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Neuro > Seizures & Epilepsy > Flashcards

Seizures & Epilepsy Flashcards

1
Q

Define seizure

A

manifestation of abnormal hypersynchronous discharge of cortical neurons

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2
Q

Name the 2 primary types of seizures

A

Focal and generalized

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3
Q

What are the types of focal seizures

A
  • focal aware
  • focal with impaired awareness
  • focal tonic/clonic
  • focal with bilateral tonic/clonic
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4
Q

What are the types of generalized seizures

A
  • generalized tonic/clonic
  • generalized absence
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5
Q

What are some risk factors for seizures

A

Hx meningitis/encephalitis, TBI, Family history, PMH, alc/sub use, medications (imipenem, bupropion, SSRIs with Tramadol)

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6
Q

Which seizures/disorders typically involve gain of function and which involve loss of function

A

GOF: epileptic seizures, pseudoseizures
LOF: TIA, Todd’s phenomenon/paralysis, atonic seizures

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7
Q

Describe the characteristics of an epileptic seizures

A
  • stereotypical
  • aura (deja vu, upset stomach, lip smacking)
  • eyes open
  • confusion
  • post-ictal state (seconds to days)
  • “stiffen like a board & fall like a log”
  • LOC with tonic-clonic
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8
Q

During an acute focal seizure, eye deviation is ________, whereas in Todd’s phenomenon eye deviation is ______

A

during = contralateral (GOF)
Todd’s = ipsilateral (LOF)

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9
Q

What might labs show following seizures

A
  • elevated prolactin
  • elevated CPK
  • BMP: anion gap and hyponatremia
  • Utox to assess for any stimulants
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10
Q

What meds might induce seizures

A
  • Imipenem
  • Bupropion
  • SSRIs and TCAs with Tramadol
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11
Q

What medications are best indicated for Focal seizures

A
  • lamotrigine
  • levetiracetam
  • lacosamide
  • oxcarbazepine
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12
Q

What medications are best indicated for Generalized seizures

A
  • lamotrigine
  • levetiracitam
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13
Q

Describe SUDEP (sudden unexpected death in epilepsy)

A
  • death due to an unknown cause
  • could be cardiac arrhythmia, status epilepticus, respiratory depression
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14
Q

Describe status epilepticus

A
  • technically after a seizure lasts 30+ minutes but clinically after 5+ minutes
  • life threatening
  • treat with stepwise protocol (ABCs, Midazolam, IV ASMs, intubate and sedate)
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15
Q

How long does a seizure typically last

A

90 seconds, with post-ictal states lasting seconds to days

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16
Q

Describe some common spells, in addition to epileptic seizures

A
  • TIAs
  • hypoglycemia
  • pseudoseizure/psychogenic
  • panic attacks
  • syncope
  • cataplexy
  • etc.
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17
Q

What are the important questions to ask on history following a seizure

A
  • walk me through one of the spells, what do you notice first
  • how long did it last
  • was there confusion after
  • did you bite your tongue and where
  • were the eyes open
  • have you ever woken from sleep feeling like you got hit by a train or have bitten your tongue
  • describe the fall
  • could the body be controlled when it happened
18
Q

Why are the eyes typically open in an epileptic seizure

A

because of excessive brain activity

19
Q

Describe a limbic seizure

A
  • panic sensation
  • panic attack inducing
  • spontaneous with no triggers
20
Q

An ______ is usually a focal seizure before it spreads

A

aura

21
Q

What is the typical recurrence rate for a second seizure following the first one

A

20-40%

22
Q

The term for unknown cause is _______ and the term for presumed genetic is _______

A

cryptogenic, idiopathic

23
Q

What is the condition depicted

A

Hippocampal atrophy/mesial temporal sclerosis
(scarred, astrophied) (coronal view)

24
Q

What is the condition depicted

A

Malignancy/tumor (transverse view)

25
Q

What is the condition depicted

A

Intracranial hemorrhage (transverse view)

26
Q

What is the condition depicted

A

Focal cortical dysplasia (too much gray matter when compared to the other side)

27
Q

What is the condition depicted

A

Heterotropia (supposed to be white matter where the arrows are pointing)

28
Q

What is the condition depicted

A

Polymicrogyria (too much gyri)

29
Q

What is the condition depicted

A

Schizencephaly (separation where there shouldn’t be)

30
Q

What is the condition depicted

A

Cavernoma (enlarged deformed blood vessels in clusters)

31
Q

What is the condition depicted

A

Tuberous Sclerosis (genetic, benign tumors)

32
Q

What is the condition depicted

A

Neurocystircercosis (parasitic)

33
Q

Describe the types of EEG

A
  • Time: 30 min, 60 min, 3 hrs, 24 hrs
  • +/- sleep deprivation
  • +/- video
  • ambulatory, extended (no video)
34
Q

Describe how an EEG works

A

A spike in the corresponding EEG electrodes indicates seizure activity in that region (L temporal lobe epilepsy in this photo)

35
Q

What medications are contraindicated for generalized seizures (they make it worse)

A
  • carbamazepine
  • oxcarbazepine
  • phenytoin
  • gabapentin
  • vigabatrin
36
Q

What is first line tx for a focal seizure and for a generalized seizure

A

Focal: carbamazepine and lamotrigine (2nd = levetiracetam)

Generalized: sodium valproate (2nd = lamotrigine and levetiracetam)

37
Q

Which seizure meds are the safest in pregnancy

A
  • levetiracetam and lamotrigine
  • levels should be checked frequently when pregnant or taking oral contraceptives
38
Q

What are the driving restrictions in MN following seizures

A
  • no driving for 3 mos unless okayed by a physician after a provoked seizure
  • no driving for 1 year if following a substance induced seizure
  • no driving a school bus 5 years post seizure and 2 years off meds
39
Q

What are the surgical interventions for seizures

A
  • vagal nerve stimulator
  • resection
  • neurostimulation
  • laser ablation
    (after 2 adequately tried and failed ASMs)
40
Q

What are some complications of status epilepticus

A
  • hypoxic nerve damage, cerebral edema, increased ICP
  • rhabdomyolysis, renal failure
  • electrolyte abnormality
  • arrhythmia
  • pumonary edema
  • disseminated intravascular coagulation

Neuro (22 decks)

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