Seizures Flashcards
Define Tonic movements
Producing tone or contraction of muscles
Define Clonic movements
Alternating pattern of relaxation and contraction
What is the most common cause of seizures?
70% idiopathic Head trauma Brain tissue infxn Brain tumor Stroke Genetics Prenatal disturbance of brain development
1st seizure after age 30 must be worked up to rule out what condition?
Tumor until proven otherwise
What are some accompanying S/Sx with a seizure?
Fever (infxn) Focal neurologic finding Papilledema (ICP) Roth spots / Retinal hemorrhages HA (infectious or hemorrhagic cause of seizures) Meningismus
A physical exam should look for what in a PT suspected of having seizures of unknown origin?
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
What are Grand-Mal seizures also known as?
Tonic-Clonic (Grand Mal)
What are Petit Mal seizures also known as?
Absence (Petit Mal)
What are some of the features of generalized seizures?
Begin with a rigid phase followed by repetitive clonic movement
Bilateral-symmetric (without local onset)
Oral frothing
Respiratory distress
Cyanosis
Incontinence
What is the associated triad with Lennox-Gastaut Syndrome?
Developmental delay
Absence and tonic seizures
Slow spike-wave D/Cs on EEG
(onset 2-7 years)
(1/3rd have status epilepticus initially)
What is the definition of Ictal?
Relating to or caused by stroke / seizure
What does post-ictal mean?
Altered consciousness after a seizure
When would Valproic Acid be absolutely contraindicated?
Pregnant women
What drugs can be used to control generalized seizures?
Barbiturates
Phenytoin
Valproic Acid
Ethosuximide
What medications could you use to control partial seizures?
Phenytoin
Valproic Acid
Carbamezapine
What are some side effects you should keep in mind with Phenytoin?
What is Phenytoin’s trade name?
Dilantin
Gingivitis
Osteoporosis
Hirsuitism
Pseudolyphoma
If you Rx Depakote; what lab should you order to monitor the PT?
LFTs
If you Rx a PT Tegretol (Carbamazepine) what lab should you additionally order to monitor the PT?
CBCs
S/E can include:
BLOOD DYSCRASIA
HYPOnatremia
Steven Johnson Syndrome
What is the drug of choice for a Pregnant PT with seizures?
Lamotrigine
Lamictal
What are some of the key features of Pseudoseizures?
Asynchronous movements (90%) Arching of back (90% of PTs) Occurrence from sleep Extended duration Ictal crying Abnormal triggers Tight eye closing No postictal symptoms
How would you characterize a seizure with fumbling movements and lip smacking during the seizure, but also transient somnolence after the event?
Complex Partial Seizure
Psychomotor seizure
Can present with an aura
How long do typical febrile seizures last?
1 to 2 minutes
Rapid return of consciousness
What are the most common seizures of childhood?
Febrile Seizures
usually only one; if multiple happen during illness; considered ATYPICAL
What are some of the criteria of ATYPICAL FEBRILE SEIZURES?
Prolonged seizures > 15min
Focal seizure manifestations
Multiple seizures during same febrile illness
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
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
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
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:
- Adenoma sebaceum
- Seizures
- Developmental Delay
Hypomelanotic macules (ash leaf) 90%
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
What would the treatment for a Lennox-Gastaut syndrome be?
Callosotomy
Vagal nerve stimulator
What is the acute management for epilepsy?
What is the Tx for burst suppression?
Benzodiazepines
Pentobarbitol coma (last resort)
What is the definition for Status epilepticus (SE)?
Seizure > 30min
Occurrence of several seizures w/ no return to normal consciousness b/t
What agent should be 1st line to stop a seizure in a neonate?
Phenobarbital
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
What are some potential side effects of Diazepam (Valium) or Lorazepam (Ativan)?
HYPOtension
Respiratory depression
What’s the proper dosage for Phenytoin (Dilantin)?
Up to 1000mg IV (50kg PT)
Infuse in NS
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)
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)
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
Phenobarbital should be monitored for what during therapy?
Hepatotoxicity Rash Sedation Ataxia Hyperactivity
What long term use side effects are associated with Phenytoin?
What kind
Gingival hyperplasia
Hirsutism
Lymphadenopathy
Sedation and ataxia
