Seizures

Question 1

What is the mnemonic to remember the causes of seizures?

Answer 1

VITAMIN E:

• Vascular, e.g. stroke, AVM
• Infection, e.g. meningitis, encephalitis
• Trauma (bleed)
• Alcohol + drugs
• Metabolic disturbance, e.g. hypoglycaemia, hypoxia, hyponatraemia
• Intracranial mass
• NEAD
• Epilepsy

Question 2

What is the name given to the condition where a patient develops seizures as a result of acute alcohol withdrawal?

Answer 2

Delirium tremens

Question 3

Which drugs can lower the seizure threshold?

Answer 3

SSRIs

Antibiotics, e.g. ciprofloxacin

Question 4

What is the definition of epilepsy?

Describe the pathophysiology

Answer 4

Epilepsy is an umbrella term which means there is a tendency to have seizures

In epilepsy, seizures happen due to transient episodes of abnormal electrical activity in the brain

Question 5

Give some examples of types of epileptic seziure

Answer 5

• Generalised tonic clonic
• Focal
• Absence
• Atonic
• Myoclonic

Question 6

What is the definition of status epilepticus?

Answer 6

A seizure that lasts longer than 5 minutes

OR

Having more than one seizure in a 5 minute period, without returning to a normal level of consciousness between episodes

Question 7

Describe the initial approach to managing status epilepticus

Answer 7

ABCDE and get help!

A - consider need for NP airway
B - 15L oxygen via NRB mask
C - IV access
D - check for hypoglycaemia
E - signs of head injury?

Question 8

Which drugs can be given in status epilepticus…

a) Out of hospital
b) In hospital

If these measures are unsuccessful, which medication can be given next?

Answer 8

a) Usually buccal midazolam or PR diazepam
b) Lorazepam 4mg IV (can be repeated once after 10 minutes if needed

If these measures are unsuccessful, give levetiracetam