Seizures Flashcards
What percentage of the population will have a seizures during their lifetime?
10%
What is the definition of a simple partial seizure?
a seizure that begins in a focal area of the brain and does not impair awareness.
What is the definition of a complex partial seizure/
a seizure with a focal onset that causes an impairment in awareness
Where is the most common location of onset for a complex partial seizure?
temporal lobe
What are some typical signs of a complex partial seizure?
lip smacking, chewing movements, picking at clothes, etc.
How do generalized tonic-clonic seizures typically start?
with a tonic phase that lasts several seconds in which the entire body becomes stiff, followed by a clonic phase
True or false: the rhythmic jerking of the clonic phase tends to occur asymmetrically in the body.
false - symmetric
What is the classic EEG finding in absence seizures?
three-per-second generalized spike-and-wave pattern
Is an absence seizure focal or generalized?
generalized
What is the most common cause of seizures in children?
febrile
What is the most common cause of seizures in the elderly?
stroke
What genetic cause of seizures will present in childhood with essentially any seizure type, intellectual disability and an EEG with slow (1 to 2/second) spike and wave discharges?
Lennox-Gastaut syndrome
What genetic epilepsy syndrome will present in childhood with simple partial seizures that have a nocturnal preponderance with centrotemporal spikes on an EEG?
benign rolandic epilepsy
What genetic epilepsy syndrome will present in adolescence or young adulthood with myoclonic, absence, or generalized tonic-clonic seizures occurring mainly in the early morning with a 4 to 6/per second polyspike and wave pattern on EEG?
Juvenile myoclonic epilepsy
Todd’s paralysis will typically be seen after what type of seizure?
after a secondarily generalized seizure
What lab abnormality will typically be seen after a tonic clonic seizure?
lactic acidosis with low bicarb
What is the preferred imaging modality in a patient with a first-time seizure?
MRI
What percentage of patients with epilepsy will have their seizures well controlled on monotherapy?
70%
For phenytoin: site of action, seizure type treated, and main side effects?
Na+ channel
partial
gingival hyperplasia, coarsening of facial features, ataxia
For carbamazepine: site of action, seizure type treated, and main side effects?
Na+ channel
partial
hyponatremia, agranulocytosis, diplopia
For valproic acid: site of action, seizure type treated, and main side effects?
Na+ channels, GABA receptor
partial, generalized
GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, thrombocytopenia
For phenobarbital: site of action, seizure type treated, and main side effects?
GABA receptor
partial, generalized
sedation
Ethosuximide: site of action, seizure type treated, and main side effects?
T-type Ca2+ channel
Absence
GI symptoms
Gabapentin: site of action, seizure type treated, and main side effects?
unknown, but possibly a voltage-gated Ca2+ channel
partial
sedation, ataxia
Lamotrigine: site of action, seizure type treated, and main side effects?
NA+ channel, glutamate receptor
partial, generalized
Rash, Stevens-Johnson syndrome
Topiramate: site of action, seizure type treated, and main side effects?
NA+ channel, GABA activity
partial, generalized
word-finding difficulty, renal stones, weight loss, tingling in hands and feet
Tiagabine: site of action, seizure type treated, and main side effects?
GABA reuptake
partial
sedation
Levetiracetam: site of action, seizure type treated, and main side effects?
unknown, but possibly at synaptic vesicles
partial, generalized
insomnia, anxiety, irritability
Oxcarbazepine: site of action, seizure type treated, and main side effects?
Na+ channel
partial
sedation, hyponatremia
Zonisamide: site of action, seizure type treated, and main side effects?
unknown mech of action
partial, generalized
sedation, renal stones, weight loss
What are the management steps for status epilepticus?
- ABCs, check glucose, establish IV access
- 100 mg IV thiamine followed by D50 influsion
- Lorazepam 0.1 mg/kg IV
- Phenytoin 20 mk/kg IV (or fosphenytoin)
- intubate if not already done
- phenobarbital 20 mg/kg IV
- induce coma with barbiturates, midazolam or propofol and institute continuous beside EEG monitoring
Which AED is particularly concerning for birth defects?
valproic acid (neural tube defects)
