Seizures

Question 0

What does a seizure manifest as?

Answer 0

Paroxysmal, stereotyped episodes of altered or diminished consciousness, involuntary movements, or convulsions

Question 1

What is a seizure?

Answer 1

Transient signs and symptoms due to excessive of synchronous neuronal activity of the brain

Question 2

What is the etiology of a seizure?

Answer 2

Idiopathic
Stroke > 60 cause seizure 
Brain tumor in elderly 
Trauma
Medication withdrawal 
Dehydration?

Question 3

What are secondary or provoked seizures?

Answer 3

Metabolic disturbances (sugar, sodium, calcium)
Infections
Focal neurological lesions
Medication withdrawal
Amoeba infections
Toxins (EtOH)

Question 4

What is the diagnostic evaluation of a seizure?

Answer 4

First seizure you get some sort of neuroimaging
EEG in all patients (except febrile seizure in a kid)
LP only if concern for infection
Always CBC
Urine tox
Pregnancy test (epilepsy, meds)

Question 5

What is epilepsy?

Answer 5

Primary seizure disorder
Chronic
Not caused by any secondary, seizure is primary
Characterized by at least 2 unprovoked seizure at least 24 hour apart

Question 6

What mimics a seizure?

Answer 6

Syncope
Psychogenic
Sleep disorders
Movement disorders 
Migraine
TIA
Transient global amnesia

Question 7

What are the two catagories of seizures?

Answer 7

Focal and generalized

Question 8

What kind of seizure presents as conscious and in tact, still somewhat aware and has memory. Can have some sort of focal presentation?

Answer 8

Focal, local (simple partial)

Question 9

What is the overall theme of pathogenesis of seizures?

Answer 9

Increase in glutamate
Decrease in GABA

Increased extra cellular K
Decreased extra cellular Ca or Mg
Changes in permeability of BBB
Imbalance between excitation and inhibitory

Question 10

How do you treat an absence seizure?

Answer 10

Ethosuximide

Bad for clonic-tonic, or partial (focal) seizures

Question 11

How do you treat a partial (focal) and secondarily generalized tonic-clonic seizure?

Answer 11

Carbamazepine

(Make absence or myoclonic seizure worse)

Also phenytoin

Question 12

What is the drug of choice for primary generalized tonic-clonic seizures?

Answer 12

Valproic acid

Worse for all, also bipolar

Question 13

What do you use to treat a myoclonic seizure?

Answer 13

Levetiracetam

But primarily for focal

Question 14

What is the primary therapy for focal seizures?

Answer 14

Levetiracetam

Question 15

What do you treat with topirimate?

Answer 15

Focal and primarily generalized seizures