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%
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)
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
