Seizures

Question 1

define epilepsy

Answer 1

• a condition in which a person has recurrent sz due to a chronic, underlying process
  
  • at least 2-3 sz w/o clear precipitating factors

Question 2

interictal

Answer 2

• between seizures

Question 3

clonic

Answer 3

• repetitive, flexion/extension movements

Question 4

tonic

Answer 4

• rigid posturing, continuous muscle tension

Question 5

epileptogenic

Answer 5

• factors that lower one’s sz threshold

Question 6

epileptiform

Answer 6

• having the appearance of sz activity

Question 7

list the types of partial sz

Answer 7

• simple partial
• complex partial
• partial with secondary generalization

Question 8

list types of generalized sz

Answer 8

• absence
• generalized tonic clonic
• myoclonic
• atonic
• tonic

Question 9

partial seizures arise from what area of the brain

Answer 9

• focal area

Question 10

differentiate between simple partial and complex partial sz

Answer 10

• simple: no alteration of consciousness
• complex: impaired consciousness

Question 11

jacksonian seizure

Answer 11

• type of simple partial sz
• clonic movements starting in hand or foot and progressing to involve whole limb

Question 12

todd’s paralysis

Answer 12

• focal weakness in a part of the body after a seizure.
• typically affects appendages and is localized to either the left or right side of the body
• usually subsides completely within 48 hours

Question 13

simple partial sz in temporal lobe usually presents as

Answer 13

• deja vu
• epigastric discomfort

Question 14

describe complex partial sz

Answer 14

• combination of focal motor and focal sensory activity with alteration of consciousness

Question 15

automatisms

Answer 15

• involuntary, automatic behaviors
  
  • e.g chewing, lip smacking, swallowing, hand movements, emotional outburst

Question 16

define generalized seizures

Answer 16

• bilateral generalized electrical discharge arising from both cerebral hemispheres simulataneously

Question 17

which sz is characterized by a sudden brief loss of consciousness lasting only a few seconds without loss of postural control

Answer 17

absence “petit mal”

Question 18

absence “petit mal” sz may be confused with

Answer 18

daydreaming

Question 19

is absence “petit mal” associated with postictal confusion

Answer 19

no, consciousness returns promptly

Question 20

during a absence “petit mal”, pt is absent to during the attack

Answer 20

higher cortical function

Question 21

most common type of sz due to metabolic syndromes

Answer 21

tonic-clonic “grand mal”

Question 22

describe tonic clonic sz

Answer 22

1. sudden loss of consciousness
2. tonic phase (10-40 sec): body rigid
3. clonic phase (30 sec - 3 min): muscles relax and contract, lose bowel/bladder control
4. postictal phase (min to hours)

Question 23

define status epilepticus

Answer 23

• continuous sz, or recurrence without regaining consciousness

Question 24

status epilepticus is a medical emergency and can lead to

Answer 24

• cardiorespiratory dysfunction
• metabolic derangement
• hyperthermia
• irreversible brain damage after 2 hr

Question 25

which type of sz presents as sudden, brief generalized muscular contraction of limbs and trunk

Answer 25

* generalized myoclonic sz

Question 26

generalized myoclonic sz is most commonly seen in what conditions

Answer 26

* metabolic disorders * degenerative CNS disease * anoxic brain injury

Question 27

what are atonic seizures

Answer 27

* **sudden loss of postural tone lasting 1-2 sec** * consciousness briefly impaired, no postictal confusion * may cause brief drop of head or nodding movement * longer -\> fall to ground

Question 28

what are some drugs that lower sz threshold

Answer 28

* theophylline: PDE inhibitor * anticonvulsants

Question 29

why should serum magnesium level be ordered in pt presenting with sz

Answer 29

low magnesium -\> sz

Question 30

key diagnostic test for sz

Answer 30

EEG

Question 31

immediate treatment of acute sz

Answer 31

* ABC * do no try to put anything in patient's mouth * **turn pt on side, protect head**

Question 32

acute treatment of status epilepticus

Answer 32

* IV **lorazepam** or diazepam + * IV **phenytoin**

Question 33

acute treatment of status epilepticus that continue after lorazepam and phenytoin tx

Answer 33

1. add phenobarbital 2. midazolam

Question 34

Antiepileptic drugs therapy is almost always started with how many drugs

Answer 34

* **single drug** * **​**titrated upward

Question 35

first line drugs for partial seizuers

Answer 35

* carbamazepine * phenytoin * valproic acid

Question 36

first line drugs for generalized tonic-clonic

Answer 36

* valproic acid * carbamazepine * phenytoin

Question 37

first line drugs for absence seizuers

Answer 37

* ethosuximide * valproic acid

Question 38

first line drugs for myoclonic seizuers

Answer 38

* valproic acid

Question 39

first line drugs for atonic seizuers

Answer 39

* valproic acid

Question 40

what is vagal nerve stimulation

Answer 40

* tx of refractory partial sz * implantable pacemaker-like device