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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

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

A

complex involves alteration in consciousness

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

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2
Q

Describe the progression of a generalized tonic clonic seizure

A

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

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3
Q

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

A

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

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4
Q

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

A

lennox gastaut

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5
Q

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..

A

benign rolandic epilepsy

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6
Q

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

A

juvenile myoclonic epilepsy

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7
Q

What percentage of epilepsy patients have normal EEG?

A

50%

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8
Q

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

A

Na channel

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9
Q

What types of seizures does phenytoin treat?

A

partial

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10
Q

What are the characteristic side effects of phenytoin?

A

gingival hyperplasia, ataxia, course facial features

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11
Q

What is the site of action of carbamazepine?

A

Na channel

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12
Q

What types of seizures does carbamazepine treat?

A

partial

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13
Q

What are the characteristic side effects of carbamazepine?

A

hyponatremia, agranulocytosis

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14
Q

What is the site of action of valproic acid?

A

Na channel, GABA

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15
Q

What types of seizures does valproic acid treat?

A

partial and generalized

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16
Q

What are the characteristic side effects of valproic acid?

A

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

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17
Q

What is the site of action of phenobarbital?

A

GABA receptor

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18
Q

What types of seizures does phenobarb treat?

A

partial and generalized

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19
Q

What are the characteristic side effects of phenobarb?

A

sedation

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20
Q

What is the site of action of lamictal?

A

Na channel, glutamate

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21
Q

What kinds of seizures can be treated with lamictal?

A

partial and generalized

22
Q

What are the characteristic side effects of lamictal?

A

steven johnson

23
Q

What is the site of action of topamax?

A

Na and GABA

24
Q

What kind of seizures can be treated with topamax?

A

partial and generalized

25
Q

What are the characteristic side effects of topamax?

A

word finding difficulty, kidney stones, weight loss

26
Q

What kinds of seizures can betreatd with keppra?

A

partial and generalized

27
Q

What are the characteristic side effects of keppra?

A

insomnia, anxiety, irritability

28
Q

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

A

surgery, vagal nerve stimulator

29
Q

What is the algorithm for response to status epilepticus?

A 
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

30
Q

What is the definition of epilepsy?

A

two unprovoked seizures greater than 24 hours apart

31
Q

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

A

Purple glove syndrome

32
Q

What are some risk factors for epilepsy?

A

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

33
Q

What types of infections are responsible for the most seizures?

A

viral

34
Q

How can syncope be distinguished from a seizure?

A

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)

35
Q

Why are tonic clonic seizures dangerous?

A

can affect diaphragmatic muscles, make it hard to breathe

36
Q

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..

A

rolandic seizures (benign childhood epilepsy)

37
Q

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

A

absence seizure

38
Q

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

A

juvenile myoclonic epilepsy

39
Q

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

A

Lennox Gastault

40
Q

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

A

temporal lobe epilepsy

41
Q

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..

A

frontal lobe epilepsy

42
Q

What are the consequences associated with epilepsy?

A

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

43
Q

What are the causes of death in epilepsy?

A

status epilepticus, accidents, aspiration PNA, SUDEP

44
Q

What general modes of treatment exist for epilepsy?

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

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

A

don’t wait more than 5 minutes to start

48
Q

What is the therapy recommended for absence seizures?

A

ethusuximide

49
Q

What is the most common form of seizures in adults?

A

common partial seizures

50
Q

What seizure drugs in particular interact with OCPs?

A

carbamazepine really speeds up metabolism of OCPs

Neurology (24 decks)

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