Seizures

Question 1

partial seizure

Answer 1

1 area of brain, usually temporal lobe

preceded by aura

• smell burning tires
• tunnel vision
• deja vu
• euphoria

Question 2

Simple vs complex partial seizures

Answer 2

simple - intact consciousness

complex - altered consciousness

Question 3

Generalized seizure

Answer 3

affects brain diffusely

Question 4

Petit mall absence

Answer 4

staring spell
smacking lips/quivering of facial muscle
no post-octal state

tx: Ethosuximide. If that fails, then valproic acid

Question 5

myoclonic

Answer 5

brief involuntary twitch of muscle or group of muscles

Question 6

Grand mal

Answer 6

tonic/clonic

stiffness, shaking, convulsive

Question 7

Tonic seizure

Answer 7

muscle stiffening only

Question 8

Atonic seizure

Answer 8

“drop seizure”
lose tone
confused with syncope

Question 9

Status epilepticus

Answer 9

persists more than 5 min
recurrence w/o regaining consciousness between seizures

can lead to permanent brain damage or death

tx: Benzodiazepines - diazepam or lorazepam either IV or IM

Question 10

Cause of seizure in kids

Answer 10

developmental etiology
infection - febrile seizure
trauma
metabolic abnormality

Question 11

Cause of seizure in adults

Answer 11

tumors

stroke - elderly

Question 12

Sturge-Weber Syndrome

Answer 12

Congenital neurological and skin disorder d/t vascular malformations

Port-wine stain on face - CN V1 or V2 area

• overabundance of capillaries
• present at birth

GNAQ mutation

causes glaucoma, seizures, hemiparesis, intellectual disability

Question 13

Tuberous sclerosis

Answer 13

AD
Incomplete penetrance and variable expressivity

TSC1: hamartin protein
TSC2: tuberin protein

Triad: seizures, intellectual disability, angiofibromas

Other findings: ash-leaf spots - hypomelanotic macule, retinal hamartomas, cortical tubers (glioneuronal hamartomas)

Tumor associations: renal angiomyolipoma, cardiac rhabdomyoma, astrocytoma (subependymal giant cell astrocytoma)

Question 14

Trigeminal neuralgia (Tic douloureux)

Answer 14

“Lightening like” pain, “electric shocks” along division of trigeminal (usually maxillary) triggered by light touch - wind, bedsheets

tx: carbamazepine or other anticonvulsants (phenytoin, gabapentin, topiramate)

Question 15

Treatment of eclampsia

Answer 15

MgSO4

Question 16

Anti seizure drugs that block Na+ channels to decrease AP in neurons

Answer 16

phenytoin
carbamazepine
lamotrigine
topiramate
valproic acid

Question 17

Anti seizure drugs that increase GABA activity to reduce neuron excitability

Answer 17

gabapentin
phenobarbital
valproic acid
Benzodiazepines
tiagabine
vigabatrin
levetiracetam

Question 18

Anti seizure drugs that block T type Ca2+ channels to decrease neuronal APs

Answer 18

Gabapentin
ethosuximide
phenytoin - high doses

Question 19

Common side effects of all anti seizure meds

Answer 19

lethargy
ataxia
dizziness
HA
wt gain
diplopia

Question 20

Side effects specific to phenytoin

Answer 20

“Phenytoin Has Given MDS Frustration”

peripheral neuropathy
hirsutism
gingival hyperplasia
Megaloblastic anemia d/t decreased folate absorption
Drug induced lupus
Stevens Johnson Sn
Fetal hydantoin syndrome

Question 21

Fetal hydantoin syndrome

Answer 21

cleft lip/palate
congenital heart dz
intellectual disability w/ developmental delay

Question 22

Antiepiletpics that are teratogens

Answer 22

Phenytoin
Carbamazepine
Valproic acid (spina bifida)

If need to continue in pregnancy, give 4 mg folic acid QD

Question 23

Drugs that cause Stevens-Johnson Syndrome

Answer 23

“Steve Jobs made APPLE PCS”

Allopurinol
Phenytoin
Phenobarbital
Lamotrigine
Ethosuximide
Penicillin
Carbamazepine
Sulfonamides

Question 24

Drugs known to cause agranulocytosis

Answer 24

Carbamazepine
Clozapine
Colchicine
PTU
Methimazole

Question 25

Hepatotoxic antiepileptics

Answer 25

Valproic Acid

Carbamazepine