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Flashcards in Seizures, Cohen II Deck (43):
1

complex partial seizure

partial because 1 cerebral hemisphere
complex because level of consciousness partly reduced

2

signs before complex partial seizure

aura
deja vu
bad sensations: irritating smell or taste, sense of dizziness, abdominal discomfort that rises to head fast

3

patients who have complex partial seizures

any age, usually elderly
alone or witnessed to have TIA
may be from trauma
last 1-2 minutes

4

signs of complex partial seizure

sudden loss of speech, blank look on face, automatisms

5

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

6

how old are patients with absent seizures

4 or 5 or 6 y.o

7

common cause of seizures in children

absence seizures

8

petit mal seizures

absence seizures

9

length of absence seizures

less than 10 sec in duration
always less than 60 sec
inability to speak or respond in any way

10

do patients fall in absence seizure

no

11

after absence seizure

no idea had seizure
quick recovery of consciousness

12

MRI absent seizures

normal

13

Prognosis children with absence seizures

hundreds a day
poor in social situation or in school work
often Dx by teacher in kindergarten
frustrated parents

14

EEG absent seizures

three per second spike/wave complex

15

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

16

ethosuximate

used for absence seizures
NOT tonic clonic

17

Antiepileptic drug usually not indicated

after first seizure with normal EEG and no risk factors

18

second unprovoked seizure

definition epilepsy and patients should take medication

19

90% or more seizures end in how much time

2 minutes or less

20

common damage from seizures

trauma: falling, including fractures or aspiration of gastric or oral contents or biting tongue or cheek

21

do not give what drug unless status epilepticus

IV benzos

22

what occurs with IV benzos if given to regular seizures

increased risk respiratory arrest

23

Pseudoseizures

psychologic nonepileptic seizures
usually have serious psychiatric illnesses
Hx of psychiatric or sexual abuse

24

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

25

pseudoseizures do not responde to what drugs

epilepsy drugs

26

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

27

which type seizure patient more difficult to control with meds

partial epileptics

28

anticonvulsants

phenytoin
valproic acid
carbamazepine
lamotrigine
topiramate

29

side effects phenytoin

stevens johnson syndrome

30

phenytoin not useful in what patients

absent seizures

31

problems with carbamazepine

auto induction
dizzy
nausea

32

carbamazepine replaced by

oxcarbazepine

33

side effect lamotrigine

rash

34

side effect topiramate

slow down speech and thinking
changes the body temp

35

Status epilepticus

medical EM

36

risk of status epilepticus

permanent brain damage
lack of respiration may cause death immediately

37

definition status epilepticus

multiple seizures without regaining of normal level consciousness
or
prolonged generalized seizure for 30 minutes

38

are partial seizures that last 30 minutes dangerous

yes

39

Tx of status epilepticus

check ABCs, glucose and O2 and urine for toxicology
lorazepam or diazepam

40

loading dose for lorazepam or diazepam in status epilepticus

phenytoin or another anticonvulsant

41

first steps status epilepticus

ABCs
IV line
glucose and O2

42

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

43

Vagal Nerve stimulator

detect and try to stop seizures at onset of electrical shocks (future maybe?)