Seizures

Question 1

Lesions to white or gray matter can cause seizures?

Answer 1

Gray

Question 2

What is a complex partial seizure?

Answer 2

They have a focal onset and involve an impairment in awareness. Usually arise from the temporal lobe, but they may also arise from the frontal lobe

Question 3

What are simple partial seizures?

Answer 3

They begin in a focal area of brain and do not impair awareness. Can cause motor symptoms, hallucinations, tingling, gustatory and olfactory symptoms, and psychic phenomenon (e.g. deja vu) depending location

Question 4

What is a generalized tonic-clonic seizure?

Answer 4

The tonic phase usually lasts a few seconds where the body becomes stiff. This is followed by rhythmic jerking of the extremities (more or less symmetrically) for 1-2 minutes usually. Followed by postictal phase

Question 5

What is the EEG pattern of absence seizures?

Answer 5

3 Hz generalized spike-and-slow-wave discharges

Question 6

What are the most common seizures in children (age 6 mo - 5 years)?

Answer 6

Febrile (usually a generalized seizure).
The risk for future epilepsy is small unless the seizure is prolonged or partial in onset or if there are other neurologic abnormalities

Question 7

What is the most common cause of new-onset seizures in young adults?

Answer 7

Trauma and alcohol

Question 8

What is the most common etiology of new-onset seizures in the elderly?

Answer 8

Strokes

Question 9

What is Lennox-Gastaut syndrome?

Answer 9

It is a childhood-onset epilepsy that most often appears between the second and sixth year of life. LGS is characterized by a triad of signs including frequent seizures of multiple types, an abnormal EEG pattern of less than 2.5 Hz slow spike wave activity, and moderate to severe intellectual impairment.

Question 10

What is benign rolandic epilepsy?

Answer 10

The most common epilepsy syndrome of childhood. It usually resolves by age 14. Seizures often involve the mouth and face. Hypersalivation may occur

Question 11

What is Todd’s paralysis?

Answer 11

It is postictal hemiparesis - it is a sign that a seizure was secondarily generalized even if that was not apparent to onlookers (may have just looked like a generalized seizure)

Question 12

What is the treatment for benign rolandic epilepsy?

Answer 12

Carbamazepine, or can opt not to treat

Question 13

What are the preferred treatments for Lennox-Gastaut syndrome?

Answer 13

Valproic acid, lamotrigine, felbamate, fufinamide

Question 14

What treatments are used for juvenile myoclonic epilepsy?

Answer 14

Valproic acid, lamotrigine, or levetiracetam

Question 15

What medications are used to treat absence seizures?

Answer 15

Ethosuximide and valproic acid

Question 16

When do neurologist generally start drug therapy for seizures?

Answer 16

After two unprovoked seizures

Question 17

What should be done if a patient is in status epilepticus?

Answer 17

ABCs, check fingerstick glucose, establish IV access → send blood lab studies, give 100 mg IV thiamine, followed by 50% dextrose → lorazepam 0.1 mg/kg IV → if continues give phenytoin 20 mg/kg IV (or fosphenytoin equivalent) → if continues intubate if not already done and give phenobarbital 20 mg/kg IV → if continues induce coma with barbiturates, midazolam, or propofol and institute continuous bedside EEG

Question 18

Seizures originating from what area of the brain are must likely to respond to surgery?

Answer 18

Medial temporal lobe (success in 60-80% of patients)

Question 19

What is the best treatment for a patient with mesial temporal sclerosis with intractable complex partial seizures?

Answer 19

Surgical resection - these seizures are poorly controlled by medications

Question 20

What is a Jacksonian march?

Answer 20

A sequential seizure (primarily motor) that usually begins in the hand and spreads. Often becomes secondarily generalized