Seizures And Epilepsy Flashcards
Does a normal EEG or MRI rule out a seizure?
Nope.
What is considered the best diagnostic test for seizures?
Electroencephalography EEG
But a normal result does not RULE OUT seizures
What is the most common cause of status epilepticus
Discontinuation of anticonvulsant drugs
A patient comes in the ED with loss of consciousness accompanied by urinary incontinence, generalised body stiffness and jerky movement lasting 1-2 minutes, what is the most likely diagnosis?
Seizure until proven orherwise
What are two commonest causes of an acute symptomatic seizure
Neurological cause or Metabolic cause
What is the commonest cause of seizures in the elderly
Stroke accounts for 30% of seizures in adults
Do the majority of patients with epilepsy have a reversible cause?
Nope
Name three seizures types that has loss of consciousness
Generalized tonic-clonic seizures; Absence seizure; Focal unaware seizures
What is the most common seizure in adults?
Complex focal seizures (temporal lobe seizure) also known as Focal unaware seizure
Last less than 3 minutes and have a post ictal state
Which age group are more likely to have absence seizures?
Children
Last 5-10 seconds and can be associated with hyperventilation
Spontaneous remission before adulthood
List three commonest features of the post ictal atate
Headaches, confusion and somnolence
List 4 triggers of seizures in epilepsy
Sleep deprivation, alcohol, flashing lights and menstruations
Name three most common medications that trigger seizures.
Antipsychotics, antidepressants and quinolone antibiotics
They lower the seizure threshold
List 5 commonest causes of provoked seizures.
Cerebrovascular accidents, remote head trauma, developmental brain problems, brain tumours and neurodegenerative diseases.
Feature of psychogenic non epileptic seizures
Biting the tip of the tongue, seizures lasting more than 2 minutes, seizures having a gradual onset, eyes being closed during a seizure, and side-to-side head movements.
List features that are unusual in psychogenic non-epileptic seizures
Severe tongue biting, urinary/Fecal incontinence and biting inside the mouth
When is a Lumbar puncture typically indicated in seizures?
Signs and symptoms of meningism
Immunocompromised patients
What is the best diagnostic test for seizures?
EEG not only do they diagnose the seizure but determine the type of seizure
Why is neuroimaging usually indicated in adults>40 in seizures?
To rule out stroke, malignancy and intracerebral hemorrhage
What is the immediate treatment of an active seizure?
Lorazepam or midazolam or clonazepam or diazepam 10 mg slow IV never IM
Old saying is still
What is a life threatening adverse effect of benzodiazepine
Respiratory depression
What should you do if after the second dose of lorazepam/midazolam/clonazepam/diazepam the patient is still seizing or does not recover consciousness between the fits?
Give phenytoin in sodium chloride in a different line treatment to those drugs and refer urgently.
Name one adverse effect of phenytoin in the heart
Dysrhythmia
What is the treatment of generalized tonic-clonic seizures long term?
Lamotrigine or carbamazepine
Which anticonvulsant are teratogenic?
Sodium valproate and phenytoin
What is the treatment of generalized tonic-clonic seizures in HIV patients?
Adults: Lamotrigine
Children: Sodium valproate
What is the treatment of partial seizures?
Carbamazepine or lamotrigine
What is the treatment of absence seizures and juvenile myoclonic epilepsy
Sodium valproate Or lamotrigine
What should be checked in every routine visit for epilepsy?
Symptoms, side effects of medications, other medications, alcohol/drug abuse, depression and family planning
What is the most common adverse effect of lamotrigine, phenytoin and carbamazepine?
Rash ( considered urgent so referral is paramount)
What are the two common adverse effects of levetiracetam?
Suicidal thoughts or behaviour and psychosis
Others include aggression, depression and irritability
List two adverse effects of sodium valproate requiring urgent attention.
Jaundice and nausea/vomiting/abdominal pain
Check ALT if >100 stop the drug
Which anticonvulsant can lead to unsteadiness, slurring and double vision
Phenytoin
When to use levetiracetam?
Woman of child bearing age and on/needing ART or switching from valproate and lamotrigine is not suitable or tolerated
What is the indication for phenytoin?
If on phenytoin and well controlled
If there was a head trauma as prophylaxis
