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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

Define Tonic movements

A

Producing tone or contraction of muscles

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2
Q

Define Clonic movements

A

Alternating pattern of relaxation and contraction

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3
Q

What is the most common cause of seizures?

A 
70% idiopathic
Head trauma
Brain tissue infxn
Brain tumor
Stroke
Genetics 
Prenatal disturbance of brain development
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4
Q

1st seizure after age 30 must be worked up to rule out what condition?

A

Tumor until proven otherwise

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5
Q

What are some accompanying S/Sx with a seizure?

A 
Fever (infxn)
Focal neurologic finding
Papilledema (ICP)
Roth spots / Retinal hemorrhages
HA (infectious or hemorrhagic cause of seizures)
Meningismus
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6
Q

A physical exam should look for what in a PT suspected of having seizures of unknown origin?

A 
Neuro exam
Todd's Paralysis (one arm or side of body)
Postural HYPOtension
Abnormal HR and rhythm
Head trauma
Carotid Dz
Cardiac Dz
Systemic Infxn
Alcohol or drug abuse
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7
Q

What are Grand-Mal seizures also known as?

A

Tonic-Clonic (Grand Mal)

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8
Q

What are Petit Mal seizures also known as?

A

Absence (Petit Mal)

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9
Q

What are some of the features of generalized seizures?

A

Begin with a rigid phase followed by repetitive clonic movement

Bilateral-symmetric (without local onset)

Oral frothing

Respiratory distress

Cyanosis

Incontinence

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10
Q

What is the associated triad with Lennox-Gastaut Syndrome?

A

Developmental delay
Absence and tonic seizures
Slow spike-wave D/Cs on EEG

(onset 2-7 years)
(1/3rd have status epilepticus initially)

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11
Q

What is the definition of Ictal?

A

Relating to or caused by stroke / seizure

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12
Q

What does post-ictal mean?

A

Altered consciousness after a seizure

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13
Q

When would Valproic Acid be absolutely contraindicated?

A

Pregnant women

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14
Q

What drugs can be used to control generalized seizures?

A

Barbiturates
Phenytoin
Valproic Acid
Ethosuximide

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15
Q

What medications could you use to control partial seizures?

A

Phenytoin
Valproic Acid
Carbamezapine

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16
Q

What are some side effects you should keep in mind with Phenytoin?

What is Phenytoin’s trade name?

A

Dilantin

Gingivitis
Osteoporosis
Hirsuitism
Pseudolyphoma

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17
Q

If you Rx Depakote; what lab should you order to monitor the PT?

A

LFTs

18
Q

If you Rx a PT Tegretol (Carbamazepine) what lab should you additionally order to monitor the PT?

A

CBCs

S/E can include:
BLOOD DYSCRASIA
HYPOnatremia
Steven Johnson Syndrome

19
Q

What is the drug of choice for a Pregnant PT with seizures?

A

Lamotrigine

Lamictal

20
Q

What are some of the key features of Pseudoseizures?

A 
Asynchronous movements (90%)
Arching of back (90% of PTs)
Occurrence from sleep
Extended duration
Ictal crying
Abnormal triggers
Tight eye closing
No postictal symptoms
21
Q

How would you characterize a seizure with fumbling movements and lip smacking during the seizure, but also transient somnolence after the event?

A

Complex Partial Seizure

Psychomotor seizure

Can present with an aura

22
Q

How long do typical febrile seizures last?

A

1 to 2 minutes

Rapid return of consciousness

23
Q

What are the most common seizures of childhood?

A

Febrile Seizures

usually only one; if multiple happen during illness; considered ATYPICAL

24
Q

What are some of the criteria of ATYPICAL FEBRILE SEIZURES?

A

Prolonged seizures > 15min
Focal seizure manifestations
Multiple seizures during same febrile illness

25
Q

What is the most common form of adult epilepsy?

What is the dominant medical treatment for this?

A

Mesial Temporal Sclerosis

(Complex partial seizure)
(Olfactory involvement)

Tegretol

26
Q

A 4 year old child with Down Syndrome presents to your clinic with flexion / extension of the extremities and trunk. What epileptic syndrome do you suspect?

A

Infantile spasms
(West Syndrome)

Treatment includes ACTH

27
Q

A 4 year old child with Down Syndrome presents to your clinic with flexion / extension of the extremities and trunk. What epileptic syndrome do you suspect?

A

Infantile spasms
(West Syndrome)

Treatment includes ACTH

28
Q

What is the associated triad with Tuberous Sclerosis?

What are some other presenting S/Sx that are more common?

A

Most prevalent INHERITED TUMOR SYNDROMES

Triad:

  1. Adenoma sebaceum
  2. Seizures
  3. Developmental Delay

Hypomelanotic macules (ash leaf) 90%

29
Q

What is the mnemonic device to remember the presenting S/Sx of Tuberous Sclerosis?

A 
A-  Ashleaf spots (hypomelanin spots)
S-  Shagreen patches 
H-  Heart rhabdomyosarcoma
L-  Lung hamartomas
E-  Epilepsy from tubers
A-  Angiomyolipoma in kidney
F-  Facial angiofibroma
30
Q

What would the treatment for a Lennox-Gastaut syndrome be?

A

Callosotomy

Vagal nerve stimulator

31
Q

What is the acute management for epilepsy?

What is the Tx for burst suppression?

A

Benzodiazepines

Pentobarbitol coma (last resort)

32
Q

What is the definition for Status epilepticus (SE)?

A

Seizure > 30min

Occurrence of several seizures w/ no return to normal consciousness b/t

33
Q

What agent should be 1st line to stop a seizure in a neonate?

A

Phenobarbital

34
Q

What agents should be used to stop a seizure in an adult PT?

A

Lorazepam (Ativan) 4mg max q 10 min SL x 3
Diazepam (Valium) 10mg max q 10 min Rectally x 3
Paraldehyde

If persists –> longer term
Phenobarbital
Phenytoin

35
Q

What are some potential side effects of Diazepam (Valium) or Lorazepam (Ativan)?

A

HYPOtension

Respiratory depression

36
Q

What’s the proper dosage for Phenytoin (Dilantin)?

A

Up to 1000mg IV (50kg PT)

Infuse in NS

37
Q

If seizures persist >60min what should you be worried about controlling?

What would you Rx?

A

ICP

Mannitol (0.5 - 1 g/kg IV over 15min)

Dexamethasone (0.25mg/kg STAT)
Maintenance: (0.5mg/kg/day x 24hrs)

38
Q

Give me a differential Dx of what could mimic a Seizure?

A 
Sleep myoclonus
REM motor activity
Jitteriness of newborn
GERD
Pallid infantile syncope
Night terrors
Migraine and syncope
Benign paroxysmal vertigo
Tics / Tourette's 
Pseudoseizures (PNES)
39
Q

Every seizure PT should have what labs ordered?

A

Serum electrolytes
Serum calcium, phosphate, and magnesium
EEG
Brain imaging CT or MRI

If febrile consider:
CBC w/ diff & blood culture
CSF culture
Urinalysis

40
Q

Phenobarbital should be monitored for what during therapy?

A 
Hepatotoxicity 
Rash
Sedation
Ataxia
Hyperactivity
41
Q

What long term use side effects are associated with Phenytoin?

What kind

A

Gingival hyperplasia
Hirsutism
Lymphadenopathy

Sedation and ataxia

Neurology (18 decks)

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