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Neuro > Lecture 9: Seizure Disorders > Flashcards

Lecture 9: Seizure Disorders Flashcards

1
Q

What is required to diagnose a seizure disorder?

A

At least 2 unprovoked/natural seizures.

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2
Q

What is a non-epileptic seizure?

A

Provoked seizure, such as via fever.

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3
Q

What are the high-risk features that increase seizure recurrence after an unprovoked seizure?

A
  1. Epileptiform abnormality on EEG
  2. Remote symptomatic cause
  3. Abnormal neurologic examination
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4
Q

What are the primary risk factors for epilepsy?

A
  • Age (esp >60)
  • Brain infections/tumors
  • Dementia
  • Family history
  • Vascular disease
  • Hypoxic brain injury
  • Cerebral edema
  • Caucasians
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5
Q

What are the precipitating factors that may induce seizure?

A
  • Fatigue
  • Decreased physical health
  • Alcohol ingestion
  • Emotional stress
  • Flashing lights
  • Menstrual cycle
  • Hypoglycemia
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6
Q

Withdrawal from what medication class might provoke a seizure?

A

BZD withdrawal

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7
Q

What are the 4 stages of a seizure?

A
  1. Prodromal (sometimes)
  2. Pre-ictal/aura (technically phase 1 of a seizure)
  3. Ictal (What people witness)
  4. Post-ictal
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8
Q

What is the aura/pre-ictal part of a seizure?

A

A focal onset seizure

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9
Q

What is jamais vu?

A

Memory disorder that something familiar is being encountered for the first time

Opposite of deja vu

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10
Q

What typically characterizes a post-ictal phase?

A
  • Confusion
  • Agitation
  • LOC
  • Unresponsiveness
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11
Q

What are the two types of seizures?

A
  1. Focal onset
  2. Generalized onset
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12
Q

What are the two primary types of focal onset seizures?

A
  • With retained awareness (NO LOC, NO MEMORY LOSS)
  • Impaired awareness (ALOC)
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13
Q

What is the only generalized seizure that does not involve a LOC?

A

Myoclonic seizures

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14
Q

What generally does not precipitate a generalized seizure?

A

Aura

They don’t feel its coming

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15
Q

What is the only non-motor onset generalized seizure?

A

Absence seizure (staring spells, lip smacking)

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16
Q

What characterizes an absence seizure?

A
  • Abrupt onset and offset.
  • Lip smacking, staring
  • MC in children
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17
Q

What might make us consider that an absence seizure is a focal seizure instead?

A

If it is longer than 45s

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18
Q

What characterizes a myoclonic seizure?

A
  • Sudden/myoclonic jerks of movement for >30mins
  • Partial awareness
  • Can occur upon waking or prior to falling asleep
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19
Q

What is benign myoclonus of infancy and what makes it unique from a myoclonic seizure?

A
  • Normal EEG
  • No delay of neurologic development
  • Often occurs prior to age 1 and is self-limiting
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20
Q

What characterizes atonic seizures/drop attacks?

A
  • Sudden loss of muscle control for < 2s
  • Often associated with intellectual impairment
  • Patient is usually unaware.
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21
Q

What characterizes tonic seizures?

A
  • Tightening and stiffening of muscles
  • People often fall due to the rigidity
  • Usually associated with intellectual impairment

Tonic = tightening

The reverse effect of an atonic seizure, but both are associated with intellectual impairment.

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22
Q

What characterizes clonic seizures?

A
  • Bilateral, jerking movements (rhythmic jerking)
  • ALOC

Clonic is consistent jerking

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23
Q

What characterizes a tonic clonic seizure?

A
  • LOC, violent shaking, and body stiffening
  • Bilateral, symmetrical generalized motor involvement
  • Foaming of the mouth

The classic seizure we see on TV

Alternating

24
Q

When are most cases of infantile spasms/West Syndrome seen?

A

4-7 months

Usually gone by age 4

25
What is the suspected underlying etiology for West syndrome?
Immature CNS
26
What are the common features of West Syndrome?
* **Hypsaarhythmia on EEG** * Symmetric, synchronous * Brief contractions of muscle groups * Clusters * 4-6s | BIS has a normal EEG, but may appear similar ## Footnote Hypsarrhythmia is very high voltage, randomly slow waves with spikes in all cortical areas on EEG.
27
What is a pseudo seizure?
* Resembles an actual seizure but **nothing physically wrong** * Treat with psychotherapy * **They will protect their hands from hitting their face** * Tongue biting still occurs
28
What lab might help us see if a patient is faking a seizure?
Draw a PRL 10-20 mins after and check from baseline.
29
What lab may be elevated post tonic-clonic activity?
PRL a few hours after (but not specific or sensitive)
30
When is a sleep-deprivation EEG ordered?
To check if seizures are being induced by a lack of sleep
31
What are the main purposes of EEG?
* Distinguishing true epileptic seizures from other causes. * Classifying seizures, because certain meds treat certain types better * A localized area might be a candidate for surgery * Prognosis
32
When is MRI indicated for seizure?
A progressive disorder or **new onset seizure over age 20.**
33
What are the Antiepileptic drugs (AEDs) that need drug level monitoring?
* Phenytoin * Carbamazepine * Valproic Acid (VPA) * Barbs (phenobarbital)
34
When do you treat epileptic seizures?
Should start after >2 unprovoked seizures or for abnormal EEGs
35
What are the AED therapy guidelines?
1. Monotherapy is preferred 2. Only add a second drug if we have SE or uncontrolled seizures still. You will slowly withdraw the first drug while titrating up the second drug.
36
What are the common SE among the AEDs?
* Drowsiness * Imbalance * N/V * Diplopia * Dizziness
37
What kind of AEDs tend to interact with other drugs like warfarin or OCPs?
Enzyme-inducing AEDs
38
What AED is associated with gingival hyperplasia?
Phenytoin
39
How are AEDs often dosed?
BID due to variable halflives
40
What AEDs have QD dosing?
* ESL * Phenytoin * Phenobarbital * VPA
41
What AEDs should be avoided in pregnant women?
* Carbamazepine * Gabapentin * Lamotrigine * Phenytoin * Phenobarbital * Topiramate * VPA
42
How often should we check drug levels for patients on a stable AED regimen?
Annually
43
For focal seizures, what is the first-line therapy?
Lamotrigine
44
For generalized seizure, what is the first-line therapy? What is the alternative?
1. Valproate (unless pregnant) 2. Levetiracetam for pregnant | LP
45
When can AEDs be considered for discontinuation?
After 2 years of no seizures.
46
What two medications must be tapered slowly?
* BZDs * Barbs
47
For a patient on combo therapy for seizures, how is tapering achieved?
Taper 1 drug at a time.
48
What are the guidelines regarding driving restriction during AED withdrawal?
State guidelines.
49
What are the two ways surgery is performed in patients with uncontrolled seizures?
* Focal seizures use excision of that area. * Generalized will ablate the possible connection points that allow the seizure to spread. * Generalized may involve cutting the corpus callosum if the spread can't be contained easily.
50
What is a new therapy for suboptimal surgical candidates for epilepsy?
Chronic vagal nerve stimulation
51
What diet may help with seizures and why?
Keto, probably due to the acidic nature of it. | Requires ketone monitoring
52
When is a seizure an emergency?
1. Continuous seizure activity > 5 mins 2. Unable to fully regain consciousness between 2+ seizures 3. Several seizures within 30 mins.
53
How do you treat status epilepticus?
1. 2 large bore IVs, 1 w/ ativan and 1 w/ cerebryx ## Footnote Ativan = acute treatment Cerebyx/fosphenytoin = prevention
54
What topical treatment might help with status epilepticus?
Diazepam rectal gel | **All pts dxd with epilepsy should get a rx for this.**
55
If someone presents with first-time seizure, what are our initial steps?
1. Protect their airway 2. Protect their head 3. Remove any obstacles near them 4. DO NOT try to restrain them 5. Call 911 if > 5 mins 6. Try to surround them with padding
56

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