Seizures, Cohen II

Question 1

complex partial seizure

Answer 1

partial because 1 cerebral hemisphere

complex because level of consciousness partly reduced

Question 2

signs before complex partial seizure

Answer 2

aura
deja vu
bad sensations: irritating smell or taste, sense of dizziness, abdominal discomfort that rises to head fast

Question 3

patients who have complex partial seizures

Answer 3

any age, usually elderly
alone or witnessed to have TIA
may be from trauma
last 1-2 minutes

Question 4

signs of complex partial seizure

Answer 4

sudden loss of speech, blank look on face, automatisms

Question 5

what are the automatisms seen in complex partial seizure

Answer 5

repetitive blinking, chewing movements of mouth, simple motioning with the hands, odd fumbling with clothes or even undressing, repetition of very simple spoken phrases or words

Question 6

how old are patients with absent seizures

Answer 6

4 or 5 or 6 y.o

Question 7

common cause of seizures in children

Answer 7

absence seizures

Question 8

petit mal seizures

Answer 8

absence seizures

Question 9

length of absence seizures

Answer 9

less than 10 sec in duration
always less than 60 sec
inability to speak or respond in any way

Question 10

do patients fall in absence seizure

Answer 10

no

Question 11

after absence seizure

Answer 11

no idea had seizure

quick recovery of consciousness

Question 12

MRI absent seizures

Answer 12

normal

Question 13

Prognosis children with absence seizures

Answer 13

hundreds a day
poor in social situation or in school work
often Dx by teacher in kindergarten
frustrated parents

Question 14

EEG absent seizures

Answer 14

three per second spike/wave complex

Question 15

Tx absent seizure

Answer 15

usually respond to small dose of valproic acid (depakote)
lamotrigine (lamictal) effective
2/3 lose seizures after puberty
some go on to generalized tonic clonic seizure

Question 16

ethosuximate

Answer 16

used for absence seizures

NOT tonic clonic

Question 17

Antiepileptic drug usually not indicated

Answer 17

after first seizure with normal EEG and no risk factors

Question 18

second unprovoked seizure

Answer 18

definition epilepsy and patients should take medication

Question 19

90% or more seizures end in how much time

Answer 19

2 minutes or less

Question 20

common damage from seizures

Answer 20

trauma: falling, including fractures or aspiration of gastric or oral contents or biting tongue or cheek

Question 21

do not give what drug unless status epilepticus

Answer 21

IV benzos

Question 22

what occurs with IV benzos if given to regular seizures

Answer 22

increased risk respiratory arrest

Question 23

Pseudoseizures

Answer 23

psychologic nonepileptic seizures
usually have serious psychiatric illnesses
Hx of psychiatric or sexual abuse

Question 24

what do pseudoseizures look like

Answer 24

asynchronous limb movements, eyes closed, involve pelvic thrusting or odd movements of trunk, go on for more than 2 minutes
come on more slowly than typical seizures

Question 25

pseudoseizures do not responde to what drugs

Answer 25

epilepsy drugs

Question 26

when do doctors need to reevlauate if patient truly has epilepsy or if medication not right for type of seizure

Answer 26

when patient has seizures after use of 3 different anticonvulsants at high doses

Question 27

which type seizure patient more difficult to control with meds

Answer 27

partial epileptics

Question 28

anticonvulsants

Answer 28

phenytoin
valproic acid
carbamazepine
lamotrigine
topiramate

Question 29

side effects phenytoin

Answer 29

stevens johnson syndrome

Question 30

phenytoin not useful in what patients

Answer 30

absent seizures

Question 31

problems with carbamazepine

Answer 31

auto induction
dizzy
nausea

Question 32

carbamazepine replaced by

Answer 32

oxcarbazepine

Question 33

side effect lamotrigine

Answer 33

rash

Question 34

side effect topiramate

Answer 34

slow down speech and thinking

changes the body temp

Question 35

Status epilepticus

Answer 35

medical EM

Question 36

risk of status epilepticus

Answer 36

permanent brain damage

lack of respiration may cause death immediately

Question 37

definition status epilepticus

Answer 37

multiple seizures without regaining of normal level consciousness
or
prolonged generalized seizure for 30 minutes

Question 38

are partial seizures that last 30 minutes dangerous

Answer 38

yes

Question 39

Tx of status epilepticus

Answer 39

check ABCs, glucose and O2 and urine for toxicology

lorazepam or diazepam

Question 40

loading dose for lorazepam or diazepam in status epilepticus

Answer 40

phenytoin or another anticonvulsant

Question 41

first steps status epilepticus

Answer 41

ABCs
IV line
glucose and O2

Question 42

surgery for seizure

Answer 42

if definite focal source of electrical discharge can be found, commonly in one of temporal lobes
surgical excision safe and highly effective

Question 43

Vagal Nerve stimulator

Answer 43

detect and try to stop seizures at onset of electrical shocks (future maybe?)