Seizures and Syncope

Question 1

Episodic/paroxysmal disorders in neurology

Answer 1

migraine
syncope
dizziness
seizure
transient global amnesia

Question 2

Define epilepsy

Answer 2

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

more common than people think (1/26)

Question 3

What carries strong stigma and prejudice?

Answer 3

epilepsy

Question 4

Absence seizure is also known as _____-

Answer 4

petit mal

Question 5

Can you diagnose epilepsy with a single EEG?

Answer 5

only Petit mal with hyperventilation (to see on EEG)

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

generalized tonic-clonic: only 20%

Question 6

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

Answer 6

3 sleep deprived EEGs (trigger)

Question 7

What is the most important information for epilepsy?

Answer 7

history via witness

Question 8

Define partial/focal seizures

Answer 8

seizure activity starts with one side of the brain:

simple partial

complex partial

secondarily generalized (starts partial then spreads)

Question 9

Define generalized/primary seizures

Answer 9

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

Question 10

Most adult onset of epilepsy have what type of seizures?

Answer 10

partial

Question 11

What is a well-known medication that causes seizures?

Answer 11

tramadol

Question 12

Define simple partial seizure

Answer 12

focal motor or sensory activity

no LOC

last seconds

no post-ictal state

Question 13

Define complex partial seizure

Answer 13

nonresponsive staring

possible preceding aura

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

LOC

1-3 minutes

have post-ictal state

Question 14

Define secondary generalized seizure

Answer 14

starts partial but evolves to bilateral tonic-clonic activity

LOC

lasts 1-3 minutes

post-ictal state

Question 15

Define absence generalized seizure

Answer 15

AKA petit mal

nonresponsive staring

rapid blinking, chewing

clonic hand motions

LOC

lasts 10-30 seconds

no post-ictal state

Question 16

Define tonic-clonic generalized seizure

Answer 16

BL extension followed by symmetric jerking of extremities

LOC

lasts 1-3 minutes

post-ictal state

Question 17

Define atonic generalized seizure

Answer 17

sudden loss of muscle tone

head drops or collapse

LOC

variable duration

post-ictal state

Question 18

Define myoclonic generalized seizure

Answer 18

brief, rapid symmetrical jerking of extremities and/or torso

LOC

last few seconds

minimal post-ictal state

Question 19

tonic vs clonic

Answer 19

stiff vs jerking

Question 20

Are there more meds for partial or generalized seizure?

Answer 20

more for partial

Question 21

What drugs are used for generalized seizures?

Answer 21

valproic acid
lamotrigine
topiramate
levetiracetam
zonisamide
perampanel

Question 22

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

Answer 22

levetiracetam

Question 23

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

Answer 23

valproic acid

TERATOGENIC

Question 24

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

Answer 24

lamotrigine

Question 25

What is associated with cleft deformities?

Answer 25

topiramate

Question 26

What drug 100% to avoid in pregnancy and women of childbearing age?

Answer 26

valproic acid

Question 27

What drug is for absence/petit mal only?

Answer 27

ethosuxamide

use until motor seizure

Question 28

What is the only synergistic combo of drugs for generalized seizures?

Answer 28

valproic acid

lamotrigine

Question 29

Define status epilepticus

Answer 29

prolonged seizure >10minutes or repeat seizures without recovery in between

Question 30

Grand mal vs petit mal

Answer 30

grand mal: tonic-clonic with post-ictal state

petit mal: staring without post-ictal

both generalized seizures

Question 31

Treatment for status epilepticus

Answer 31

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

Question 32

General traetment of epilepsy

Answer 32

try monotherapy d/t drug interactions (lots with oral contraceptives)

consider long-term side effects (bone loss with carbamazepine or phenytoin)

Question 33

Women with epilepsy

Answer 33

all women of child-bearing age should be on folic acid

avoid valproic acid

new drugs typically safer in pregnancy than older ones

Question 34

Signs of syncope

Answer 34

pallor
sweating
abnormal head sensation
lightheadedness
positionally related
slow onset
brief unconsciousness

Question 35

Signs of seizure

Answer 35

urinary/bowel incontinence
tongue injury (with tonic)
tonic/clonic movements
postictal state

Question 36

Define transient global amnesia

Answer 36

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