Seizures

Question 1

What distinguishes a simple partial seizure from a complex partial seizure?

Answer 1

complex involves alteration in consciousness

simple - often involves positive neurologic signs (e.g. tingling, hallucinations, aura)

Question 2

Describe the progression of a generalized tonic clonic seizure

Answer 2

tonic phase - rigidity in entire body, followed by a clonic phase in which extremities jerk rhythmically

Question 3

Describe the most common causes of seizure depending on age (infants, children, young adults, elderly)

Answer 3

children - febrile
older children - head injury, meningitis
young adults - head injury, alcohol
elderly - metabolic disturbances, strokes

Question 4

A young patient can present with any and all seizure types and has associated intellectual disability. This is..

Answer 4

lennox gastaut

Question 5

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..

Answer 5

benign rolandic epilepsy

Question 6

A young adult presents with myoclonic siezures with an early morning preponderance. EEG shows 4 to 6 per second polyspike. This is..

Answer 6

juvenile myoclonic epilepsy

Question 7

What percentage of epilepsy patients have normal EEG?

Answer 7

50%

Question 8

What is the site of action of dilantin (phenytoin)?

Answer 8

Na channel

Question 9

What types of seizures does phenytoin treat?

Answer 9

partial

Question 10

What are the characteristic side effects of phenytoin?

Answer 10

gingival hyperplasia, ataxia, course facial features

Question 11

What is the site of action of carbamazepine?

Answer 11

Na channel

Question 12

What types of seizures does carbamazepine treat?

Answer 12

partial

Question 13

What are the characteristic side effects of carbamazepine?

Answer 13

hyponatremia, agranulocytosis

Question 14

What is the site of action of valproic acid?

Answer 14

Na channel, GABA

Question 15

What types of seizures does valproic acid treat?

Answer 15

partial and generalized

Question 16

What are the characteristic side effects of valproic acid?

Answer 16

GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, aplastic anemia, congenital malformations

Question 17

What is the site of action of phenobarbital?

Answer 17

GABA receptor

Question 18

What types of seizures does phenobarb treat?

Answer 18

partial and generalized

Question 19

What are the characteristic side effects of phenobarb?

Answer 19

sedation

Question 20

What is the site of action of lamictal?

Answer 20

Na channel, glutamate

Question 21

What kinds of seizures can be treated with lamictal?

Answer 21

partial and generalized

Question 22

What are the characteristic side effects of lamictal?

Answer 22

steven johnson

Question 23

What is the site of action of topamax?

Answer 23

Na and GABA

Question 24

What kind of seizures can be treated with topamax?

Answer 24

partial and generalized

Question 25

What are the characteristic side effects of topamax?

Answer 25

word finding difficulty, kidney stones, weight loss

Question 26

What kinds of seizures can betreatd with keppra?

Answer 26

partial and generalized

Question 27

What are the characteristic side effects of keppra?

Answer 27

insomnia, anxiety, irritability

Question 28

What therapies are available for epileptics that are refractory to medical therapy?

Answer 28

surgery, vagal nerve stimulator

Question 29

What is the algorithm for response to status epilepticus?

Answer 29

``` 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

Question 30

What is the definition of epilepsy?

Answer 30

two unprovoked seizures greater than 24 hours apart

Question 31

What is one potential complication of phenytoin administration in status epilepticus?

Answer 31

Purple glove syndrome

Question 32

What are some risk factors for epilepsy?

Answer 32

prenatal toxin/infection exposure, febrile seizures in infancy, encephalitis as a child, severe head trauma

Question 33

What types of infections are responsible for the most seizures?

Answer 33

viral

Question 34

How can syncope be distinguished from a seizure?

Answer 34

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)

Question 35

Why are tonic clonic seizures dangerous?

Answer 35

can affect diaphragmatic muscles, make it hard to breathe

Question 36

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..

Answer 36

rolandic seizures (benign childhood epilepsy)

Question 37

A patient has staring spells triggered by hyperventilation. EEG shows a generalized 3 Hz spike and wave. This is..

Answer 37

absence seizure

Question 38

A patient presents with myoclonic jerks and a 3Hz spike and wave. This is...

Answer 38

juvenile myoclonic epilepsy

Question 39

A young patient presents with cognitive impairment and EEG suggesting slow spike and wave. This is..

Answer 39

Lennox Gastault

Question 40

A patient presents with complex partial seizures (automatisms), staring. MRI shows mesial temporal sclerosis. This is..

Answer 40

temporal lobe epilepsy

Question 41

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..

Answer 41

frontal lobe epilepsy

Question 42

What are the consequences associated with epilepsy?

Answer 42

self injury, social embarassment, cognitive decline, mortality twice that of general population

Question 43

What are the causes of death in epilepsy?

Answer 43

status epilepticus, accidents, aspiration PNA, SUDEP

Question 44

What general modes of treatment exist for epilepsy?

Answer 44

AEDs, vagus nerve stimulator, resective surgery, ketogenic diet, brain stimulators

Question 45

How does liklihood of response to drug therapy change when you add two drugs? 3 drugs?

Answer 45

at 2 drugs, down to 13%, at 3 drugs, down to 1% - therefore, if not responsive to 2 drugs, not likely responsive

Question 46

What are some of the clues of a psychogenic event vs. an actual seizure?

Answer 46

complicated motor activity, start-stop-start, prolonged, eyes closed forcefully, no no sign,

Question 47

How long should you wait for a seizure before you start treating?

Answer 47

don't wait more than 5 minutes to start

Question 48

What is the therapy recommended for absence seizures?

Answer 48

ethusuximide

Question 49

What is the most common form of seizures in adults?

Answer 49

common partial seizures

Question 50

What seizure drugs in particular interact with OCPs?

Answer 50

carbamazepine really speeds up metabolism of OCPs