SEIZURES

Question 0

What is the difference between focal and generalized seizures?

Answer 0

Focal affects 1 hemisphere

Generalized affects both.

Question 1

What is a seizure? What is a simple pathology behind it?

Answer 1

Episode of neurological dysfunction

General result of imbalance between excitation and inhibition in CNS.

Question 2

What is epilepsy?

Answer 2

2 or more unprovoked seizures

Question 3

What is status epilepticus?

Answer 3

Seizure continuously occurring for 30 minutes

Question 4

Causes of provoked seizures?

Answer 4

Infection, systemic
Iatrogenic
- TCA
- antipsychotics
- benzodiazepines
- cocaine

Endocrine-metabolic disorders

• BGL
• electrolyte imbalance (Na, Ca)

Neurological

• stroke
• SOL
• TBI

Question 5

How do you classify seizures?

Answer 5

Partial

• simple (conscious)
• complex (unconscious)

Generalized

• absence (stops talking mid sentence and states)
• tonic clinic (LOC, stiff limbs then jerking)
• myoclonus (sudden jerking of limbs)
• atonic (sudden loss of muscle tone)

Question 6

Features of partial seizures in frontal, parietal, temporal and occipital lobes?

Answer 6

Frontal

• motor: posturing, Jacksonian March,
• dysphasia
• post-ictal Todd’s palsy

Occipital
- visual phenomena such as spots, lines or flushes

Parietal

• sensory disturbances: tingling, numbness, pain
• motor Sx

Temporal lobe

• automatisms: repetitive stereotyped movements (lip snacking, hand fumbling)
• memory phenomena (déjà vu)
• hippocampal involvement

Question 7

Ix for seizures?

Answer 7

CBE EUC LFT CRP BGL URINALYSIS
Toxic screen
If on anti-epileptics drug levels

Rad

• CT head
• MRI
• EEG

Question 8

Long term Rx?

Answer 8

If single unprovoked seizure depends on likelihood of reoccurrence.

If acute provoked

• treat underlying cause
• cease antiepileptics after recovery unless cause associated with enduring seizure tendency (e.g. Strike, TBI, meningitis)

1st line antiepileptics all the same

• partial: carbamazepine
• GTCS: valproate
• absence: valproate
• myoclonus: valproate

Levitiracetam is good

Question 9

Side effects of sodium valproate?

Answer 9

VALPROATE
Appetite increase, weight gain 
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity, tremor, thrombocytopenia
Encephalopathy

Question 10

Short term Rx?

Answer 10

Clear the area, prevent harm
Assess and clear airways (oropharyngeal or nasopharyngeal)
Breathing - O2 mask

Once seizures over assess ABCs again.

EEG

If not stopping consider benzodiazepines