Seizure

Question 1

Seizure
Definition

Answer 1

Excessive abnormal neuronal activity associated with alternations in
sensory, motor, autonomic and/or cognitive function

Question 2

Seizure
Definition Status Epilepticus

Answer 2

Unremitting seizure activity >5 mins in duration or recurrent seizure activity without intervening return to baseline

Question 3

Seizure
Definition Refractory Status Epilepticus

Answer 3

No termination after 1st-or 2nd-line agents

Question 4

Seizure
Definition Psychogenic Non-Epileptic Seizures

Answer 4

Functional convulsions not associated
with abnormal neuronal activity (usually variable convulsions, pelvic thrusting, forced eye-closure, responding or maintaining normal LOC no post-ictal phase)

Question 5

Seizure
Common Causes
Metabolic Disturbances

Answer 5

Hepatic encephalopathy
Hypoglycemia or hyperglycemia
Hyponatremia
Uremia

Question 6

Seizure
Common Causes
Infections

Answer 6

CNS abscess
Encephalitis
Meningitis

Question 7

Seizure
Common Causes
CNS Lesions

Answer 7

Brain metastases
Anoxia/hypoxia
Stroke
Arteriovenous malformations
Cerebral Venous Sinus Thrombosis (CVST)
Epilepsy
Bleeds: SAH, SDH, EDH, ICH

Question 8

Seizure
Common Causes
Intoxication*/Withdrawal

Answer 8

Bupropion*
TCAs*
Lithium*
Alcohol/benzos
Anti-epileptic drugs

Question 9

Seizure
Assessment History

Answer 9

Triggers
Aura
Memory before and after incident, appearance of convulsions
Post-ictal phase
Urinary incontinence
Tongue biting
Infectious symptoms
Sensorimotor symptoms
Med non-compliance
Recent trauma,
pregnancy
EtOH
Immunocompromised
H/A
Other injuries

Question 10

Seizure
Physical assessment

Answer 10

Vitals (esp pupils)
Neuro exam (GCS, nystagmus, tone, reflexes)

Question 11

Seizure
Investigations Labs

Answer 11

CBC
CMP
BUN/Crt
β-HCG
If post-ictal confusion, status or first time seizure add:
CMP
Lactate
VBG
Drug Screen
EtOH level,
Anti-epileptic drug levels AED

Question 12

Seizure
Investigations Tests

Answer 12

ECG
Non-contrast CT head if first-time seizure, status, persistent focal
deficits, change in seizure pattern, or prolonged post-ictal state

Question 13

Seizure
Management of Status
1st Line

Answer 13

IV Lorazepam 0.1mg/kg (up to 4mg x2 doses)
IM Midazolam 0.2mg/kg (up to 10mg x2 doses)

Question 14

Seizure
Management of Status
2nd Line

Answer 14

IV Keppra 60mg/kg IV OR
IV Phenytoin or Fosphenytoin 20mg/kg OR
IV Valproate 40mg/kg (contraindicated in pregnancy)

Question 15

Seizure
Refractory

Answer 15

RSI intubation, call ICU
IV Propofol 2-5mg/kg (infusion 3-5mg/kg/hr)
IV Midazolam 0.2mg/kg (infusion 0.05-2mg/kg/hr)