Seizures & Epilepsy Lecture Flashcards
difference between seizures and Epilepsy
Seizure is single 24 hour period of provoked/unprovoked episodes
Epilepsy is 2 or more unprovoked seizure episodes
simple partial - what type of seizure?
Partial (focal) seizure
what type of seizure? - complex partial
Partial (focal) seizure
what type of seizure?- secondarily GTC
Partial (focal) seizure
eyes deviated to one side, what does this tell us
maybe dealing with a focal seizure
eyes looking forward, what does this tell us
maybe dealing with a generalized seizure
what type of seizure? - GTC
Generalized seizure
what type of seizure? - Absence
Generalized seizure
what type of seizure? - Myoclonic
Generalized seizure
what type of seizure? - clonic
Generalized seizure
what type of seizure? - Tonic
Generalized seizure
what type of seizure? - Atonic
Generalized seizure
what kind of seizure where they just drop to the floor from loosing all muscle tone (typically need the helmet to prevent more trauma)
Atonic
what term describes
Motor or sensory
No alteration in consciousness
often describes an “aura”
Simple
What type of seizure descriptor
Alteration in consciousness
May be able to continue activity, but with slowed response time
often involves staring or automatisms
duration 25 sec to 3 min
Complex
weakness of one extremity (usually one sided) brief and temporary
Todd’s paralysis -
what seizure type can be mistaken for ADHD
Absence seizures
Drug of choice for absence seizures
Ethosuximide
why do you medicate for absence seizures
the more they happen the more likely they are to have a generalized tonic clonic
seizures can effect development
stiffening of all extremities without the clonic phase
tonic
brief shock little jerks of extremities
can occur in clusters
with or without postictal confusion
myoclonic
these seizures have postictal confusion, somnolence, with or without transient local deficit
generalized tonic clonic
bowel/bladder incontinence
seizure
generalized tonic clonic
tongue biting
seizure
generalized tonic clonic
EEG for absence seizure
3 Hz spike and wave
occur in clusters upon awakening
seizure
Infantile spasms
contraction of trunk with extension of arms most common
seizure
infantile spasms
treatment for infantile spasms
ACTH or Vigabatrin
classification of epilepsy due to known abnormality on MRI or lab studies
symptomatic
classification of epilepsy due to unknown cause, MRI and labs all normal
Cryptogenic
classification of epilepsy due to unknown cause, MRI and labs all normal
Cryptogenic (we think we know the cause, but we dont really know the cause)
what class of seizure is absence
idiopathic
when is the best time to obtain a EEG after a seizure like event
1-2 weeks
so swelling has time to resolve for best results
malformation of cortical development could lead to what type of seizure
focal
Tuberous Sclerosis leads to what type of seizures
multi-focal
what imaging and tests for seizures
EEG - what type of seizure
MRI- is there a cause
labs to order for status epilepticus treatment (0-4 min)
blood glucose
chemistry to include Ca, Mg, Ph, CBC,
consider anemia of chronic disease levels
labs to order for status epilepticus treatment (0-4 min)
what else should be done?
blood glucose
chemistry to include Ca, Mg, Ph, CBC,
consider anemia of chronic disease levels
vitals ekg monitoring o2 oral airway suctioning
status epilepticus treatment for 5-9 min
PIV with NS
Treat hypoglycemia, hypocalcemia, hypomagnesemia
Ativan 0.1mg/kg and repeat in 2-3 min to max of 8mg
status epilepticus treatment for 10-30 min
fosphenytoin 20mg/kg (150mg/min max)
repeat fosphenytoin 5-10mg/kg if persists
call for EEG and alert ICU
likely to require pressor support
31-60 min status epilepticus treatment
phenobarbital 20mg/kg (max rate 100mg/min)
Consider valproic acid 20mg/kg
Drips:
Pentobarbital coma - 5-10mg/kg load until burst suppression then 0.5-5mg/kg/hr
Diazepam drip 2mg/kg/hr
versed drip 0.2mg/kg load then 0.05-0.5mg/kg/hr
Propofol: 1-2mg/kg iv bolus and repeat if needed. Infuse 5-10mg/kg/hr
Taper drips slowly
what qualifies as refractory epilepsy and what are other management techniques
tried 3 or more AEDs daily and still having seizures
Try
Vagus nerve stimulator
ketogenic diet
surgical if focal
ages and peak ages for febrile seizures
6mos and 5 yrs
peak at 18mos
most febrile seizures are
simple febrile
what qualifies febrile seizures as complex
greater than 15 min
recurs within 24 hours
focal
temp for a simple febrile seizure
greater than 101.5
what age group would you get an LP for a febrile seizure workup
<3 months - yes
6-18 mos - maybe
> 18 mos - no
2-5% of kids with meningitis present with fever and a seizure
seizure rescues
rectal Diastat
intranasal midazolam
prognosis of febrile seizures vs infantile spasms
2% of febrile will continue with epilepsy
infantile spasms - almost half will battle life long with neuro deficits and learning impairments.
psychogenic non-epileptiform seizures diagnosis
EEG
definition of status epilepticus
> 30 min continuous
