Seizure Flashcards
(56 cards)
1
Q
______ (3) can mimic seizures (must r/o).
A
- Syncope
- Cardiac disturbances
- Psychological (PNES)
2
Q
Examples of provoked seizures
A
- Head trauma
- Drugs alcohol intoxication
- Metabolic disturbances
- Stroke
- Fever
(provoked seizures are not considered epilepsy)
3
Q
Seizure lifetime prevalence
A
- 9% (1/3 are benign febrile seizures)
- 30-70% recurrence rate over three years after a single seizure
- 80/1000,000
4
Q
Define epilepsy
A
- Disease of the brain that predisposes a person to recurrent unprovoked seizures
- Must have two or more unprovoked seizures
(TQ)
5
Q
Non-epileptic seizures
A
- Cardiovascular
- Drug or substance
- Metabolic
- Infection
- Fever
- Sleep disorder
- Psychogenic
6
Q
Seizure precipitants
A
- Cocaine
- High or low (more common) blood sugar
- Low calcium, sodium or magnesium
- Stimulant (cocaine)
- Sedative withdrawal
- Severe sleep deprivation
7
Q
Third most common neurological disease
A
Epilepsy
8
Q
Epilepsy prevalence and incidence
A
9
Q
Seizure classification
A
10
Q
Common causes of seizure in newborns
A
- Malformation
- Lack of oxygen during birth
- Low levels of blood glucose, calcium, or magnesium
- Inborn error of metabolism
- Intracranial hemorrhage
- Maternal drug use
11
Q
Common cause of seizures in infants and children
A
- Fever
- Brain tumor
- Infection
12
Q
Common causes seizures in children and adults
A
- Congenital conditions (Angelman’s, Tuberous sclerosis)
- Genetic factors
- Progressive brain disease
- Head trauma
13
Q
Common causes of seizures in seniors
A
- Stroke
- Alzheimer’s disease
- Trauma
14
Q
Epilepsy pathophysiology
A
- Synchronous interaction of large populations of neurons that intermittently discharging abnormal patterns
- High voltage, long duration depolarization with superimposed high-frequency burst of action potentials
- Extracellular current flow results in inter-ictal EEG “spike and sharp wave”
15
Q
Normal waves on EEG (4)
A
16
Q
A
Normal EEG
17
Q
EEG abnormalities
A
- Background abnormalities
- Transient abnormalities
- Under all these can be a focal lateral or general
18
Q
Background abnormalities
A
Significant abnormalities and or degree of slowing inappropriate for clinical state
19
Q
Transient abnormalities associated with seizures
A
- Spike waves
- Sharp waves
- Spike - wave complex
20
Q
A
EEG-GTC Seizure
21
Q
How are focal onset seizures subdivided?
A
aware or unaware
22
Q
General seizures are subclassified as
A
Motor or non motor
23
Q
Myoclonic seizure symptoms (3)
A
- bilateral
- shock-like muscle contractions (head/UE)
- consciousness preserved
24
Q
Myoclonic seizures are precipitated by _______ or ______
A
- waking up
- falling asleep
25
Myoclonic seizures may progress to _______ or \_\_\_\_\_\_.
* clonic or tonic-clonic seizure
* progressive neurological deterioration
26
Main differentiating factor of **simple partial seizure**
NO loss of awareness
27
**Complex partial seizure** symptoms (4)
1. impaired consciousness
2. automatisms (i.e. lip smacking, blinking)
3. amnesia
4. aura
(different presentation when it originates in the temporal lobe)
28
Example of aura experienced with **complex partial seizures** (3)
1. smells
2. epigastric sensation
3. deja vu
29
Complex partial seizures last \_\_\_\_\_\_.
30 sec - 3 min
30
**Simple partial seizures** may lead to \_\_\_\_\_\_.
depression of epileptogenic cortical area → focal weakness & numbness
(these are reversible)
31
Todd's paralysis
reversible focal weakness & numbness following simple partial seizure
(caused by post-ictal depression of the epileptogenic cortical area)
32
70-80% of complex partial seizures arise from the \_\_\_\_\_lobe.
temporal
33
uncinate fit
olfactory auras that precede complex partial seizures; temporal lobe orign
(associated w/brain tumors)
34
Presentation of **complex partial seizure** arising from the temporal lobe (5).
(70-80% arise from the temporal lobe)
1. motionless state
2. altered consciousness
3. automatisms
4. dystonic posturing
5. confusion
35
The majority of seizures can be treated with medication, but \_\_\_\_\_% of patients will continue to **always** have seizures.
25
36
Valproate is used to treat all, but _____ seizures
focal
37
Topiramate treats ______ seizures
myoclonic
38
Lamotrigine treats all seizures **except** \_\_\_\_\_\_.
generalized absent
39
Levitracetam is used to treat ________ (2 seizure types)
1. Focal
2. Myoclonic
40
Zonisimide is used to treat \_\_\_\_\_\_\_.
| (only one type of seizure)
focal
41
2 reasons why anti-epileptic drugs fail?
1. Rx efflux transporters create Rx resistance (P-glycoprotein (Pgp) & MRP1-9)
2. tolerance to non-benzos (receptor & channel response change)
(also Rx interaction, enzyme induction)
42
Epilepsy work up (4)
1. MRI brain
2. EEG
3. Neuropsych eval
4. labs AED levels
43
What labs would you order for a patient with epilepsy (8)?
1. CBC
2. HbA1C
3. LFTs
4. Na+
5. BUN/Cr
6. Blood cultures
7. LP
8. Tox screen
44
\_\_\_\_\_\_% of epilepsy patients who have depression
37
(increases medical expenses, decreases quality of life)
45
If an epileptic patient fails 3 mono-therapy trials, the next step is \_\_\_\_\_\_\_.
video EEG monitoring
46
After an epileptic patient does video-EEG monitoring, it is determined to be non-epileptic what are the potential causes (5)?
1. sleep disorder
2. migraine
3. syncope
4. movement disorder
5. psychogenic
47
What are the 3 treatments to choose from after an epileptic patient fails 3 monotherapies and video EEG monitoring confirms epilepsy?
1. poly-therapy
2. resective surgery
3. stimulator therapy
48
Brain stimulation for epilepsy (3)
1. TMS
2. Deep brain/Intracranial stimulation
3. Vagal Nerve (NVS)
49
Deep brain stimulation (Intracranial stimulation) for epilepsy targets ________ (3).
1. thalamus
2. cerebellum
3. hippocampus
50
When a woman with seizures becomes pregnant, refer them to \_\_\_\_\_\_\_\_.
neurology for assessment
(if they have been seizure free for one year prior, they shouldn't have seizures during pregnancy)
51
Status epilepticus is a seizure lasting longer than ____ or ____ .
* 5 minutes
* 2 seizures so close together, patient doesn't recover between
52
Status epilepticus is _______ (convulsive/non-convulsive).
can be either
53
status epilepticus: treatment for ongoing seizure
lorazepam
or
diazepam
(also check blood glucose)
54
status epilepticus treatment (ongoing seizure 10-30 min) (4)
1. fosphenytoin
2. levetiracetam
3. phenobarbital
4. valproic acid
55
status epilepticus treatment at 30-60 min (5)
1. INTUBATE
2. EEG monitoring
3. midazolam or propofol
4. fluids & pressors
5. AEDs
56
Status epilepticus treatment at \>72 hours (5)
1. burst suppression 24-48 hours
2. IV magnesium
3. Ketamin
4. Pentobarbital (titrate to burst suppression)
5. pyridoxine
