Seizures

Question 1

Epileptic Seizures

Answer 1

result from abnormal discharges in cerebral cortex generated by cortical neurons
Idiopathic, symptomatic or myoclonic (sub-cortical focus)

Question 2

Epilepsy Morbidity

Answer 2

Recurrent, unprovoked seizures
Head trauma/body injury
Social ostracism
Learning/behavior difficulty
Endocrine/pregnancy
TX side effects
Osteoporosis
Death (SUDEP) - 1% - seizures affect HR, RR in sleep

Question 3

Generalized Seizure

Answer 3

Whole brain
Tonic - stiff
Clonic - rhythmic jerking
Tonic-clonic - should lose consciousness
Absence - zone out (kids) - 3 spike, 3 slow per second (EEG)
Myoclonic - symptom of other types of disorders
Atonic/Akinetic - kids or significant brain disease - freeze up/fall down
Infantile spasms

Question 4

Partial seizure

Answer 4

One side - 80% of seizures
Simple partial (focal) - motor sensory, autonomic, psychic; maintain consciousness/interaction
Complex partial - altered consciousness
Secondary generalization - focal to generalized

Question 5

MRI shows

Answer 5

Hippocampal atrophy

Question 6

Recognition of Seizure episodes

Answer 6

Episodic behavior changes
Stereotypy of events
Automatisms
Post-event confusion 
Non-directed behavior
Recurrent, unexplained obtundation/confusion resolving spontaneously over minutes/hours

Question 7

SX of Convulsive Seizure

Answer 7

Single/multiple body jerks (myoclonus)
Stiffening of body
Jerking of body
Sudden truncal flexion
Drop attacks
Tongue biting
Bowel/bladder incontinence

Question 8

SX of Nonconvulsive seizure

Answer 8

Altered awareness
Staring, blinking
Chewing, swallowing 
Picking at objects
Repetitive movements
Head/body turning
Posturing of extremities

Question 9

Non-Epileptic SX

Answer 9

Continuous aberrant behavior
No post-event confusion
Variable behavior
Directed aggression
Identifiable emotional trigger
Secondary gain
No response to TX

Question 10

Epilepsy eval

Answer 10

H/P
Labs - blood chem, LP
Brain scan - MRI, CT
EEG

Question 11

First aid for Seizures

Answer 11

Position (on side, head dependent)
Clear objects
Loosen neck clothing
Minimal restraint
Nothing in Mouth *****
Secure airway
Observe until over ****

Question 12

Epilepsy TX

Answer 12

Prophylaxis - avoid trauma
Treat causation - infection, temp, intoxication
Anticonvulsant therapy
Dietary - ketogenic diet
Surgery 
Vagus nerve stimulator
Psycho-social support

Question 13

Goals of Therapy

Answer 13

Complete Seizure control***
Few AE
Improved QOL
Affordable

Question 14

Anticonvulsant Therapy

Answer 14

Choose right med, low dose, avoid polypharmacy

Question 15

Anticonvulsant Interaction

Answer 15

Influence by absorption, protein binding, hepatic enzymes

Question 16

Status Epilepticus

Answer 16

Frequent seizures without recovery
One seizure > 30 min
Generalized SE = true medical emergency

Question 17

Status Epilepticus TX

Answer 17

ABC
H/P
IV + labs
O2 thiamine, glucose, IV
Lorazepam
Fosphenytoin
Persisting seizures - IV phenobarbital, levetiracetam, valproate, propofol

Question 18

Women’s Issues

Answer 18

Epilepsy/anticonvulsants affect menstrual cycles and interact w/birth control
Pregnancy = risk of breakthrough seizures/bleeding and fetal teratogenesis
No risk with breastfeeding