Seizures

Question 1

What is the dose of Levetiracetam in Status epilepticus?

Answer 1

60mg/kg max dose 4.5gm

Question 2

What is the dose of Phenytoin in status epilepticus?

Answer 2

20mg/kg slow IV infusion

Question 3

What is the dose of a Midazolam infusion for status epilepticus?

Answer 3

0.2mg/kg/hr

0.15mg/kg (max 10mg) bolus 5mins apart

Question 4

What is the definition of status epilepticus?

Answer 4

A single seizure lasting >5mins
or
2 or more seizures with incomplete recovery of consciousness between

Question 5

What are the differentials for seizures during pregnancy?

Answer 5

Eclampsia (1)
SAH
Meningoencephalitis
Venous sinus thrombosis
Hypoglycaemia
Drug/ETOh withdrawal
Toxic ingestion
Hyponatraemia
Exacerbation of epilepsy
Brain tumour

Question 5

What are the complications of status epileptics?

Answer 5

Hypoxic brain Injury
Non-hypoxic brain injury
- Caused by length of seizure
Fracture/dislocation/muscle tears
Aspiration
Neurogenic pulmonary oedema
Death

Question 6

What factors on assessment negate the need to start anticonvulsants in first time seizures?

Answer 6

Question 7

What is the discharge advice post first seizure?

Answer 7

• No driving until cleared by neurology, may need to report to road authorities if will be non-compliant
• If job involves driving or use of heavy machinery then will need to mandatory report to licensing authority
• No climbing ladders or heights, no swimming, avoid power tools ie saws until cleared
• Try and avoid alcohol, stimulants or anything patients knows brings on own seizures
• Give handout on first seizures
• if present discuss with family or at least patient regarding first aid if another seizure occurs
• F/U with neurology or trained GP
• Risk for recurrent seizure is greatest within the 1st 2 years (21-45%)

Question 8

Which dislocation is commonly associated with seizures? What are its potential complications?

Answer 8

Posterior shoulder dislocation

Complications
- Axillary/Suprascapular nerve injury
- Osteonecrosis of humeral head
- Instability and re-dislocation
- Reverse Bankart/Hillsachs lesions
- Other associated fractures ie greater tuberosity, humeral head/neck

*Light bulb sign in pic

Question 9

What are the differences between simple and complex febrile seizures?

Answer 9

Question 10

What motor signs and history/lab findings increase the likelihood of PNES?

Answer 10

• Longer episodes (>5mins)
• Asynchronous (stop/start)
• Paradoxically worse with pharmacotherapy
• No change in lactate
• Lack of physiological changes
• Generalised seizure activity but patient has memory or awareness

Question 11

What are the risk factors for PNES?

Answer 11

• Female gender
• Intercurrent conversion disorders
• PTSD
• History of abuse
• Personality disorders
• Poor patient-doctor relationships
• Developmental disabilities
• Intercurrent or past actual epilepsy