Thursday, 8-25-Seizures and Syncope-Hon

Question 1

epilepsy is defined as ___

Answer 1

2 or more UNPROVOKED seizures

Question 2

In regards to the % positive findings for epilepsy on a SINGLE EEG:

All types= \_\_\_ %
Generalized tonic-clonic= \_\_\_%
Petit mal (with Hyperventilation)=\_\_\_ %
Partial seizure= \_\_\_%

Answer 2

all types=40%
Generalized tonic-clonic=20%
Petit mal=90%
Partial=30%

Question 3

the percent positive for epilepsy (all types) with 3 sleep-deprived EEGs: ___ %

Answer 3

85%

Question 4

although the EEG is an important tool in the dx of epilepsy, the single most important information is ___

Answer 4

history of the events-prefereably by witnesses

Question 5

These types of seizures have seizure activity that begins on 1 side of the brain

Answer 5

Partial seizures

Simple partial, complex partial, and secondarily generalized (partial onset)

Question 6

Secondary generalized seizures starts on 1 side then spreads to both sides. It is categorized as a ___ seizure

Answer 6

partial or partial onset

Question 7

absence (petit mal), tonic-clonic, tonic, clonic, atonic, clonic-tonic-clonic are all examples of ___ seizures

Answer 7

Generalized seizures –> starts on both sides of the brain

Question 8

___ seizures are focal motor or sensory activity, no loss of consciousness, lasts seconds, no post-ictal state

Answer 8

simple partial

Question 9

___ seizures are characterized by non responsive staring, possible preceding aura, automatisms, loss of consciousness, lasts 1-3 mins, post-ictal state

Answer 9

complex partial

Question 10

__ seizures are bilateral tonic-clonic activity, loss of consciousness, lasts 1-3 minutes, post-ictal state

Answer 10

secondary generalized

Question 11

__ seizures include non responsive staring, rapid blinking, chewing, clonic hand motions, loss of consciousness, lasts 10-30 seconds, no post-ictal state

Answer 11

absence (petit mal)

generalized

Question 12

___ seizures include bilateral extension followed by symmetrical jerking of extremities, loss of consciousness, lasts 1-3 mins, post-ictal state

Answer 12

tonic-clonic

generalized

Question 13

__ seizures has sudden loss of muscle tone, head drops, or pt collapses, loss of consciousness, variable duration, post-ictal state

Answer 13

atonic

generalized

Question 14

___ seizures are brief, rapid symmetrical jerking of extremities and/or torso, loss of consciousness, lasts

Answer 14

myoclonic

generalized

Question 15

These drugs are for both primary generalized as well as partial onset seizures:

Answer 15

Valproic acid
Lamotrigine
Topiramate
Leviteracetam
Zonisamide
Perampanel

Question 16

This drug is used for absence seizures only

Answer 16

ethosuxamide

Question 17

___ is a condition characterized by prolonged seizure (generally greater than 10 minutes) or repeated seizures without recovery in between

Answer 17

status epilepticus

Question 18

pallor, sweating, abnormal head sensation, lightheadedness, positionally-related, slow onset, and brief unconsciousness are characteristic of:

Answer 18

Syncope

Question 19

urinary or bowel incontinence, tongue injury, tonic/clonic movements, and postictal state are characteristic of :

Answer 19

seizure

Question 20

Describe the tx of status epileptics:

Answer 20

• A,B,C’s, Establish IV
• Try to gain a history-? seizures previously, allergies to seizure meds
• Labs: Accuchek, CBC, Chem panel, Drug levels
• Non contrast CT of the head
• Give benzodiazepine (lorazepam 2-4 mg IV) –> BUYS TIME, but must give longer lasting AED

Question 21

This drug for status epilepticus requires that you intubate the pt first, in anticipation of respiratory depression

Answer 21

phenobarbital

Question 22

if unsuccessful in tx of status epileptics, you can try ___ continuous IV drip (pt must be intubated)

Answer 22

midazolam or propofol

Question 23

what is the last resort for treating status epilepticus?

Answer 23

Pentobarbital coma

Question 24

What are some general principles in tx of pts with epilepsy?

Answer 24

• Try to use mono therapy
• Consider drug interactions –> OCs with carbamazepine
• Consider long-term side effects –> bone loss with carbamazepine or phenytoin

Question 25

You want to avoid this AED in pregnancy

Answer 25

Valproic acid