Seizures And Syncope (Hon) Flashcards
What are some paroxysmal (episodic) disorders in neurology?
Migraine
Syncope
Dizziness
Seizure
What is epilepsy?
Generally defined as 2 or more unprovoked seizures
4th most common neurological disorder (behind migraine, Alzheimer’s, stroke)
1/26 people will develop epilepsy in their lifetime
Describe percent positive findings for epilepsy on a single EEG? With 3 sleep-deprived EEGs?
Singe: All types: 40% Generalized tonic-clonic: 20% Petit mal (with HV): 90% Parital: 30%
for all types with 3 EEGs: 85%
What is the single most important information for diagnosing epilepsy?
Although EEG is an important tool, history of events (preferably by witnesses) is most important
- normal EEG does not exclude presence of epilepsy
- minor abnormalities on EEG does not necessarily indicate a pt will have seizures
What are the seizure classifications?
Partial seizures (activity begins on one side of brain)
- simple partial
- complex partial
- secondarily generalized (partial onset)
Generalized seizures
- absence (petit mal)
- tonic-clonic
- myoclonic
- tonic
- clonic
- atonic
- clonic-tonic-clonic
Describe simple partial seizures
Focal motor or sensory activity
No loss of consciousness
Lasts seconds
No post-ictal state
Describe complex partial seizures
Nonresponsive staring Possible preceding aura Automatisms Loss of consciousness Lasts 1-3 min Post-ictal state
Describe secondary generalized (partial onset) seizures
Bilateral tonic-clonic activity
Loss of consciousness
Lasts 1-3 min
Post-ictal state
Describe absence (petit mal) generalized seizures
Nonresponsive staring Rapid blinking Chewing Clonic hand motions Loss of consciousness Lasts 10-30 seconds No post-ictal state
Describe tonic-clonic generalized seizures
Bilateral extension followed by symmetrical jerking off of extremities
Loss of consciousness
Lasts 1-3 min
Post-ictal state
Describe atonic generalized seizures
Sudden loss of muscle tone Head drops or pt collapses Loss of consciousness Variable duration Post-ictal stat
Describe myoclonic generalized seizures
Brief, rapid symmetrical jerking of extremities and/or torso
Loss of consciousness
Lasts
What drugs treat partial/secondary generalized seizures?
Phenytoin, carbamazepine, valproic acid, phenobarbital, gabapentin, lamotrigine, topiramate, gabatril, felbamate, oxcarbamazepine, leviteracetam, zonisamide, lacosamide, perampanel, vigabatrin
What drugs treat primary generalized seizures?
Ethosuxamide (absence only) Valproic acid* Lamotrigine* Leviteracetam* Zonisamide* Perampanel*
*also treat partial/secondary generalized
What is status epilepticus?
Condition characterized by prolonged seizure (generally greater than 10 mintues) or repeated seizures without recovery in between
What is the treatment for status epilepticus?
ABC’s, establish IV
History
Labs: Accuchek, CBS, Chemistry panel, drug levels
Noncontrast CT head
Benzodiazepine (buys time but must give longer lasting AED)
Fosphenytoin
Phenobarbital (intubate first to anticipate respiratory depression)
Valproic acid
Lacosamdie (watch for cardiac conduction abnormalities)
If unsuccessful, midazolam or propofol (intubated)
Last resort: pentobarbital coma
In some cases, pt may only respond to one oral AED (carbamazepine). Consider NG tube
What are the general principles in treatment of pts with epilepsy?
Try to use monotherapy
Consider drug interactions (oral contraceptives with carbamazepine)
Consider long term side effects (bone loss with carbamazepine or phenytoin)
Describe women with epilepsy
All women of child-bearing age should be on a MVI with 1 mg folic acid. Particularly important in women with epilepsy, as many of AEDs are folate-depleting
Avoid valproic acid in pregnancy
In general, newer AEDs (lamotrigine, leviteracetam) are probably safer in pregnancy than older ones (phenytoin or valproic acid), but the drug of choice for a woman is the drug which best controls her seizures
Compare/contrast syncope vs seizure
Syncope: Pallor Sweating Abnormal head sensation Lightheadedness Positionally related Slow onset Brief unconsciousness
Seizure: Urinary or bowel incontinence Tongue injury Tonic/clonic movements Postictal state
