Epilepsy And Status Epilepticus

Question 1

Status epilepticus

Answer 1

Single convulsion over 5 mins, or a series w/o recovery interval over 5 min.
Can occur in any type of epilepsy
Mx-
A to E
BDZ lorazepam 0.1mg/kg IV, or rectal if have to
phenytoin 15-20mg/kg- zero order kinetics, reaches therap levs fast, monitor for arrhyth and hypot
Exclude hypoglycaemia
Think about ITU

Question 2

Anti epileptic drugs

Answer 2

VGSC blockers-
Carbamazepine- not for absence
Phenytoin- not for absence
Lamotrigine- LESS IN KIDS, but 1st choice adults and preg for all types
GABA enhancers-
BDZs- loraz for SE, clonazepam for absence
sodium valproate- for all types. Us first choice for kids.

Question 3

Seizure diffs

Answer 3

Epilepsy has post ictal
Infection
Metabolic eg gluc, Na, ammonia etc
Trauma
Congenital anomaly
Neurodegen
Neoplasia
Not real eg faint, fake, breathold, reflux, self gratif

Question 4

Defins

Answer 4

Epilepsy- excess neuronal activity in brain
Partial- One hemisphere
Simple- retain awareness, often precursor to larger seiz aura
Complex- lose awareness, odd behavs
Generalised- both hemis eg cross corpus callosum

Question 5

types

Answer 5

Tonic clonic- LOC, stiff, jerking, loss bladder control, tongue bite, resp arrest, post ictal.
Atonic- sudd loss tone.
Myoclonic- jerking
Absence- loss awareness

Question 6

Ix

Answer 6

Hx

ECG

Question 7

Emergency mx in community

Answer 7

If over 5 mins- try support airway, buccal midazolam

Question 8

Mx

Answer 8

A to E
Oxygen
Do BM
IV loraz and phenytoin
Find cause eg drug intox or withdrawal, elec distrub, infec
AEDs