Seizures & Epilepsy

Question 1

Definition of seizure

Answer 1

abnormal, synchronized excessive discharge from an aggregate of CNS neurons

Question 2

Highest RF for chronic seizure disorder

Answer 2

penetrating head trauma

Question 3

Precipitating factors of seizure

Answer 3

sleep deprivation, stress, extreme fatigue, drug/etoh withdrawal, fever, cocaine use

Question 4

Causes of seizures in neonatal/early infancy

Answer 4

CNS infection
postpartum drug withdrawal (mother using drugs/etoh)
hypoglycemia

Question 5

Causes of seizures in late infancy/early childhood

Answer 5

febrile seizures

CNS infection

Question 6

Causes of seizures in childhood

Answer 6

develop “epilepsy”
idiopathic
temporal lobe

Question 7

Causes of seizures in adolescence

Answer 7

CNS lesions
head trauma
illicit drug use

Question 8

Causes of seizures in adults

Answer 8

cerebral vascular disease
trauma
tumor
metabolic disturbances (ethos withdrawal, uremia, hepatic failure, hypoglycemia)

Question 9

ictal, post-ictal states

Answer 9

ictal: seizure state

post-ictal: symptomatic time frame after seizure

Question 10

RF of seizures

Answer 10

head trauma, stroke, CNS infection, electrolyte or metabolic disturbances, drugs, alcohol, FHX

Question 11

Most common type of seizure

Answer 11

complex partial

Question 12

PE work up of seizure

Answer 12

• Search for signs of systemic illnesses (liver, renal)
• Signs of head trauma
• CV (heart, carotid arteries)
• Complete neuro exam: mental status, visual fields, motor/sensory fx, DTRs, gait, coordination

Question 13

Lab/imaging in seizure work up

Answer 13

CBC, Chem 20, toxicology, lumbar puncture (if suspect infx or if has HIV), EEG, CT/MRI

Question 14

Definition of epilepsy

Answer 14

recurrent seizures; 2 or more unprovoked seizures

Question 15

partial vs generalized seizures

Answer 15

partial = limited to discrete region of brain
generalized = whole brain

Question 16

partial seizure where consciousness is fully preserved

Answer 16

simple partial

Question 17

partial seizure where consciousness is impaired

Answer 17

complex partial

Question 18

febrile seizures

Answer 18

• 3 mon to 5 yrs old
• occurs when temp rising
• typically isolated event, brief, symmetric
• likely to recurr

Question 19

First priority in treating possible seizure

Answer 19

STABILIZE - look at vitals, respiration, CV

Question 20

DDX of possible seizure

Answer 20

vasovagal reaction, MI, TIA, migraine

Question 21

What is the best imaging for detection of cerebral lesions in epilepsy?

Answer 21

MRI > CT

Question 22

Mainstay tx for seizures

Answer 22

anti-epileptic drugs

o Generalized: Levetiracetam (Keppra), Valproic acid or lamotrigine
o Absence: Ethosuximide
o Partial: Carbamazepine, phenytoin, lamotrigine and topiramate

Question 23

When should anti-epileptic drugs be started?

Answer 23

• recurrent seizures of unknown cause
• cause can’t be treated
• usually not for single seizure unless thought to be epileptogenic

Question 24

How to discontinue antiepileptic meds?

Answer 24

most patients with complete control of seizures for significant time may d/c

withdraw very slowly over 2-3 months

Question 25

What kind of diet may help seizures?

Answer 25

ketogenic diet

Question 26

"Jacksonian March"

Answer 26

simple partial seizure that begins in small area and progresses to larger area (fingers to arm)

Question 27

"Todd's Paralysis"

Answer 27

localized paresis for minutes to hours in involved region after simple partial seizure

Question 28

partial seizure with secondary generalization

Answer 28

begins as partial seizure and propagates throughout cortex to become generalized

Question 29

How are partial seizures treated?

Answer 29

Carbamazepine, Phenytoin, Iamotrigine, Topiramate

Question 30

5 types of generalized seizures

Answer 30

absence, myoclonic, grand mal, tonic, atonic

Question 31

Most common type of seizure in CHILDREN

Answer 31

absence (petit mal)

Question 32

absence seizure

Answer 32

- only last few seconds - brief lapses of consciousness w/o loss of posture or post-ictal confusion - TX: Ethosuximide

Question 33

tonic-clonic more commonly known as _______.

Answer 33

grand mal seizure

Question 34

3 phases of grand mal seizure

Answer 34

1) Tonic: muscle contraction, ictal cry, foaming of mouth, sympathetic effects (BP, pulse, pupils dilate) 2) Clonic: alternate contraction & relaxation 3) Post-ictal: regains consciousness, confusion, unresponsive

Question 35

atonic seizures

Answer 35

sudden loss of postural muscle tone with brief impairment of consciousness for a few seconds usually head drop, if longer fall risk

Question 36

myoclonic seizure

Answer 36

sudden brief muscle contraction involving part or all of body

Question 37

psychogenic seizure

Answer 37

non-epileptic behaviors that resemble a seizure

Question 38

Definition of status epilepticus

Answer 38

continuous seizure or recurrent seizures without return to baseline between them

Question 39

Prolonged seizure of status epilepticus may cause what?

Answer 39

cardiorespiratory compromise, metabolic derangement, irreversible neuro damage

Question 40

Common cause of status epilepticus

Answer 40

anticonvulsant withdrawal or noncompliance others: CNS infection, tumor, drug toxicity, metabolic

Question 41

Status epilepticus treatment

Answer 41

IMMEDIATE anticonvulsant 1) IV Lorazepam 2) Phenytoin if seizure continues Ultimately anesthesia to shut off CNS

Question 42

Imaging for febrile seizures

Answer 42

No imaging needed, plus CT not good for < 18 yo If inconsistent hx or PE do lumbar puncture

Question 43

Febrile seizure treatment

Answer 43

Reassurance and parent education | Tylenol and ibuprofen to control fevers