Seziures

Question 1

What is syncope?

Answer 1

Loosing consciousness/passing out/fainting. The whole brain doesn’t get blood. 90% of the time it is not a seizure, mostly likely vasovagal syncopy.

Question 2

What is vasovagal syncope?

Answer 2

When your brain over-reacts to a trigger (shuts down your heart&laquo_space;Neurocardiogenic syncope)

Most common cause of fainting.

Triggers: Emotional stress, seeing blood, fever, BM, GI illness, heat, pain, trauma. Can cause skaking/jerking (convulsive syncope).

Confusion lasts ~5-15min (vs s/p Seizure ~45minutes)

Question 3

What are sx/sxs and triggers for vasovagal syncope?

Answer 3

S/Sx: Tunnel/blurred vision, warm feeling, diaphoresis, dizziness.

Tx: Counsel to avoid triggers, hydrate, vasoconstrictiors (mineralocoticoids= keep salt= keep ^bp).

Question 4

What is orthostatic hypertension?

Answer 4

Pass out /get dizzy after you stand up.

Due2: Hypovolemia (dehydration, blood loss, adernal insufficiency, diarrhea, diabetes insipidus), Cardiac impairment, Vasodilation (venous pooling)

Question 5

What is postural hypotension?

Answer 5

Drop in systolic BP by 20 or a drop in diastolic BP by 10 after standing for 3 minutes.

Measure 3bp’s (laying for 5 mins, 1 min after standing, 3 min after standing)

Question 6

What is POTS?

Answer 6

Postural Orthostatic Tachycaria syndrome is a condition that affects circulation (blood flow).

POTS is a form of orthostatic intolerance, the development of symptoms that come on when standing up from a reclining position, and that may be relieved by sitting or lying back down.

Question 7

What can cause postural hypotension?

Answer 7

meds and cardiac arrhythmia

Question 8

What is cardiac sinus syndrome?

Answer 8

Sensitive baro receptors at carotid body (syncopize when shaving beard over neck area). Poor brain perfusion => Syncope

Question 9

What is myoclonus?

Answer 9

Muscle jerk (sz meds can cause this)

Question 10

What is a seizure?

Answer 10

Excessive and abnormal brain cell activity.

1.2% of Americans have active epilepsy (at least 2 seizures).

Most commonly diagnosed before age 20 or after age 65.

No driving for 3 months after last seizure (don’t have to report, just make recommendation)

Question 11

What are three types of sz?

Answer 11

• Partial:
• –Simple partial: remains conscious (hand twitching or tingling in body)
• –Complex partial: lose consciousness (confused)
• –Generalized partial: tonic-clonic and unconsciousness

Question 12

What is a tonic-clonic sz?

Answer 12

1) Tonic phase (Incontinence, flexing, cynosis, generalized stiffening of body and limbs, back arched).
2) Clonic phase (Salivary frothing, Cyanosis, Eyes blinking, Clonic jerks of limbs/body/head.
3) Post-ictal confusion (limbs and body limp) -last around 15 minutes

Question 13

What are temporal lobe sz symptoms?

Answer 13

Nausea and deja vu

Question 14

What do frontal lobe sz cause?

Answer 14

Personality changes

Question 15

Sz can result in _____ _____ & _________

Answer 15

Tongue biting, incontinence

Question 16

What is status epilepticus?

Answer 16

When sz last more than 5 min

Question 17

What to do if someone has a sz?

Answer 17

Turn on side, move objects that could harm them, call ER

Question 18

Causes of sz?

Answer 18

• Brain tumor
• Trauma or injury of the head
• Overconsumption of alcohol (check ETOH) or drugs, drug/alcohol withdrawal
• Low levels of glucose/calcium/magnesium (check metabolic panel and blood sugar)
• Stroke or ruptured blood vessel in brain…anything that scars the brain.
• Potassium deficiency cannot cause sz’s.

Question 19

What testing should you order on your new onset sz patients?

Answer 19

Always order an EEG and a MRI brain with and w/o gadolinium on your new onset sz patients

Question 20

EEG

Answer 20

Electroencephalogram is a test used to find problems related to electrical activity of the brain. An EEG tracks and records brain wave patterns.can catch a seizure disorder but cannot rule out a seizure disorder. Can get one from 20min to 72hrs.

Question 21

What molecules are main contributors for sz?

Answer 21

Main contributors: low glucose, Na+, Mg2+, Ca2+ (this is why we check metabolic panel and blood sugar)

Question 22

What is a psychogenic non-epileptic sz?

Answer 22

Spells associated with emotional situations. Ask if stress triggers sz’s. on EEG, brain’s electrical activity remains normal.

Sz typically last for 3 min so more than that could be faking

Question 23

How do the eyes tell you if you are having a stroke or sz?

Answer 23

Stroke- eyes will look away from injury

Seizure- eyes look same side of injury

Question 24

What are triggers of sz?

Answer 24

Stress, insominia, ETOH, missed meds (most common cause of a break-through sz), meds (Tramadol, Wellbutrin/bupropion, abx)

Question 25

What is a tx for sz and headaches?

Answer 25

(Topamax). Great for HA’s and Sz’s, but can make you forget words (dopamax)

Question 26

What is the mc med for sz?

Answer 26

(levetiracetam)- makes you cranky and depressed. Mostly harmless and works FAST (in pt drug)

Question 27

What is a good sz med for mood and IQ?

Answer 27

Lamotrigine

Out/pt drug (slow acting). Safe and good for mood and IQ. Used for pregnant women with seizures.
*ok in pregnancy

Few S/E besides rash (rare)
*ok in pregnancy

Question 28

Which sz med causes weight gain?

Answer 28

Valproic acid

*bad for pregnancy

Question 29

Which sz med is good for trigem neuralgia and sz?

Answer 29

Carbamazepine/ Tegretol

Check liver enzymes and Na levels with CBC and CMP

Question 30

What is a temporary sz med?

Answer 30

Benzos (ativan/lorazapam) and Valium/midazolam

Temprary but fast. Put them on long term. Muscle relaxer so watch for airway if they overdose/ovreruse

Question 31

What sz med is good for the ICU?

Answer 31

Propofol or Versed

drip is great for ICU b/c dosent drop bp much

Question 32

What med helps with sz and essential tremor?

Answer 32

Primidone

Question 33

What sz med causes leg swelling?

Answer 33

Gabapentin and pregabalin

Question 34

When would you use a vagus nerve stimulator in patient’s with sz?

Answer 34

Is like a pacemaker that stops seizures (great for >3 meds). Stimulates vagus nerve (in charge of calming the brain)