Seizure

Question 1

A febrile seizure that is recurrent is ___

Answer 1

NOT epilepsy

Question 2

Def. of epilepsy (2):

Answer 2

1. More than 1 seizure

2. Enduring alteration of brain that increases risk for seizure

Question 3

An acute symptomatic seizure is called:

Answer 3

Provoked

Question 4

What are the two causes of a provoked seizure?

Answer 4

• Electrolyte imbalance

- ETOH withdraws (first 48 hours)

Question 5

Cause for an unprovoked seizure?

Answer 5

CVA, brain tumor, TBI

Question 6

What is a Jacksonian March?

Answer 6

Seizure activity that starts unilateral in 1 muscle group and spreads systemically

Question 7

What is Todd’s Paresis/paralysis?

Answer 7

Todd = T; Transient hemiplegia after a seizure

Question 8

Incidence for seizures is highest in what age groups?

Answer 8

Under 5 and over 65

Question 9

Two main historic features suggestive of a seizure:

Answer 9

• Aura associated with onset

- Post-ictal confusion state

Question 10

Febrile seizure in kids common between 3 mo - 5 years on:

Answer 10

1st day of febrile illness (d/t speed of fever)

Question 11

Treatment of febrile seizure

Answer 11

Tylenol - Control the fever

Question 12

After a TBI, may start experiencing seizures within 1 week - treat with:

Answer 12

Phenytoin or levetiracetam

Question 13

Seizures in AIDS patients may indicate:

Answer 13

Toxoplasmosis, cryptococcal meningitis, AIDS complex dementia

Question 14

Seizure from hypoglycemia at:

Answer 14

20 - 30 mg/dL

Question 15

Seizure from hyponatremia at:

Answer 15

< 120 mEq/L - CHANGE is what causes seizure

Question 16

Low levels of Calcium and Magnesium at:

Answer 16

<0.8 mEq/L of Mg

Question 17

Seizure from hyperosmolar state at:

Answer 17

> 330 mOsm/L

Question 18

Seizure from drug/ETOH withdrawal:

Answer 18

Within a few days of withdrawal

Question 19

Seizure from Eclampsia - woman with:

Answer 19

HTN, proteinuria and edema

Question 20

Seizure from THYROID:

Answer 20

Hyper-thryoidism

Question 21

Seizure from drug __

Answer 21

Overdose: Abx, antidepressants, narcotics, lithium and more.

Question 22

Most common type of seizure:

Answer 22

Generalized

Question 23

Two types of focal seizures:

Answer 23

Simple partial: Retained awareness

Complex partial: Impaired awareness

Question 24

Three types of a generalized seizure:

Answer 24

1. Motor
2. Non-motor (absence)
3. Other: Tonic, clonic, myoclonic, atonic

Question 25

When does the patient urinate/start breathing again with a generalized motor seizure?

Answer 25

Clonic phase

Question 26

What is status epilepticus?

Answer 26

Seizures over 30 minutes without ceasing spontaneously - FULL CONSCIOUSNESS IS NOT RESTORED BETWEEN SEIZURES

Question 27

Why is status epilepticus a medical emergency?

Answer 27

Can cause brain damage

Question 28

How do you abort status epilepticus?

Answer 28

Lorazepam + maintenance therapy too

Question 29

Maintenance medication for status epilepticus?

Answer 29

Fosphenytoin or phenytoin

Question 30

What type of seizure is a "drop seizure"? (common with what syndrome?)

Answer 30

Atonic - loss of postural tone | *Syndrome: Lennox-Gastaut

Question 31

Most common pediatric epilepsy syndrome:

Answer 31

Absence (non-motor) - Simple (just staring)

Question 32

Common age for pediatric absence seizures:

Answer 32

4-8

Question 33

Most common symptom of a complex partial seizure (focal)?

Answer 33

Epigastric sensation (dysphagia)

Question 34

Which type of seizure has orobuccolingual automatisms?

Answer 34

Complex partial seizures (focal)

Question 35

What test should you order in determining syncope vs. tonic-clonic?

Answer 35

Pregnancy test

Question 36

Three characteristics of EEG for seizures?

Answer 36

- Abnormal spikes - Polyspike Discharge - Spike-wave complexes

Question 37

To diagnosis epilepsy, should you trial AEDs?

Answer 37

NO

Question 38

When can you initiate a second drug for seizure prevention?

Answer 38

- After drug max has been reached with drug #1

Question 39

Should you use two drugs for seizures?

Answer 39

Monotherapy is best. Start the second drug and wean off drug #1 that was not working. Using two drugs together is last resort.

Question 40

When can you withdraw from AEDs?

Answer 40

After 2-5 years of being seizure free

Question 41

Diet proven to reduce all seizures by 50%

Answer 41

Keto - Body burns fat instead of glucose for energy

Question 42

Alternative diet to keto that is more flexible:

Answer 42

Low Glycemic index treatment (GIT)

Question 43

Two stimulation devices for seizures:

Answer 43

- Vagus nerve stimulator | - RNS therapy

Question 44

Only try surgery for epilepsy if:

Answer 44

At least two single drugs and a combination of 2 or more drugs has been tried

Question 45

Treatment for absence seizure:

Answer 45

Ethosuximide

Question 46

Treatment for partial seizures:

Answer 46

Lamotrigine

Question 47

Treatment for Tonic-Clonic seizures:

Answer 47

Valproate/Lamotrigine