Epilepsy

Question 1

A seizure is a discrete, time-limited alteration in brain function that includes what changes?

Answer 1

motor activity, autonomic functioning, consciousness, sensations

Question 2

Abnormal and excessive discharge of a group of neurons within what?

Answer 2

cerebral cortex

Question 3

What are some clinical manifestations?

Answer 3

indescribable bodily sensations, pins and needles, smells/sounds, fear/depression, hallucinations, head nods, staring with loss of awareness, convulsive movements

Question 4

This is a specific type of seizure where the attack is primarily manifested by involuntary muscular contractions.

Answer 4

Convulsion

Question 5

A condition characterized by recurrent seizures unprovoked by any immediately identificable cause.

Answer 5

Epilepsy

Question 6

Subjective disturbance of perception that represents the start of certain seizures

Answer 6

Aura

Question 7

The actual seizure itself.

Answer 7

Ictus or ictal phase

Question 8

Period after the seizure where the individual may be sleepy, confused, disoriented or may experience temporary neurological dysfunction.

Answer 8

Post-ictal phase

Question 9

Describe the imbalance in neurotransmitter processes in the brain.

Answer 9

Decreased GABA - inhibitory

Enhanced Glutamate - Excitatory

Question 10

Involvement of a localized area of the brain at seizure onset, begin in one hemisphere of the brain.

Answer 10

Focal

Question 11

Involvement of both hemispheres of the brain at seizure onset.

Answer 11

Generalized

Question 12

What causes a focal seizure?

Answer 12

injury to the brain,( tumor, trauma, neurodengerative disease)

Question 13

See tonic/clonic movements with which seizure?

Answer 13

focal without impairment of consciousness

Question 14

Sensory seizures are what type of seizures?

Answer 14

focal without impairment of consciousness

Question 15

What is the duration of a focal without impairment of consciousness?

Answer 15

30 seconds or less

Question 16

A focal seizure without impaired consciousness that may precede a focal seizure with impaired consciousness or progression to a generalized seizure

Answer 16

Aura

Question 17

What is the duration of a focal seizure with impairment of consciousness?

Answer 17

1-3 minutes

Question 18

Repetitive motor activities such as mumbling, picking clothing, lip smacking are signs of?

Answer 18

Automatisms seen in focal seizure with impairment

Question 19

Confusion, lethary, altered behavior, amnesic for event are of what phase?

Answer 19

Postictal

Question 20

EEG findings: local contralateral discharge starting over the cortical area.

Answer 20

Focal without impairment

Question 21

EEG findings: unilateral or bilateral discharge in the temporal or frontotemporal regions.

Answer 21

Focal with impairment

Question 22

May progress through several stages reflecting spread of discharge to different brain areas.

Answer 22

Evolving to a bilateral, convulsive seizure

Question 23

Seizures begins in both hemispheres. Loss of consciousness.

Answer 23

Generalized seizures

Question 24

Loss of consciousness followed by sudden fall to ground. muscles become rigid, clonic movements of head, legs, arms.

Answer 24

Generalized tonic-clonic

Question 25

What is the duration of Generalized tonic-clonic?

Answer 25

2-5 minutes

Question 26

Patients with primary GTC seizures occur most commonly when?

Answer 26

awakening and lesser extent in evening when relaxing

Question 27

Brief episodes of staring with impairment of awareness and responsiveness that begin without warning and end suddenly.

Answer 27

Absence

Question 28

What is the duration of an absence seizure?

Answer 28

10-45 seconds

Question 29

EEG of 3 per second spike and wave pattern.

Answer 29

Absence

Question 30

Sudden and total loss of muscle tone and postural control that causes eyelids to drop, head to nod, and patients drop to the ground.

Answer 30

Atonic

Question 31

What is the duration of an atonic seizure?

Answer 31

10-60 seconds

Question 32

Sudden, brief, shock-like jerk of a muscle often occurs in healthy people as they fall asleep.

Answer 32

Myoclonic

Question 33

Sudden bilateral stiffening of the body, arms, or legs. More common during sleep.

Answer 33

Tonic

Question 34

Rhythmic, repetitive, jerking muscle movements.

Answer 34

Clonic

Question 35

ACTH, prednisone and vigabatrin can be used to treat?

Answer 35

Infantile spasms

Question 36

Convulsions brought on by a fever greater than 102F. What seizure and how do you treat?

Answer 36

Febrile seizure | Diazepam orally or rectally

Question 37

Triad of intractable seizures, mental and developmental retardation, and slow spike and wave pattern.

Answer 37

Lennox-Gastaut Syndrome

Question 38

Myoclonic seizures begin around puberty in early morning. What seizure and how do you treat?

Answer 38

Juvenile myoclonic epilepsy | Treat: valproic acid

Question 39

What other conditions may look like epilepsy?

Answer 39

pseudoseizure, syncope, breath holding spells, narcolepsy, hemiplegic migraines, drug toxicity, transient ischemic attack

Question 40

What factors define epilepsy?

Answer 40

abrupt onset, loss of consciousness, brief duration, rapid recovery, stereotypic episodes

Question 41

What are some underlying causes of seizures?

Answer 41

hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia, withdrawal, sleep deprivation, fever, stimulants

Question 42

What tests should be ran?

Answer 42

CBC, LFT, serum albumin, urinalysis, serum electrolytes, EEG, MRI

Question 43

What are signs of need for immediate medical attention?

Answer 43

``` Seizure lasting 10 minutes or more Difficulty rousing in 20 minutes Vision complaints Vomiting Persistent Headache after rest period Unconsciousness with failure to respond Unequal size pupils or excessively dilated ```

Question 44

What are the nonpharmacologic treatments for seizures?

Answer 44

Surgery - temporal lobectomy Vagal nerve stimulation Ketogenic diet

Question 45

What are the toxic effects of AED?

Answer 45

somnolence, fatigue, dizziness, vision changes, nystagmus, ataxia, tremor, GI, difficulty thinking, behavioral disorders

Question 46

Chronic adverse effects of AED long term therapy?

Answer 46

connective tissue, endocrine, GI, hematologic, neurologic disorder

Question 47

Fetal hydantoin syndrome is associated with which drug? Manifestations?

Answer 47

phenytoin | Cranial facial abnormalities, cleft lip/palate, wide mouth, prominent lips, digit hypoplasia, mental retardation

Question 48

What should be given to pregnant women?

Answer 48

Folic acid 1-4mg daily | Vitamin K during 8th month

Question 49

Recurrent epileptic seizures without full recovery of consciousness before next full seizure begins.Continuous clinical or electrical seizure activity lasting more than 30 minutes, regardless of consciousness.

Answer 49

Status epilepticus

Question 50

Continuous seizure activity lasting more than 5 minutes. two or more seizures without complete recovery of consciousness

Answer 50

Status epilepticus

Question 51

Persistent state of impaired consciousness and motor/sensory seizure without impaired consciousness.

Answer 51

Non-Convulsive Status Epilepticus

Question 52

Involves the entire brain. Full body tonic-clonic motor seizures. Impaired consciousness.

Answer 52

Generalized Convulsive Status Epilepticus

Question 53

What can cause status epilepticus?

Answer 53

CNS tumor or infection, trauma, hypoxia, stroke, metabolic disorder, chronic alcohol abuse, drug toxicity, AED change in levels

Question 54

What drug is given first for SE?

Answer 54

Thiamine 100mg + Glucose if hypoglycemic

Question 55

What drug is given in 10 minutes for SE?

Answer 55

``` Lorazepam 0.1mg/kg IV OR Diazepam 10mg PR OR Midazolam 0.2mg/kg IM ```

Question 56

What drug is given in 10-30 minutes for SE?

Answer 56

Phenytoin 15-20 mg/kg IV

Question 57

What drug is given in 30-60 minutes for SE?

Answer 57

Additional phenytoin bolus 5-10mg/kg OR Phenobarbital 20mg/kg

Question 58

What drug is given in 60 minutes for SE?

Answer 58

``` Bolus phenobarbital 10mg/kg Valproate sodium 20mg/kg Midazolam 2mg/kg Bolus Propofol 1mg/kg bolus pentobarbital 10-15 mg/kg ```