SEIZURES Flashcards
Causes of seizures?
Epilepsy and AED non-compliance
Brain tumour
Intracranial infections
Hypoglycaemia
Head injuries
Electrolyte disturbances
Drug overdose
Drug withdrawal e.g. alcohol
Hypoxia
Stroke sequelae
which electrolyte disturbances can cause seizures?
Hyponatraemia
Hypocalcaemia
Hypomagnesemia
which drug withdrawals can cause seizures?
Alcohol
AEDs
Benzodiazepines
Barbiturates
Stimulants
Opiates can rarely lower seizure threshold
Overdose of which drugs can cause seizures?
TCAs and SSRIs
Antipsychotics
Salicylates e,g, aspirin
Antimalarial
Phenothiazines
Beta blockers?
Lithium
Stimulant drugs - cocaine, amphetamines, methamphetamines
Ecstasy
Opioids can lower the seizure threshold
Theophylline and related drugs
Organophsophorous
What is status epilepticus?
a single seizure lasting >5 minutes, or
>= 2 seizures within a 5-minute period without the person returning to normal between them
Management of status epilepticus?
A-E - make sure you check glucose
Prehospital - PR diazepam or buccal midazolam
Hospital - IV lorazepam and repeat once after 5-10 mins if necessary
If ongoing then start a second line agent e.g. levetiracetam or… phenytoin or sodium valproate
If no response within 45 mins then induce GA or phenobarbital
What is refractory status epilepticus?
persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine.
Investigtaions for seizures?
Bedside: ECG & urine dip & BM
Bloods: FBC, U&Es, BP and magnesium, LFTs, toxicology screen, ABG, Coag studies, CRP, AED levels?, blood culture
Imaging - CT head or MRI brain, EEG
If you think hyponatraemia is causing the seizures, why should you correct this slowly?
As over correction can cause osmotic demyelination syndrome aka central pontine myelinolysis
MOA of benzodiazepines?
Increase activity of GABA by binding to GABA-A and increasing the frequency of chloride channels
GABA is the major inhibitory neurotransmitter in the CNS - produces a sedating effect, relaxing skeletal muscles and inducing sleep, anaesthesia and amnesia
Common side efefcts of benzodiazepines?
Tolerance and dependance
Drowsiness
Confusion
Headache
Syncope
N&V
Diarrhoea
Tremors
Short term memory loss
Respiratory depression
Benzodiazepine withdrawal syndrome?
Up to 3 weeks after stopping a long acting benzo…
- insomnia
- irritability
- anxiety
- tremor
- loss of appetite
- tinnitus
- perspiration
- perceptual disturbances
- seizures
