Seizures

Question 1

What 3 key features are used to classify seizures?

Answer 1

1. Where seizure begins in the brain
2. Level of awareness during the seizure
3. length of seizure

Question 2

What is the other name for a focal seizure, what is it, how are they classified?

Answer 2

Previously termed partial seizure.
Start on one side of the brain
- Focal aware (simple partial)
- Focal impaired awareness (complex partial)
- Awareness unknown 

Can also be classified as being motor, non-motor or having other features such aura.

Question 3

What are generalised seizures and its classification?

Answer 3

Involves both sides of the brain and consciousness is lost.

Divided into motor (tonic-clonic) or non-motor (absent)

Question 4

Name the types of generalised seizures

Answer 4

tonic-clonic (starts tonic and turns clonic)
tonic (stiff body)
clonic (repeated jerking)
typical absence (petit mal)
myoclonic (brief rapid muscle jerk)
Atonic (no stiffness)

Question 5

What is a secondary generalised seizure?

Answer 5

This is when the seizure goes from focal to generalised, so one side of the brain to both sides.

Question 6

What is the treatment of generalised and focal seizures?

Answer 6

Sodium valproate - generalised

Carbamazepine - focal seizure

Question 7

What antiepileptic mediation must be avoided in pregnant women?

Answer 7

Sodium valproate - it is teratogenic

Question 8

What are the 4 common antiepileptics and their mechanism?

Answer 8

Sodium valproate - increases GABA
Carbamazepine - Binds Na channels increasing refractory period
Lamotrigine - sodium channel blocker
Phenytoin - same as carbamazepine

Question 9

What is the acute management of seizures?

Answer 9

Give diazepam
If the patient continues it is status epilepticus and more benzos are needed, and a general anaesthetic might be needed (medical emergency)