Seizures& Managment Of Seizures Flashcards
In status epilepticus, what is the time threshold for tonic clonic?
5 minutes
A patient came to you with absence seizure , when do you consider it abscence status?
10-15
A patient came to you with focal complex seziure , what is the time threshold for it to consider it status?
10 minutes
A patient came to you with an attack of seizure for 20 minutes , whats your next step of management ?
Give benzodiazepines:
1-Iv lorazipam
2-Iv diazipam , Iv midazolam
3-IM midazolam , buccal- intranasal any one of them <— if can’t tolerate oral
A patient came to you seizing for two minutes, whats your next step?
Stabilize the patient
ABC
Oxygen , pulse ox
Iv access : 2 Iv lines/ intraosseous
Lab:
Glucose
BMP
Anticonvulsant drug level
Tox studies
CBC
YOU MIGHT GIVE:
Initial supportive measures according to the cause
Nalaxone/thiamine/glucose
If a patient came to you seizing for 5 minutes, whats your next step in management? ,
If the seizure stops whats your next step?
1-benzodiazepines
2-further diagnostic approach:
EEG
CT
LP if needed
When do you give non benzos? And what are they?
As a second line of TT
If the patient was seizing for 20-40 minutes
Iv fosphenytoin
Iv phenobarbital
Iv levetiracetam
Iv valproic acid
When is it considered refractory status? How do you treat it
40-60 minutes
In the ICU!
Third treatment phase:
IV infusion:
Phenobarbital or Midazolam
General anesthesia:
Thiopental
Propofol
+ monitor , intubate, continuous EEG
A patient came to you with convulsive syncope , what would you order other than EEG?
ECG , to exclude prolonged QT interval
(Its recommended in all children with seizures , especially convulsive)
In which types of seizures you can use an ictal EEG?
1-suspected childhood absence
2-suspected infantile spasm (west syndrome)
When is it indicated to ask for metabolic investigations?
1-developmental arrest
2-related to feed/ fasting
3-epilepsy starting in the first 2 years of life (excluding febrile)
Who do you give rescue therapy?
Convulsive epileptic seizures with loss of consciousness >5
Buccal midazolam
You can discontinue therapy after 2 years free of seizure, except young people who have
1-juvenile abscence epilepsy
2-juvenile myoclonic epilepsy
Is it indicated to use steroids in seizures?
If its infantile spasm (west syndrome)
Whats the CP of west syndrome
And how would you treat it
Violent flextion lf head, trunk, limbs
Followed by extension of the arms
Lasts for 1-2 seconds
20-30 times
Give
Corticosteroids
Vigabatrin
Whats the specific EEG of
1-west syndrome
2-absence
1-hypsarrhytmia
2-3 hz spikes and waves
What kind of motor affection happens in absence seizure?
Flickering of the eyelid (mouth hands)?
Risk factors for west
Syndrome?
TB
HIE
PKU
PERINATAL INFECTION
Trigger for absence?
First line of tt?
Hyperventilation
Ethosuximide
1-What is the most common childhood epilepsy?
2-what will you find in the EEG
3-CP?
4-how would you treat
1-benign rolandic epilepsy
2-centrotemporal spikes (rolandic area)
3-usually during sleep
Facial twitching/ numbness
Hyper salivation
Speech arrest
Tonic clonic while he’s sleeping
Or simple focal seizure with abnormal feelings in the tongue and distortion of the face
4-maybe no tt / or
Levetiracetam
Carbamazepine
RONALDO LEV THE CARBS!!
The most common type of seizure ?
And which age group does it effect
Febrile
6 months to 5 years
Risk factors for febrile?
1-family
2-rapid rise 38 or more
3-viral :
Rosela, influenza
URI
otitis media
4-recent immunization
DTAP
MMR
Risk factors for epilepsy after FS
SRC FFFCN
Simple 1%
Recurrent 4%
Complex febrile ( >15, >2 a day) 6%
Fever <1 hour before FZ 11%
Family of epilepsy 18%
Focal complex febrile 29%
Neuro developmental 33%
Risk factors for recurrence of FS
And how do you calculate it
MAJOR
age <1 year
Duration of fever <24 h
Degree of fever 38-39
MINOR
Family + for FS
Family + for epilepsy
Daycare
Male
Complex febrile seizure
Hyponatremia
No risk 12%
1 risk 25-50%
2 risks 50-59%
3 risks 73-100%
Management of febrile
Uncomplicated : reassure , NSAId
Abortive ( rescue ) if
>5 minutes
Or
Complex FZ
Give benzos
Choice #1 lorazepam IV
High risk:
Non benzos
Sodium valproate
Phenobarbitone
For 1.5 years- 2 years
What type of seizure is jacksonian seizure ?
Secondary generalized
A patient was brought to the ER seizing
, both his upper limbs were raised , he had gaze deviation , excessive salivation and impairment of speech
Which lobe is mainly effected , and what type of seizure is this?
What is likely to be seen after the seizure
Frontal lobe
Simple focal seizure
Tods paralysis
(No confusion)
Which lobe is affected if the patient had dejavu, james vu or fear? And what other findings would be found too
Temporal ( focal complex )
Timing: 1-2 minutes
Pre ictal: aura
Ictal
Automatism: lip smacking, walking in non purposeful manner (premotor) , decrease of consciousness, autonomic , daydreaming
Post ictal: confusion
Whats petit mal, and whats grand mal?
1-absence
2-tonic clonic
Characters of generalized seizures
1-both hemispheres
2-loss consciousness for MORE than 3 seconds
3-aura
4-symmetrical bilateral
5-EEG: synchronous , bilateral
Atonic (drop attacks) characteristics ?
Sudden transient loss of muscle tone for less than 15 seconds
“Sudden head drop”
Mistaken for syncope
What is the most common form of epilepsy ?
Complex partial - temporal lobe
Most common childhood epilepsy?
Rolandic
