Seizures and Syncope Flashcards
Episodic/paroxysmal disorders in neurology
migraine syncope dizziness seizure transient global amnesia
Define epilepsy
2 or more unprovoked seizures (not a/w alcohol withdrawal or meds known to cause seizures)
more common than people think (1/26)
What carries strong stigma and prejudice?
epilepsy
Absence seizure is also known as _____-
petit mal
Can you diagnose epilepsy with a single EEG?
only Petit mal with hyperventilation (to see on EEG)
all seizures: can pick up only 40% with one EEG
generalized tonic-clonic: only 20%
What can you do to pick up abnormalities on EEG for all seizure types?
3 sleep deprived EEGs (trigger)
What is the most important information for epilepsy?
history via witness
Define partial/focal seizures
seizure activity starts with one side of the brain:
simple partial
complex partial
secondarily generalized (starts partial then spreads)
Define generalized/primary seizures
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
Most adult onset of epilepsy have what type of seizures?
partial
What is a well-known medication that causes seizures?
tramadol
Define simple partial seizure
focal motor or sensory activity
no LOC
last seconds
no post-ictal state
Define complex partial seizure
nonresponsive staring
possible preceding aura
automatisms (pick at clothing, reaching for something, mouth movements)
LOC
1-3 minutes
have post-ictal state
Define secondary generalized seizure
starts partial but evolves to bilateral tonic-clonic activity
LOC
lasts 1-3 minutes
post-ictal state
Define absence generalized seizure
AKA petit mal
nonresponsive staring
rapid blinking, chewing
clonic hand motions
LOC
lasts 10-30 seconds
no post-ictal state
Define tonic-clonic generalized seizure
BL extension followed by symmetric jerking of extremities
LOC
lasts 1-3 minutes
post-ictal state
Define atonic generalized seizure
sudden loss of muscle tone
head drops or collapse
LOC
variable duration
post-ictal state
Define myoclonic generalized seizure
brief, rapid symmetrical jerking of extremities and/or torso
LOC
last few seconds
minimal post-ictal state
tonic vs clonic
stiff vs jerking
Are there more meds for partial or generalized seizure?
more for partial
What drugs are used for generalized seizures?
valproic acid lamotrigine topiramate levetiracetam zonisamide perampanel
What drug is safe for use in pregnancy and generalized seizures?
levetiracetam
What drug has the highest efficacy in treating primary generalized seizures?
valproic acid
TERATOGENIC
What drug is safe for pregnancy but takes forever to reach therapeutic dose?
lamotrigine
What is associated with cleft deformities?
topiramate
What drug 100% to avoid in pregnancy and women of childbearing age?
valproic acid
What drug is for absence/petit mal only?
ethosuxamide
use until motor seizure
What is the only synergistic combo of drugs for generalized seizures?
valproic acid
lamotrigine
Define status epilepticus
prolonged seizure >10minutes or repeat seizures without recovery in between
Grand mal vs petit mal
grand mal: tonic-clonic with post-ictal state
petit mal: staring without post-ictal
both generalized seizures
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
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)
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
Signs of syncope
pallor sweating abnormal head sensation lightheadedness positionally related slow onset brief unconsciousness
Signs of seizure
urinary/bowel incontinence
tongue injury (with tonic)
tonic/clonic movements
postictal state
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
