Seizures & Epilepsy Flashcards
Define seizure
manifestation of abnormal hypersynchronous discharge of cortical neurons
Name the 2 primary types of seizures
Focal and generalized
What are the types of focal seizures
- focal aware
- focal with impaired awareness
- focal tonic/clonic
- focal with bilateral tonic/clonic
What are the types of generalized seizures
- generalized tonic/clonic
- generalized absence
What are some risk factors for seizures
Hx meningitis/encephalitis, TBI, Family history, PMH, alc/sub use, medications (imipenem, bupropion, SSRIs with Tramadol)
Which seizures/disorders typically involve gain of function and which involve loss of function
GOF: epileptic seizures, pseudoseizures
LOF: TIA, Todd’s phenomenon/paralysis, atonic seizures
Describe the characteristics of an epileptic seizures
- 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
During an acute focal seizure, eye deviation is ________, whereas in Todd’s phenomenon eye deviation is ______
during = contralateral (GOF)
Todd’s = ipsilateral (LOF)
What might labs show following seizures
- elevated prolactin
- elevated CPK
- BMP: anion gap and hyponatremia
- Utox to assess for any stimulants
What meds might induce seizures
- Imipenem
- Bupropion
- SSRIs and TCAs with Tramadol
What medications are best indicated for Focal seizures
- lamotrigine
- levetiracetam
- lacosamide
- oxcarbazepine
What medications are best indicated for Generalized seizures
- lamotrigine
- levetiracitam
Describe SUDEP (sudden unexpected death in epilepsy)
- death due to an unknown cause
- could be cardiac arrhythmia, status epilepticus, respiratory depression
Describe status epilepticus
- 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)
How long does a seizure typically last
90 seconds, with post-ictal states lasting seconds to days
Describe some common spells, in addition to epileptic seizures
- TIAs
- hypoglycemia
- pseudoseizure/psychogenic
- panic attacks
- syncope
- cataplexy
- etc.
What are the important questions to ask on history following a seizure
- 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
Why are the eyes typically open in an epileptic seizure
because of excessive brain activity
Describe a limbic seizure
- panic sensation
- panic attack inducing
- spontaneous with no triggers
An ______ is usually a focal seizure before it spreads
aura
What is the typical recurrence rate for a second seizure following the first one
20-40%
The term for unknown cause is _______ and the term for presumed genetic is _______
cryptogenic, idiopathic
What is the condition depicted
Hippocampal atrophy/mesial temporal sclerosis
(scarred, astrophied) (coronal view)
What is the condition depicted
Malignancy/tumor (transverse view)
What is the condition depicted
Intracranial hemorrhage (transverse view)
What is the condition depicted
Focal cortical dysplasia (too much gray matter when compared to the other side)
What is the condition depicted
Heterotropia (supposed to be white matter where the arrows are pointing)
What is the condition depicted
Polymicrogyria (too much gyri)
What is the condition depicted
Schizencephaly (separation where there shouldn’t be)
What is the condition depicted
Cavernoma (enlarged deformed blood vessels in clusters)
What is the condition depicted
Tuberous Sclerosis (genetic, benign tumors)
What is the condition depicted
Neurocystircercosis (parasitic)
Describe the types of EEG
- Time: 30 min, 60 min, 3 hrs, 24 hrs
- +/- sleep deprivation
- +/- video
- ambulatory, extended (no video)
Describe how an EEG works
A spike in the corresponding EEG electrodes indicates seizure activity in that region (L temporal lobe epilepsy in this photo)
What medications are contraindicated for generalized seizures (they make it worse)
- carbamazepine
- oxcarbazepine
- phenytoin
- gabapentin
- vigabatrin
What is first line tx for a focal seizure and for a generalized seizure
Focal: carbamazepine and lamotrigine (2nd = levetiracetam)
Generalized: sodium valproate (2nd = lamotrigine and levetiracetam)
Which seizure meds are the safest in pregnancy
- levetiracetam and lamotrigine
- levels should be checked frequently when pregnant or taking oral contraceptives
What are the driving restrictions in MN following seizures
- 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
What are the surgical interventions for seizures
- vagal nerve stimulator
- resection
- neurostimulation
- laser ablation
(after 2 adequately tried and failed ASMs)
What are some complications of status epilepticus
- hypoxic nerve damage, cerebral edema, increased ICP
- rhabdomyolysis, renal failure
- electrolyte abnormality
- arrhythmia
- pumonary edema
- disseminated intravascular coagulation
