Diagnosis and Management of Epilepsy Flashcards Preview

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Flashcards in Diagnosis and Management of Epilepsy Deck (33):
1

Define seizures

abnormal synchronous discharge of neurons in the cortex that produces stereotyped behaviours; usually self limited, lasting seconds to minutes

2

Define Epilepsy

2 or more unprovoked seizures

3

Define Postictal

Time after a seizure- seconds to hours
Characterized by disorientation and confusion

4

Define Interictal

Time between seizures

5

Define an Aura

A warning sign of an impeding seizure

6

Define an EEG

Eelectroencephalograph: recording of gross electrical activity of the cortex via the scalp

7

What are the types and subtypes of seizures?

Generalized
Partial: Simple or complex

Seizures can start partial and become generalized

8

Does a generalized seizure have an aura?

No

9

Does a partial seizure have an aura?

Yes both complex and simple

10

Does a generalized seizure have an altered LOC?

Yes

11

Does a partial seizure have an altered LOC?

Yes for complex, no for simple

12

Does a generalized seizure show postictal confusion?

Yes (except absence)

13

Does a partial seizure show postictal confusion?

No for simple, yes for complex

14

What are the subtypes of a generalized seizure?

Tonic-clonic
Atonic
Myotonic (like twitching while falling asleep)
Absence (though to originate from thalamus)

15

How does a complex partial seizure present?

Starts focally and becomes generalized

16

What would a partial (focal) seizure that includes loss of awareness classify as?

Complex

17

What are the features of an absence seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?

Pediatric
No aura
up to 100s/day
10-15 seconds
no change to tonic-clonic
no postictal confusion
generalized 3 Hz spies and waves
-ve CT/MRI
Ethosuximide

18

What are the features of a complex partial seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?

Older patients
presents with aura
not very frequent
1-2 minutes
changes to tonic-clonic sometimes
presents with postictal confusion
focal epileptiform discharges
positive findings on CT/MRI
Various treatments

19

Define the prevalence of epilepsy in terms of lifetime risk and male/female`

1% of population has epilepsy
5% life time risk
M=F
Risk starts high in life, decreases, then increases again at later age

20

What are the primary and secondary causes of seizures?

Primary: idiopathic epilepsy
Secondary: Metabolic: nonadherence, Diabetic, EtOH withdrawal, Drugs,
Structural: Tumour, puss, bleeding, stroke

21

Do subcortical strokes cause seizures?

No

22

What do we look for in bloodwork to confirm seizures?

Na, Mg, Ca

23

Is EEG helpful in diagnosing seizures?

Yes but
First EEG is 50% sensitive
Three EEG's are 80% sensitive, one of which is done sleep deprived

24

What are the ontario regulations in terms of driving for patients who present with a seizure?

Must be reported and instructed not to drive
Not able to drive for minimum 6 months
Ex. insulin induced seizure

25

How do antiepileptic drugs work?

increase GABA; ex. benzodiazepines
Decrease glutamate
Alter ion channels (Na, Ca)

Or combination of the above

26

What is the process of managing AED? what is the success rate?

start with monotherapy, titrate up
If sz or complications, switch to another monotherapy drug
if sz try dual therapy using drugs with different mechanism of action

75% of patients will become seizure free
With each failed medication, the chance of becoming seizure free becomes lower

27

1 unprovoked seizure+ abnormal MRI, EEG, or physical. Treat?

Yes

28

1 provoked seizure + reversible cause. Treat?

No

29

1 provoked seizure +irreversible cause. Treat?

Yes

30

2 unprovoked seizures. Treat?

Yes

31

what are the first aid steps for a person seizing?

1- cushion head, remove glasses
2- loosen tight clothing
3- turn to the side to keep airway open
4- time seizure
5- don't put anything in the mouth
6- don't restrain
7- offer help postictally
8- ask about diabetes

32

Define status epilepticus

Ongoing seizure lasting >5 min
repeated seizures without return to baseline in the inter-ictal period
High morbidity and mortality

33

How do you treat a patient with seizure lasting more than 2 min? (status epilepticus)

As for capillary glucose (most important)
ask for monitors +IV access
Attach O2
roll pt on the side
if glc 2 give ativan+phenytion IV