Flashcards in Seizures, Cohen II Deck (43):
1
complex partial seizure
partial because 1 cerebral hemisphere
complex because level of consciousness partly reduced
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signs before complex partial seizure
aura
deja vu
bad sensations: irritating smell or taste, sense of dizziness, abdominal discomfort that rises to head fast
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patients who have complex partial seizures
any age, usually elderly
alone or witnessed to have TIA
may be from trauma
last 1-2 minutes
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signs of complex partial seizure
sudden loss of speech, blank look on face, automatisms
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what are the automatisms seen in complex partial seizure
repetitive blinking, chewing movements of mouth, simple motioning with the hands, odd fumbling with clothes or even undressing, repetition of very simple spoken phrases or words
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how old are patients with absent seizures
4 or 5 or 6 y.o
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common cause of seizures in children
absence seizures
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petit mal seizures
absence seizures
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length of absence seizures
less than 10 sec in duration
always less than 60 sec
inability to speak or respond in any way
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do patients fall in absence seizure
no
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after absence seizure
no idea had seizure
quick recovery of consciousness
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MRI absent seizures
normal
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Prognosis children with absence seizures
hundreds a day
poor in social situation or in school work
often Dx by teacher in kindergarten
frustrated parents
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EEG absent seizures
three per second spike/wave complex
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Tx absent seizure
usually respond to small dose of valproic acid (depakote)
lamotrigine (lamictal) effective
2/3 lose seizures after puberty
some go on to generalized tonic clonic seizure
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ethosuximate
used for absence seizures
NOT tonic clonic
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Antiepileptic drug usually not indicated
after first seizure with normal EEG and no risk factors
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second unprovoked seizure
definition epilepsy and patients should take medication
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90% or more seizures end in how much time
2 minutes or less
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common damage from seizures
trauma: falling, including fractures or aspiration of gastric or oral contents or biting tongue or cheek
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do not give what drug unless status epilepticus
IV benzos
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what occurs with IV benzos if given to regular seizures
increased risk respiratory arrest
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Pseudoseizures
psychologic nonepileptic seizures
usually have serious psychiatric illnesses
Hx of psychiatric or sexual abuse
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what do pseudoseizures look like
asynchronous limb movements, eyes closed, involve pelvic thrusting or odd movements of trunk, go on for more than 2 minutes
come on more slowly than typical seizures
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pseudoseizures do not responde to what drugs
epilepsy drugs
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when do doctors need to reevlauate if patient truly has epilepsy or if medication not right for type of seizure
when patient has seizures after use of 3 different anticonvulsants at high doses
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which type seizure patient more difficult to control with meds
partial epileptics
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anticonvulsants
phenytoin
valproic acid
carbamazepine
lamotrigine
topiramate
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side effects phenytoin
stevens johnson syndrome
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phenytoin not useful in what patients
absent seizures
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problems with carbamazepine
auto induction
dizzy
nausea
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carbamazepine replaced by
oxcarbazepine
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side effect lamotrigine
rash
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side effect topiramate
slow down speech and thinking
changes the body temp
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Status epilepticus
medical EM
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risk of status epilepticus
permanent brain damage
lack of respiration may cause death immediately
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definition status epilepticus
multiple seizures without regaining of normal level consciousness
or
prolonged generalized seizure for 30 minutes
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are partial seizures that last 30 minutes dangerous
yes
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Tx of status epilepticus
check ABCs, glucose and O2 and urine for toxicology
lorazepam or diazepam
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loading dose for lorazepam or diazepam in status epilepticus
phenytoin or another anticonvulsant
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first steps status epilepticus
ABCs
IV line
glucose and O2
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surgery for seizure
if definite focal source of electrical discharge can be found, commonly in one of temporal lobes
surgical excision safe and highly effective
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