Seizures

Question 1

seizure

Answer 1

transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge

excessive amount of excitatory activity

pts can’t remember them, can’t control themselves

Question 2

dz w/ recurrent, unprovoked seizures

Answer 2

epilepsy

Question 3

what would provoke a seizure

Answer 3

hypoglycemia
febrile seizures
alcohol/drug withdrawal

Question 4

etiologies of epilepsy (8)

Answer 4

1. Tumor
2. Trauma
3. Idiopathic
4. Infection
5. Congenital/perinatal
6. genetics
7. CNS vascular dz (stroke)
8. CNS degenerative dz (Alzheimers)

Question 5

CNS vascular dz and epilepsy

Answer 5

secondary to stroke

mc cause of seizures with onset above 60 yrs

Question 6

trauma anf epilepsy

Answer 6

particularly a cause in young adults, but terms must be met

more likely if dura mater is present, occurs after first couple of weeks following event

Question 7

tumors and epilepsy

Answer 7

must be exclude

Question 8

what must be excluded when any patient presents with new onset seizures?

Answer 8

tumors/space occupying lesions of the CNS

rare in childhood (bc tumors of childhood go to cerebellum)

Question 9

ILAE classifies seizures based on which criteria? (3)

Answer 9

1. Where?
2. Aware?
3. Other

Question 10

types of seizures

Answer 10

General

Partial

Question 11

Partial Seizure

Answer 11

only restricted portion of one cerebral atmosphere

may become generalized

typically less obvious (auditory or olfactory)

Question 12

types of partial seizures

Answer 12

simple partial seizures (aware)

complex partial seizures (LOC, post ictal)

Question 13

simple partial seizures (def + manifestation)

Answer 13

focal aware seizure with no LOC

PT is able to respond

motor, sensory, psychic, autonomic

Question 14

complex partial seizures

Answer 14

starts focally and causes impairment of conciousness

last 30-120 seconds

pt is unresponsive and does not recall event

Question 15

where do complex partial seizures typically originate?

Answer 15

temporal lobe

Question 16

aura

Answer 16

simple partial seizure that lasts only a few seconds

typically precedes temporal lobe complex partial seizure

Question 17

automatisms

Answer 17

non purposeful stereotyped and repetitive behaviors that occur during the seizure

pt doesn’t recall

mc oral or manual (lip smacking, fumbling hands)

Question 18

types of general seizures

Answer 18

absent
atypical absent
myoclonic
tonic clonic

Question 19

pt population most likely to have complex partial seizure

Answer 19

older adults >60

Question 20

absence seizures

Answer 20

impairment of consciousness without loss of posture (pt. is unware of this loss)

no warning, no post ictal state

typically described as “daydreaming”

Question 21

pt population most likely to get absence seizures

Answer 21

begins in childhood (4-8) or early teens

occurs in children with above average intelligence

freq., brief seizures thru our day, older children and adults have less, more time

Question 22

atypical absence seizures

Answer 22

similar to absence seizure but obvious changes in muscle tone and more gradual onset and termination

do not respond well to medication

Question 23

tonic clonic seizures

Answer 23

generalized seizure with two phases

associated with post ictal state

mc found in adults >60 with brain lesion, rare in neonates and infants

Question 24

tonic phase

Answer 24

entire body is rigid

apnea occurs, pt falls to ground, increased HR/BP, 10-20 seconds

Question 25

clonic phase

Answer 25

jerking of body for 2-3 minutes periods of atone followed by episodes of violent flexion pupils dilate and contract, tongue bites/urinary incontinence

Question 26

post ictal phase

Answer 26

HA, disorientation, nausea, drowsiness and muscle soreness increased lactic acid gradually returns to awareness 10-15 min later

Question 27

post epileptic automatisms

Answer 27

follows tonic clonic seizure may display abnormal behavior and have no memory

Question 28

pt convulsions continue without recovery of consciousness > 30 minutes

Answer 28

status epilepticus medical emergency due to apnea, acid/base abnormalities

Question 29

second tonic clonic seizure after regaining consciousness

Answer 29

serial seizures

Question 30

prodrome

Answer 30

occurs hours before a generalized seizures HA, jerking motions, lethargy, irritability, mood alteration

Question 31

provocation?

Answer 31

seizures that result from external precipitators I.e. menstruation, photo sensitivity, caffeine

Question 32

clinical evolution of seizures

Answer 32

1. neuroimaging 2. EEG 3. LP 4. Drug levels

Question 33

neuroimaging done in seizures

Answer 33

done to rule out mass lesions MRI of brain w/ and w/o contrast CAN do CT (Pacemaker or metal in body)

Question 34

lab tests done in seizure work up

Answer 34

CBC + glucose + LFT/Renal FT +/- VRDR, prolactin levels

Question 35

study of choice for seizure evaluation

Answer 35

EEG will be normal until pt seizes

Question 36

LP in seizure work up

Answer 36

evaluation of pts with possible meningitis/encephalitis obtunded SAH

Question 37

DDX seizures

Answer 37

1. Syncope 2. TIA 3. Cardiac Dysrhythmia 4. brainstem ischemia

Question 38

syncope v seizures

Answer 38

preceded by pallor, sweating, nausea recovery occurs rapidly (no post ictal)

Question 39

when is AED used in tx

Answer 39

is NOT given after single seizure, bc recurrence is high report to public health dpt encouraged to avoid dangerous situations admitted to ICU

Question 40

mc cause of status epilepticus

Answer 40

non compliance with seizure meds

Question 41

tx of status epilepticus

Answer 41

high mortality rate, risk of neurological sequel 1. Benzo (diazepam or Ativan IV over 2 min, repeat if needed, monitor for respiratory depression) 2. intubation + D50 IV 3. Fosphenytoin (Cerebyx) loading for cartiac arrhythmia and HoTN

Question 42

drug levels are monitored

Answer 42

1. after treatment is initiated 2. after dosage is changed or another drug added 3. when seizures are poorly controlled

Question 43

mc cause of lower than expected AED serum levels

Answer 43

non compliance

Question 44

when are meds DC

Answer 44

seizure free for at least 3 yrs taper off and see if they reoccur

Question 45

SUDEP

Answer 45

sudden unexpected death not due to drowning or trauma thought to have a seizure over night that causes terminal apnea and asystole

Question 46

SUDEP risk factors

Answer 46

``` UNCONTROLLED EPILEPSY**/non compliance >3 tonic clonic sz/yr young (<40) polypharmacy nocturnal seizure ```

Question 47

management of SUDEP

Answer 47

effective seizure control | caregiver/nocturnal supervision

Question 48

solitary sz

Answer 48

pt without history of seizure has 1 and sent to ER MRI and EEG done

Question 49

risk/recurrence of solitary sz - MRI, - EEG

Answer 49

one tonic-clonic but no abnormalities and evidence of focal onset risk is low, no AED

Question 50

who is started on AED after one seizure

Answer 50

abnormal MRI (I.e. CA metastasis on brain) or abnormal EEG

Question 51

risk/recurrence of solitary sz + MRI, + EEG

Answer 51

high recurrence risk AED begun

Question 52

risk/recurrence of solitary sz either + MRI/-EEG or -MRI/+EEG

Answer 52

unsure risk is 30-50%, consult and decide

Question 53

metabolic causes of provoked seizure

Answer 53

uremia hypoglycemia withdrawal from alcohol/drugs

Question 54

delirium tremens

Answer 54

occurs in alcohol withdrawal (lack of inhibition = over excitation) highest risk > 48hrs after drink must ask if history, monitor q 4 hrs

Question 55

tx of delirium tremens

Answer 55

benson to manage if bad enough seizures are typically self limiting and don't req. AED

Question 56

types of fever provoked seizure

Answer 56

simple febrile seizure, complex febrile seizure occurs in children 3mo-5 yrs (18-24), typically during acute phase (OM, URI)

Question 57

simple febrile seizure

Answer 57

symmetric seizure brief no future risk of epilepsy

Question 58

complex febrile seizure

Answer 58

focal, repeated. prolonged associated with risk of epilepsy