Seizures

Question 0

Atonic seizure

Answer 0

Generalized
Brief loss of muscle tome
May involve all musculature resulting in fall
May only involve nuchal musculature resulting in head drop
Use helmet

Question 1

Overall generalized seizure characteristics

Answer 1

Entire brain
No aura-no warning
Postictal confusion-not absence or myoclonic
Bowel or bladder incontinence
Lateral tongue trauma
EEG-spike and slow wave discharges across all recording electrodes simultaneously

Question 2

Absence seizure

Answer 2

Generalized seizure 
Pediatric epilepsy syndrome 
Resolves by adolescence 
Staring spell lasts 5-15 seconds 
Provoked by hyperventilation-diagnose 
No Postictal state 
EEG-Classic 3/second spike and slow wave discharges 

Treatment: ethosuximide,valproic acid, lamotrigine

Question 3

Myoclonic seizures

Answer 3

Generalized seizure
3 types: tonic clinic, myoclonic, staring spells

Adults:
Associated with anoxic injuries to brain

Treat with valproic acid, lamotrigine, levitiracetam, Topiramate

Question 4

Overall Focal seizures characteristics

Answer 4

Partial seizure
Most commonly in medial temporal lobe
May have aura-smells, sights, voices

parietal= pain
occipital=unformed visual hallucinations: spots and zig zags
Temporal=formed visual hallucinations: actual objects
Frontal=motor activity, vocalizations, speech arrest

Simple
No alteration of consciousness
No postictal state
motor, sensory, autonomic, psychic (deja vu)

Complex
Alteration in level of consciousness 
May have an aura
Postictal confusion 
May have automatisms

EEG-spike and slow wave in focal area of recording electrodes

Treatment for all:
Carbamazepine, phenytoin, lamotrigine,
Add on: Topiramate, levitiracetam, gabapentin, pregabalin and zonisamide

Question 5

Motor focal seizure

Answer 5

Tonic or clinic movements

Versive head or eye movements away from the side of the seizure

Question 6

Autonomic focal seizure

Answer 6

Gustatory
Olfactory
Epigastric fullness
Nausea

Question 7

Sensory focal seizures

Answer 7

Positive phenomena
Parathesias/dyathesias
Visual hallucinations

Question 8

Psychic focal seizures

Answer 8

Déjà vu

Depersonalization

Question 9

Febrile seizure

Answer 9

Associated with quickly acquiring high temp
Seen in children 6 months to 6 years old
Treatment: treat fever
Runs in families

Simple: no focal features to seizure
No increased risk of epilepsy

Complicated:
Focal features, increased risk of epilepsy

Question 10

Status epilepticus

Answer 10

Recurrent or prolonged seizures; failure to return to baseline in between seizures
Causes: missed anticonvulsants-most common
Structural lesions-tumor, infection, stroke

Complications: hypertension, tachycardia, arrhythmias, lactic acidosis

Treatment: ABCs-metabolic issues 
1st step: IV benzodiazepines-lorazepam
2nd step: IV anticonvulsant-phenytoin, 
Still seizing: phenoarbital
still seizing: intubate and give anesthesia (midolzolam, propofol)

Question 11

Juvenile Myoclonic Epilepsy

Answer 11

Juvenile myoclonic epilepsy-most common inherited seizure
JME-EEG generalized poly spike and slow wave discharges and photic sensitive
Lifetime duration

Otherwise healthy but present during adolescence with myoclonic seizure

Preservation of consciousnesss

Occur in first hour of waking and provoked by sleep deprivation

Treat with: valproic acid, lamatrigin, levetriacetam and topirimate

Question 12

Epilepsy

Answer 12

Disorder of recurrent seizures

Give primidone

Question 13

Tonic clonic

Answer 13

Alternating stiffening and movement

Question 14

Tonic seizure

Answer 14

stiffening