Seizures And Syncope (Hon) Flashcards Preview

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Flashcards in Seizures And Syncope (Hon) Deck (19):
1

What are some paroxysmal (episodic) disorders in neurology?

Migraine
Syncope
Dizziness
Seizure

2

What is epilepsy?

Generally defined as 2 or more unprovoked seizures
4th most common neurological disorder (behind migraine, Alzheimer's, stroke)
1/26 people will develop epilepsy in their lifetime

3

Describe percent positive findings for epilepsy on a single EEG? With 3 sleep-deprived EEGs?

Singe:
All types: 40%
Generalized tonic-clonic: 20%
Petit mal (with HV): 90%
Parital: 30%

for all types with 3 EEGs: 85%

4

What is the single most important information for diagnosing epilepsy?

Although EEG is an important tool, history of events (preferably by witnesses) is most important
-normal EEG does not exclude presence of epilepsy
-minor abnormalities on EEG does not necessarily indicate a pt will have seizures

5

What are the seizure classifications?

Partial seizures (activity begins on one side of brain)
-simple partial
-complex partial
-secondarily generalized (partial onset)

Generalized seizures
-absence (petit mal)
-tonic-clonic
-myoclonic
-tonic
-clonic
-atonic
-clonic-tonic-clonic

6

Describe simple partial seizures

Focal motor or sensory activity
No loss of consciousness
Lasts seconds
No post-ictal state

7

Describe complex partial seizures

Nonresponsive staring
Possible preceding aura
Automatisms
Loss of consciousness
Lasts 1-3 min
Post-ictal state

8

Describe secondary generalized (partial onset) seizures

Bilateral tonic-clonic activity
Loss of consciousness
Lasts 1-3 min
Post-ictal state

9

Describe absence (petit mal) generalized seizures

Nonresponsive staring
Rapid blinking
Chewing
Clonic hand motions
Loss of consciousness
Lasts 10-30 seconds
No post-ictal state

10

Describe tonic-clonic generalized seizures

Bilateral extension followed by symmetrical jerking off of extremities
Loss of consciousness
Lasts 1-3 min
Post-ictal state

11

Describe atonic generalized seizures

Sudden loss of muscle tone
Head drops or pt collapses
Loss of consciousness
Variable duration
Post-ictal stat

12

Describe myoclonic generalized seizures

Brief, rapid symmetrical jerking of extremities and/or torso
Loss of consciousness
Lasts

13

What drugs treat partial/secondary generalized seizures?

Phenytoin, carbamazepine, valproic acid, phenobarbital, gabapentin, lamotrigine, topiramate, gabatril, felbamate, oxcarbamazepine, leviteracetam, zonisamide, lacosamide, perampanel, vigabatrin

14

What drugs treat primary generalized seizures?

Ethosuxamide (absence only)
Valproic acid*
Lamotrigine*
Leviteracetam*
Zonisamide*
Perampanel*

*also treat partial/secondary generalized

15

What is status epilepticus?

Condition characterized by prolonged seizure (generally greater than 10 mintues) or repeated seizures without recovery in between

16

What is the treatment for status epilepticus?

ABC's, establish IV
History
Labs: Accuchek, CBS, Chemistry panel, drug levels
Noncontrast CT head
Benzodiazepine (buys time but must give longer lasting AED)
Fosphenytoin
Phenobarbital (intubate first to anticipate respiratory depression)
Valproic acid
Lacosamdie (watch for cardiac conduction abnormalities)
If unsuccessful, midazolam or propofol (intubated)
Last resort: pentobarbital coma
In some cases, pt may only respond to one oral AED (carbamazepine). Consider NG tube

17

What are the general principles in treatment of pts with epilepsy?

Try to use monotherapy
Consider drug interactions (oral contraceptives with carbamazepine)
Consider long term side effects (bone loss with carbamazepine or phenytoin)

18

Describe women with epilepsy

All women of child-bearing age should be on a MVI with 1 mg folic acid. Particularly important in women with epilepsy, as many of AEDs are folate-depleting
Avoid valproic acid in pregnancy
In general, newer AEDs (lamotrigine, leviteracetam) are probably safer in pregnancy than older ones (phenytoin or valproic acid), but the drug of choice for a woman is the drug which best controls her seizures

19

Compare/contrast syncope vs seizure

Syncope:
Pallor
Sweating
Abnormal head sensation
Lightheadedness
Positionally related
Slow onset
Brief unconsciousness

Seizure:
Urinary or bowel incontinence
Tongue injury
Tonic/clonic movements
Postictal state