Seizures and Syncope Flashcards

1
Q

Episodic/paroxysmal disorders in neurology

A
migraine
syncope
dizziness
seizure
transient global amnesia
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2
Q

Define epilepsy

A

2 or more unprovoked seizures (not a/w alcohol withdrawal or meds known to cause seizures)

more common than people think (1/26)

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3
Q

What carries strong stigma and prejudice?

A

epilepsy

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4
Q

Absence seizure is also known as _____-

A

petit mal

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5
Q

Can you diagnose epilepsy with a single EEG?

A

only Petit mal with hyperventilation (to see on EEG)

all seizures: can pick up only 40% with one EEG

generalized tonic-clonic: only 20%

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6
Q

What can you do to pick up abnormalities on EEG for all seizure types?

A

3 sleep deprived EEGs (trigger)

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7
Q

What is the most important information for epilepsy?

A

history via witness

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8
Q

Define partial/focal seizures

A

seizure activity starts with one side of the brain:

simple partial

complex partial

secondarily generalized (starts partial then spreads)

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9
Q

Define generalized/primary seizures

A

seizure starts in both sides of brain (genetic):

Absence (petit mal)–> staring

Tonic-clonic (unconscious, switch between arms in and out)

Myoclonic (brief jerks)

Tonic (arms outstretched and stiff)

Clonic (arms flexed, jerking)

Atonic (limp and fall to ground, completely lose tone)

Clonic-tonic-clonic

CAN HAVE MORE THAN ONE AT A TIME

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10
Q

Most adult onset of epilepsy have what type of seizures?

A

partial

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11
Q

What is a well-known medication that causes seizures?

A

tramadol

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12
Q

Define simple partial seizure

A

focal motor or sensory activity

no LOC

last seconds

no post-ictal state

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13
Q

Define complex partial seizure

A

nonresponsive staring

possible preceding aura

automatisms (pick at clothing, reaching for something, mouth movements)

LOC

1-3 minutes

have post-ictal state

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14
Q

Define secondary generalized seizure

A

starts partial but evolves to bilateral tonic-clonic activity

LOC

lasts 1-3 minutes

post-ictal state

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15
Q

Define absence generalized seizure

A

AKA petit mal

nonresponsive staring

rapid blinking, chewing

clonic hand motions

LOC

lasts 10-30 seconds

no post-ictal state

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16
Q

Define tonic-clonic generalized seizure

A

BL extension followed by symmetric jerking of extremities

LOC

lasts 1-3 minutes

post-ictal state

17
Q

Define atonic generalized seizure

A

sudden loss of muscle tone

head drops or collapse

LOC

variable duration

post-ictal state

18
Q

Define myoclonic generalized seizure

A

brief, rapid symmetrical jerking of extremities and/or torso

LOC

last few seconds

minimal post-ictal state

19
Q

tonic vs clonic

A

stiff vs jerking

20
Q

Are there more meds for partial or generalized seizure?

A

more for partial

21
Q

What drugs are used for generalized seizures?

A
valproic acid
lamotrigine
topiramate
levetiracetam
zonisamide
perampanel
22
Q

What drug is safe for use in pregnancy and generalized seizures?

A

levetiracetam

23
Q

What drug has the highest efficacy in treating primary generalized seizures?

A

valproic acid

TERATOGENIC

24
Q

What drug is safe for pregnancy but takes forever to reach therapeutic dose?

A

lamotrigine

25
What is associated with cleft deformities?
topiramate
26
What drug 100% to avoid in pregnancy and women of childbearing age?
valproic acid
27
What drug is for absence/petit mal only?
ethosuxamide use until motor seizure
28
What is the only synergistic combo of drugs for generalized seizures?
valproic acid lamotrigine
29
Define status epilepticus
prolonged seizure >10minutes or repeat seizures without recovery in between
30
Grand mal vs petit mal
grand mal: tonic-clonic with post-ictal state petit mal: staring without post-ictal both generalized seizures
31
Treatment for status epilepticus
ABCs, IV gain hx (seizure, allergies) labs non-contrast head CT benzodiazepine (lorazepam) first thing--> buys time but must give longer lasting anti-epileptic drug (short acting) fosphenytoin or other anti-seizure IV if bad, need anesthetic to be intubated (midazolam or propofol) last resort: pentobarbital coma
32
General traetment of epilepsy
try monotherapy d/t drug interactions (lots with oral contraceptives) consider long-term side effects (bone loss with carbamazepine or phenytoin)
33
Women with epilepsy
all women of child-bearing age should be on folic acid avoid valproic acid new drugs typically safer in pregnancy than older ones
34
Signs of syncope
``` pallor sweating abnormal head sensation lightheadedness positionally related slow onset brief unconsciousness ```
35
Signs of seizure
urinary/bowel incontinence tongue injury (with tonic) tonic/clonic movements postictal state
36
Define transient global amnesia
sudden, temporary, isolated episode of loss of memory no other neuro signs knows self and close family but not others lasts few hours then resolves usually doesn't recur benign