Seizures Quiz

Question 1

Define Seizure and Convulsion

Answer 1

Seizure - sudden uncontrolled excessive electrical activity in the brain

Convulsion - An episode of excessive and abnormal motor activity, involving rapid contraction and relaxation of muscles

Question 2

List 6 causes of seizures

Answer 2

• Hyper/hyponatraemia
• Hyper/hypoglycaemia
• Stroke/NTBI
• Drug withdrawals
• Brain tumour
• Traumatic HI
• Eclampsia
• Febrile Illness
• Infection (meningitis/encephalitis)
• Kidney/liver failure
• Drug induced
• Hypoxia

Question 3

What is epilepsy?

Answer 3

A condition that is characterised by recurrent seizures (of no other cause) caused by excessive cortical nerve cell activity

Question 4

What is the difference between partial and a generalised seizure?

Answer 4

Partial - seizure activity originates in one part of the brain (can be simple or complex)

Generalised - Seizure activity involves the entire brain

Question 5

Define myoclonic seizure

Answer 5

Rapid, brief contractions of bodily muscles which usually occur at the same time on both sides of the body

Question 6

Define Atonic Seizure

Answer 6

Abrupt loss of muscle tone (e.g. drop attacks, astatic or akinetic seizures)

Question 7

Define absence seizure

Answer 7

• Lapse of awareness
• Start and end abruptly
• No warning and no after effect
• Common in children

Question 8

Focal onset seizures (partial seizures) are subdivided into 2 categories. What are they?

Answer 8

• Focal aware seizures (conscious retained)
• Focal impaired seizured (LOC or impaired)

Question 9

Why is status epilepsy an emergency?

Answer 9

• Continuous seizure for greater than 30 minutes

Question 10

When would you treat a patient with seizure activity?

Answer 10

• Confirmed evidence of status epilepticus >5 mins or >2 seizures with no return of consciousness in between
• Includes GCSE or subtle SE (consult)

Question 11

What is the maximum dose of midazolam you can administer an adult patient?

Answer 11

• 20mg IM
• 10mg IM (elderly or frail)

Question 12

What assessment (not in the VSS) should you perform prior to administering midazolam?

Answer 12

• BSL

Question 13

What are 4 side effects of midazolam?

Answer 13

• decreased level of consciousness
• Respiratory depression
• Loss of airway control
• Hypotension

Question 14

What are the onset, peak and duration times of midazolam?

Answer 14

Onset - 3-5 mins
Peak - 15 mins
Duration - 30 mins

Question 15

List the paediatric doses of IM Midazolam

Answer 15

• Newborn (<25 hours) 0.5mg IM
• Infant (<12 months) 1mg IM
• Small child (1-4 yrs) 2.5mg IM
• Medium child (5-11 yrs) 2.5-5mg IM

Question 16

What is subtle SE and can you treat this?

Answer 16

• may develop from prolonged or uncontrolled GCSE and is characterised by coma and ongoing electro-graphical seizure with or without body motor movements/nystagmus
• not without consulting the clinican/recieving hospital

Question 17

If a patient who is diagnosed with epilepsy and has been treated by you with IM midazolam (and is now GCS 15) can you leave them at home with a responsible person under the treat and refer guideline?

Answer 17

• No
• When they adamantly refuse, despite your best efforts, contact the clinician for advice and get the patient to sign the disclaimer on the VACIS tablet