities jerk rhythmically
Describe the most common causes of seizure depending on age (infants, children, young adults, elderly)
children - febrile
older children - head injury, meningitis
young adults - head injury, alcohol
elderly - metabolic disturbances, strokes
A young patient can present with any and all seizure types and has associated intellectual disability. This is..
lennox gastaut
A young patient presents with simple partial seizures involving the mouth and face with a preponderance for noctural seizures. EEG shows centrotemporal spikes. This is..
benign rolandic epilepsy
A young adult presents with myoclonic siezures with an early morning preponderance. EEG shows 4 to 6 per second polyspike. This is..
juvenile myoclonic epilepsy
What percentage of epilepsy patients have normal EEG?
50%
What is the site of action of dilantin (phenytoin)?
Na channel
What types of seizures does phenytoin treat?
partial
What are the characteristic side effects of phenytoin?
gingival hyperplasia, ataxia, course facial features
What is the site of action of carbamazepine?
Na channel
What types of seizures does carbamazepine treat?
partial
What are the characteristic side effects of carbamazepine?
hyponatremia, agranulocytosis
What is the site of action of valproic acid?
Na channel, GABA
What types of seizures does valproic acid treat?
partial and generalized
What are the characteristic side effects of valproic acid?
GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, aplastic anemia, congenital malformations
What is the site of action of phenobarbital?
GABA receptor
What types of seizures does phenobarb treat?
partial and generalized
What are the characteristic side effects of phenobarb?
sedation
What is the site of action of lamictal?
Na channel, glutamate
What kinds of seizures can be treated with lamictal?
partial and generalized
What are the characteristic side effects of lamictal?
steven johnson
What is the site of action of topamax?
Na and GABA
What kind of seizures can be treated with topamax?
partial and generalized
What are the characteristic side effects of topamax?
word finding difficulty, kidney stones, weight loss
What kinds of seizures can betreatd with keppra?
partial and generalized
What are the characteristic side effects of keppra?
insomnia, anxiety, irritability
What therapies are available for epileptics that are refractory to medical therapy?
surgery, vagal nerve stimulator
What is the algorithm for response to status epilepticus?
ABCs, check glucose give IV thiamine, then dextrose lorazepam 0.1mg/kg give another dose fosphenytoin 20mg/kg
phenobarb 20mg/kg - intubate
induce coma with propofol
What is the definition of epilepsy?
two unprovoked seizures greater than 24 hours apart
What is one potential complication of phenytoin administration in status epilepticus?
Purple glove syndrome
What are some risk factors for epilepsy?
prenatal toxin/infection exposure, febrile seizures in infancy, encephalitis as a child, severe head trauma
What types of infections are responsible for the most seizures?
viral
How can syncope be distinguished from a seizure?
in both can convulse, but with syncope you rarely lose control of bowels and you usually come back more quickly. seizures are also the same way every time (stereotyped)
Why are tonic clonic seizures dangerous?
can affect diaphragmatic muscles, make it hard to breathe
A child comes out of sleep with hemifacial sensorimotor involvement and spread to the ipsilateral hand. EEG shows bilateral centrotemporal spikes activated by sleep. This is..
rolandic seizures (benign childhood epilepsy)
A patient has staring spells triggered by hyperventilation. EEG shows a generalized 3 Hz spike and wave. This is..
absence seizure
A patient presents with myoclonic jerks and a 3Hz spike and wave. This is…
juvenile myoclonic epilepsy
A young patient presents with cognitive impairment and EEG suggesting slow spike and wave. This is..
Lennox Gastault
A patient presents with complex partial seizures (automatisms), staring. MRI shows mesial temporal sclerosis. This is..
temporal lobe epilepsy
A patient presents with stereotypical thrashing that wakes him up from sleep. He is believed to have a psychiatric disorder but he respond to AEDs. This is..
frontal lobe epilepsy
What are the consequences associated with epilepsy?
self injury, social embarassment, cognitive decline, mortality twice that of general population
What are the causes of death in epilepsy?
status epilepticus, accidents, aspiration PNA, SUDEP
What general modes of treatment exist for epilepsy?
AEDs, vagus nerve stimulator, resective surgery, ketogenic diet, brain stimulators
How does liklihood of response to drug therapy change when you add two drugs? 3 drugs?
at 2 drugs, down to 13%, at 3 drugs, down to 1% - therefore, if not responsive to 2 drugs, not likely responsive
What are some of the clues of a psychogenic event vs. an actual seizure?
complicated motor activity, start-stop-start, prolonged, eyes closed forcefully, no no sign,
How long should you wait for a seizure before you start treating?
don’t wait more than 5 minutes to start
What is the therapy recommended for absence seizures?
ethusuximide
What is the most common form of seizures in adults?
common partial seizures
What seizure drugs in particular interact with OCPs?
carbamazepine really speeds up metabolism of OCPs
