Seizures and Syncope - Hon

Question 1

Epilepsy

Answer 1

2 or more unprovoked seizures

Question 2

Seizures likely to be detected w/ single EEG

Answer 2

Petit mal (absence) - 90%

Question 3

Partial vs. generalized seizure

Answer 3

Partial - STARTS in one hemisphere

General - starts in both hemispheres

Question 4

ONLY seizure type W/O L.O.C.

Answer 4

Simple partial

Question 5

Tonic

Answer 5

Stiffening, rigidity

Question 6

Clonic

Answer 6

Jerky movements

Question 7

Focal motor/sensory activity, seconds long, no post-ictal state, no LOC

Answer 7

Simple partial

Question 8

Non-responsive staring, MAYBE AURA, automatisms (smacking lips, etc.), 1-3 min, LOC, post-ictal state

Answer 8

Complex partial

Question 9

Only seizure types w/o post-ictal state

Answer 9

Simple partial, absence (generalized)

Question 10

Bilateral T-C activity, LOC, 1-3 minutes, post-ictal state

Answer 10

Secondary generalized

Question 11

Non-responsive staring, automatisms, clonic hand motions, LOC, 10-30 seconds, NO post-ictal state

Answer 11

Absence (generalized)

Question 12

Bilateral extension –> symmetrical jerking of extremities

LOC, 1-3 min, post-ictal state

Answer 12

Tonic-clonic (generalized)

Question 13

Sudden loss of muscle tone, head drops or patient collapses, LOC, post-ictal state

Answer 13

Atonic (generalized)

Question 14

Brief, rapid symmetrical jerking of extremities and/or torso, LOC, VERY SHORT, minimal post-ictal state

Answer 14

Myoclonic (generalized)

Question 15

Status epilepticus

Answer 15

Prolonged seizure (more than 10 minutes) or repeated seizures WITHOUT recovery of consciousness in between

Question 16

Treatment for status epilepticus

Answer 16

A.B.C. –> lorazepam (benzo) (short term) –> Fosphenytoin, Phenobarbital, Valproic acid

Question 17

In general, when treating epilepsy…

Answer 17

Use monotherapy (1 drug)
Drug interactions
Long-term side effects

Question 18

Dangers of carbamazepine

Answer 18

Interaction with oral contraceptives
Bone loss (long-term)

Question 19

Women with epilepsy (3)

Answer 19

Multivitamin w/ folic acid (many AEDs are folate-depleting)
AVOID valproic acid
Newer drugs tend to be better for pregnant women

Question 20

Seizure-specific symptoms

Answer 20

GU/GI incontinence
Tongue injury
Tonic/clonic movements
Post-ictal state

Question 21

Syncope symptoms

Answer 21

Pallor, sweating, abnormal head sensation, lightheaded, slow onset, brief LOC