Seizures - Atia

Question 1

4 “s”s of Seizure - define

Answer 1

Abnormal SYNCHRONOUS discharge of neurons in the CORTEXXX that produces STEREOTYPED behaviours, they are SELF-LIMITED (seconds to minutes)

Question 2

What is epilepsy

Answer 2

2 or more unprovoked seizures

Question 3

What characterizes post-ictal seizure

Answer 3

Disorientation

Confusion

Question 4

What is the difference between location of onset for generalized and Psimple and Pcomplex seizures

Answer 4

Generalized - BOTH hemispheres simultaneously

PS and PC - FOCAL lesion within one hemisphere

Question 5

Which type of seizure has an aura associated?

Answer 5

Partial seizure

Question 6

Which types of seizures involve altered LOC

Answer 6

1. Generalized

2. Partial complex

Question 7

Which types of seizures have post-ictal confusion associated?

Answer 7

1. Generalized (except absence)

2. Partial complex

Question 8

4 types of generalized seizures

Answer 8

1. Atonic
2. Myoclonic
3. Absence (maybe just thalamus, brief fade out and back in)
4. Tonic-clonic

Question 9

If you have a partial seizure what must you do?

Answer 9

Search for a FOCAL lesion - tumor, stroke, abscess

Question 10

The tonic phase of a seizure is …

Answer 10

Stiffness

Question 11

Characteristic of a complex partial seizure

Answer 11

Should be asymmetrical

Question 12

If a partial seizure generalizes then

Answer 12

it is mostly tonic clonic (NOT absence)

Question 13

Key differences between Absence and complex partial seizures?

Answer 13

1. Age group (A- paediatric, CP - adult)
2. Aura (A - absent, CP - sometimes)
3. Frequency (A - 100s/day, CP - less frequent)
4. Duration (A - 10-15s, CP - 1-2 min)
5. Tonic clonic changes (A - NEVER, CP - Sometimes)
6. Post-ictal confusion (A - absent, CP - +)
7. EEF (A - GENERALIZE3Hz spike and wave, CP - Focal discharges)
8. CT/MRI lesion (A - thalamic?, CP - FOCAL lesion)
9. Treatment ( A - Ethosuximide, CP - various)

Question 14

What % of the population has epilepsy and what is the risk of having one seizure in lifetime

Answer 14

1%
5%
M=F

Question 15

DDx seizure vs syncope - awake or asleep?

Answer 15

Can be asleep in seizure, often awake in syncope

Question 16

DDx seizure vs syncope - trigger

Answer 16

Seizure - Sleep loss

Syncope - heat/injury/emotion

Question 17

DDx seizure vs syncope - ONSET

Answer 17

Seizure - SUDDEN

Syncope - Gradual

Question 18

DDx seizure vs syncope - Motor - Vocalization

Answer 18

Seizure - can be present

Syncope - ABSENT

Question 19

DDx seizure vs syncope - Motor - Tonic-clonic

Answer 19

Seizure - Pronounced

Syncope - brief can occur

Question 20

DDx seizure vs syncope - Motor - Tongue biting

Answer 20

Seizure - bite sides not tip

Syncope - ABSENT

Question 21

DDx seizure vs syncope - Autonomic - incontinence

Answer 21

Seizure - can have incontinence

Syncope - NOne

Question 22

DDx seizure vs syncope - Autonomic - Colour

Answer 22

Seizure - Normal/blue

Syncope - PALE

Question 23

DDx seizure vs syncope - Injury

Answer 23

seizure - Common

Syncope - absent

Question 24

DDx seizure vs syncope - POST event

Answer 24

Seizure - Confused/somnolent

Syncope - ALERT but tired

Question 25

What are the causes of secondary seizure

Answer 25

1. Structural - Tumor, pus, blood, stroke 2. Metabolic - non-adherence to meds, HYPO-glycemia HYPO-Na, Ca, Mg EtOH withdrawal Drugs - cocaine, amphetamines

Question 26

Which kind of strokes cause seizures?

Answer 26

NOT SUBCORTICAL STROKES - REMEMBER CORTEX - only cortical strokes

Question 27

List work-up for a seizure

Answer 27

1. cbc 2. Glucose 3. Electrolytes esp... Na 4. Mg Ca 5. Albumin/creatinine 6. fox screen 7. Check anti-epileptic drug levels IMAGE - MRI

Question 28

what would you see on an MRI for seizure

Answer 28

Abnormal fray matter around ventricles - CT not useful

Question 29

What can EEG do and can't it do?

Answer 29

1. captures inter-ictal epileptiform discharges

Question 30

FIRST EEG is...

Answer 30

50% SENSITIVE

Question 31

Three EEGs are

Answer 31

80% SENSITIVE

Question 32

Length of time a patint can't drive if they have a seizure?

Answer 32

6 months minimum

Question 33

How do the anti-epileptic drugs work?

Answer 33

Decrease neuronal activity by 1) Increase GABA - benzos, clobazem, lorazepam, diazepam 2) DECREASE glutamate (excitatory) 3) alter ion channels (Na, Ca), phenytoin, carbamazepine, lamotrigine, ethosuximide 4) Combination (valproic acid, topiramate) Unknown - Keppra

Question 34

what percent of patients will become seizure-free?

Answer 34

75%

Question 35

what is the risk of having a second seizure after first unprovoked seizure?

Answer 35

50% within 2 years (only treat if Physical/imaging or EEG is abnormal)

Question 36

when do you give treatment for a seizure?

Answer 36

1. unprovoked seizure - but pt wants 2. Provoked with an irreversible cause (stroke) 3. 2 Unprovoked

Question 37

What is status epilepticus?

Answer 37

1. Ongoing seizure lasting >5 min 2. Repeated seizure without returning to baseline (> 2 min is BAD)

Question 38

What is the first thing you do if you have a status epilepticus?

Answer 38

1. ORDER CAP GLUCOSE | If glucose 2 ativan and phenytoin IV