Seizures

Question 1

when are seizures more prevalent during the lifespan?

Answer 1

early childhood and late adulthood

Question 2

do you lose consciousness in a simple partial seizure?

Answer 2

no

Question 3

do you lose consciousness in a complex partial seizure?

Answer 3

yes

Question 4

may be motor, sensory, autonomic, psychic but without loss of consciousness

Answer 4

simple partial seizures

Question 5

what do simple partial seizures usually look like?

Answer 5

clonic with repetitive flexion/extension

Question 6

what is it called when motor activity begins distally, then spreads to the whole extremity?

Answer 6

jacksonian march

Question 7

what is it called when there is a local paresis that lasts minutes to hours?

Answer 7

todd’s paralysis

Question 8

what is it called when a seizure lasts hours to days?

Answer 8

epilepsia partialis continua

Question 9

what other symptoms can you have during a simple partial seizure?

Answer 9

changes in somatic sensations, vision, equilibrium, ANS, and odd feelings

Question 10

what is it called when focal activity progresses to loss of contact with the environment (e.g. a stare or amnesia)?

Answer 10

complex partial seizure

Question 11

what are the stages of a complex partial seizure?

Answer 11

1. aura of “feeling funny”
2. ictal stage with involuntary behaviors
3. post ictal confusion

Question 12

how long does a complex partial seizure last

Answer 12

seconds to hours

Question 13

what type of seizure is a complex partial seizure, and where in the brain is it most likely to occur?

Answer 13

tonic-clonic;

frontal lobe

Question 14

are both hemispheres involved with a simple partial seizure?
what about a complex partial seizure?

Answer 14

no with simple;

yes with complex

Question 15

what is it called when electrical impulses occur simultaneously in both brain hemispheres?

Answer 15

generalized seizure

Question 16

which type of generalized seizure is a brief LOC without loss of postural control that usually lasts a few seconds

Answer 16

absence seizure (petit mal)

Question 17

when do absence seizures usually occur in the lifespan?

Answer 17

onset in childhood and remisses in childhood

Question 18

what is different about an atypical absence seizure?

Answer 18

symptoms last longer, may have more motor features, may be associated with another brain abnormality (like a delay), and are harder to treat

Question 19

which type of seizure is most common when due to a metabolic derangement?

Answer 19

generalized tonic-clonic seizure (grand mal)

Question 20

are patients more or less likely to have an aura with a generalized tonic-clonic seizure?

Answer 20

less likely - usually happens suddenly

Question 21

what are the symptoms of a tonic-clonic seizure?

Answer 21

tonic activity, a change in respiration (e.g. cyanosis), sympathetic symptoms.
then clonic activity, a post-ictal state (unresponsive) and a post-seizure state (HA, aches)

Question 22

what does an EEG look like during the tonic phase of a seizure?

Answer 22

increased low voltage with high amplitude spikes

Question 23

what does an EEG look like during the clonic phase of a seizure?

Answer 23

spike and wave activity

Question 24

which type of seizure involves a loss of motor tone for 1-2 seconds, followed by a brief LOC without post-ictal confusion?

Answer 24

atonic seizures

Question 25

which type of seizure involves a brief contraction or jerk and is seen in brain injuries?

Answer 25

myoclonic seizures

Question 26

what type of seizure in adolescence involves a bilateral jerk with maintained consciousness, is benign, and is worse when sleepy?

Answer 26

juvenile myoclonic epilepsy

Question 27

which type of seizure is seen in children with developmental delay, trauma, infx, or neural injuries and is usu. associated with impaired cognitive fn?

Answer 27

lennox gastaut syndrome

Question 28

with which seizure will you see hippocampal sclerosis on MRI?

Answer 28

mesial temporal lobe epilepsy

Question 29

the influx of what two ions might induce seizures?

Answer 29

Ca and Na

Question 30

what type of seizure occurs in 3mo-5y/os, is usually recurrent, and is associated with infections?

Answer 30

febrile seizures

Question 31

what are the causes of seizures if the onset is in adulthood?

Answer 31

CVA (50%!), 
trauma, 
CNS tumors, 
degen diseases, 
medical problems

Question 32

when you get an EEG, what is a montage?

Answer 32

you assess brain waves in different situations

Question 33

what level might be elevated in the first 30 mins of a seizure?

Answer 33

prolactin

Question 34

what is a psychogenic seizure?

Answer 34

not epileptic behavior, but seen with stress.

involves head turning, twitching, shaking, pelvic thrust, and no LOC

Question 35

which meds are first line for seizures?

Answer 35

phenytoin [dilantin],
valproic acid [depakote],
carbamazepine [tegretol]

Question 36

what 3 conditions is gabapentin [neurontin] used for?

Answer 36

partial seizures,
post herpetic neuralgia,
neuropathic pain

Question 37

what 5 conditions do you use pregabalin [lyrica] for?

Answer 37

partial seizures, 
post herpetic neuralgia, 
neuropathic pain in diabetes, 
neuropathic pain in spinal cord, 
fibromyalgia

Question 38

which drug has hirsituism (or whatever) as a side effect?

Answer 38

phenytoin

Question 39

when should you stop a seizure drug treatment?

Answer 39

if pt is low risk, had one seizure and then was seizure free, has a normal exam and a normal EEG

Question 40

status epilepticus is a medical emergency - what causes it?

Answer 40

metabolic problems, drugs, CNS infx or tumor, head injury, refractory epilepsy

Question 41

what are the normal aspects of the status epilepticus?

Answer 41

may range from T-C seizure to more subtle movements (like eye movement)

Question 42

what aspects of a status epilepticus make it a medical emergency?

Answer 42

CV implications, hyperthermia, metabolic derangements, and CNS injury may occur

Question 43

how do you treat status epilepticus?

Answer 43

benzos, diazepam, midazolam.
phenytoin.
phenobarbitol.
anesthesia.

Question 44

what kinds of surgery could you perform for refractory epilepsy?

Answer 44

temporal lobectomy,
focal lesion removal,
corpus callosectomy

Question 45

what surgery can you do to increase the seizure threshold?

Answer 45

vagal nerve stimulator