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Seizures Flashcards

1
Q

Define Tonic movements

A

Producing tone or contraction of muscles

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2
Q

Define Clonic movements

A

Alternating pattern of relaxation and contraction

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3
Q

What is the most common cause of seizures?

A 
70% idiopathic
Head trauma
Brain tissue infxn
Brain tumor
Stroke
Genetics 
Prenatal disturbance of brain development
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4
Q

1st seizure after age 30 must be worked up to rule out what condition?

A

Tumor until proven otherwise

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5
Q

What are some accompanying S/Sx with a seizure?

A 
Fever (infxn)
Focal neurologic finding
Papilledema (ICP)
Roth spots / Retinal hemorrhages
HA (infectious or hemorrhagic cause of seizures)
Meningismus
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6
Q

A physical exam should look for what in a PT suspected of having seizures of unknown origin?

A 
Neuro exam
Todd's Paralysis (one arm or side of body)
Postural HYPOtension
Abnormal HR and rhythm
Head trauma
Carotid Dz
Cardiac Dz
Systemic Infxn
Alcohol or drug abuse
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7
Q

What are Grand-Mal seizures also known as?

A

Tonic-Clonic (Grand Mal)

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8
Q

What are Petit Mal seizures also known as?

A

Absence (Petit Mal)

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9
Q

What are some of the features of generalized seizures?

A

Begin with a rigid phase followed by repetitive clonic movement

Bilateral-symmetric (without local onset)

Oral frothing

Respiratory distress

Cyanosis

Incontinence

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10
Q

What is the associated triad with Lennox-Gastaut Syndrome?

A

Developmental delay
Absence and tonic seizures
Slow spike-wave D/Cs on EEG

(onset 2-7 years)
(1/3rd have status epilepticus initially)

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11
Q

What is the definition of Ictal?

A

Relating to or caused by stroke / seizure

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12
Q

What does post-ictal mean?

A

Altered consciousness after a seizure

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13
Q

When would Valproic Acid be absolutely contraindicated?

A

Pregnant women

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14
Q

What drugs can be used to control generalized seizures?

A

Barbiturates
Phenytoin
Valproic Acid
Ethosuximide

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15
Q

What medications could you use to control partial seizures?

A

Phenytoin
Valproic Acid
Carbamezapine

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16
Q

What are some side effects you should keep in mind with Phenytoin?

What is Phenytoin’s trade name?

A

Dilantin

Gingivitis
Osteoporosis
Hirsuitism
Pseudolyphoma

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17
Q

If you Rx Depakote; what lab should you order to monitor the PT?

18
Q

If you Rx a PT Tegretol (Carbamazepine) what lab should you additionally order to monitor the PT?

A

CBCs

S/E can include:
BLOOD DYSCRASIA
HYPOnatremia
Steven Johnson Syndrome

19
Q

What is the drug of choice for a Pregnant PT with seizures?

A

Lamotrigine

Lamictal

20
Q

What are some of the key features of Pseudoseizures?

A 
Asynchronous movements (90%)
Arching of back (90% of PTs)
Occurrence from sleep
Extended duration
Ictal crying
Abnormal triggers
Tight eye closing
No postictal symptoms
21
Q

How would you characterize a seizure with fumbling movements and lip smacking during the seizure, but also transient somnolence after the event?

A

Complex Partial Seizure

Psychomotor seizure

Can present with an aura

22
Q

How long do typical febrile seizures last?

A

1 to 2 minutes

Rapid return of consciousness

23
Q

What are the most common seizures of childhood?

A

Febrile Seizures

usually only one; if multiple happen during illness; considered ATYPICAL

24
Q

What are some of the criteria of ATYPICAL FEBRILE SEIZURES?

A

Prolonged seizures > 15min
Focal seizure manifestations
Multiple seizures during same febrile illness

25
What is the most common form of adult epilepsy? What is the dominant medical treatment for this?
Mesial Temporal Sclerosis (Complex partial seizure) (Olfactory involvement) Tegretol
26
A 4 year old child with Down Syndrome presents to your clinic with flexion / extension of the extremities and trunk. What epileptic syndrome do you suspect?
Infantile spasms (West Syndrome) Treatment includes ACTH
27
A 4 year old child with Down Syndrome presents to your clinic with flexion / extension of the extremities and trunk. What epileptic syndrome do you suspect?
Infantile spasms (West Syndrome) Treatment includes ACTH
28
What is the associated triad with Tuberous Sclerosis? What are some other presenting S/Sx that are more common?
Most prevalent INHERITED TUMOR SYNDROMES Triad: 1. Adenoma sebaceum 2. Seizures 3. Developmental Delay Hypomelanotic macules (ash leaf) 90%
29
What is the mnemonic device to remember the presenting S/Sx of Tuberous Sclerosis?
``` A- Ashleaf spots (hypomelanin spots) S- Shagreen patches H- Heart rhabdomyosarcoma L- Lung hamartomas E- Epilepsy from tubers A- Angiomyolipoma in kidney F- Facial angiofibroma ```
30
What would the treatment for a Lennox-Gastaut syndrome be?
Callosotomy | Vagal nerve stimulator
31
What is the acute management for epilepsy? What is the Tx for burst suppression?
Benzodiazepines Pentobarbitol coma (last resort)
32
What is the definition for Status epilepticus (SE)?
Seizure > 30min Occurrence of several seizures w/ no return to normal consciousness b/t
33
What agent should be 1st line to stop a seizure in a neonate?
Phenobarbital
34
What agents should be used to stop a seizure in an adult PT?
Lorazepam (Ativan) 4mg max q 10 min SL x 3 Diazepam (Valium) 10mg max q 10 min Rectally x 3 Paraldehyde If persists --> longer term Phenobarbital Phenytoin
35
What are some potential side effects of Diazepam (Valium) or Lorazepam (Ativan)?
HYPOtension | Respiratory depression
36
What's the proper dosage for Phenytoin (Dilantin)?
Up to 1000mg IV (50kg PT) | Infuse in NS
37
If seizures persist >60min what should you be worried about controlling? What would you Rx?
ICP Mannitol (0.5 - 1 g/kg IV over 15min) Dexamethasone (0.25mg/kg STAT) Maintenance: (0.5mg/kg/day x 24hrs)
38
Give me a differential Dx of what could mimic a Seizure?
``` Sleep myoclonus REM motor activity Jitteriness of newborn GERD Pallid infantile syncope Night terrors Migraine and syncope Benign paroxysmal vertigo Tics / Tourette's Pseudoseizures (PNES) ```
39
Every seizure PT should have what labs ordered?
Serum electrolytes Serum calcium, phosphate, and magnesium EEG Brain imaging CT or MRI If febrile consider: CBC w/ diff & blood culture CSF culture Urinalysis
40
Phenobarbital should be monitored for what during therapy?
``` Hepatotoxicity Rash Sedation Ataxia Hyperactivity ```
41
What long term use side effects are associated with Phenytoin? What kind
Gingival hyperplasia Hirsutism Lymphadenopathy Sedation and ataxia

Neurology (18 decks)

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