Seizures, epilepsy and syncope

Question 1

Common non-epilepsy causes of seizures?

Answer 1

• Substance intoxication / withdrawal
• Medications
• Fever / Infections
• Stroke
• Brain tumor
• Head trauma
• Electrolyte abnormalities (hyper or hypo)
• Hypoxia (drowning, strangulation, etc)

Question 2

Non motor symptoms of seizures

Answer 2

Auras – abnormal sensations – tastes, smells, sights,
sounds. In some cases may precede a motor seizure, in
other cases, this is the seizure itself
* Emotions – Pt may have a rapidly altered emotional
state – may become agitated, anxious, may cry or laugh,
etc.
* Autonomic – Pt may have changes in BP, HR, may have
flushing, palpitations, vomiting, etc. due to sz activity in
nerves affecting the ANS

Question 3

Ix for seizures?

Answer 3

EEG

Question 4

Acute treatment for seizures?

Answer 4

Benzodiazepines are first line
(lorazepam / diazepam) therapy
to abort seizures

Question 5

What is seizure epilepticus?

Answer 5

a medical emergency characterized by a prolonged seizure lasting five minutes or longer, or by a series of seizures where the person doesn’t regain consciousness between them. It requires immediate treatment to prevent brain damage and death

Question 6

Treatment for seizure epilepticus

Answer 6

1. Secure airway and give high flow O2.
2. Give glucose if blood sugar is low
3. Consider thiamine and magnesium if pt is known
   alcoholic
4. Lorazepam 2 mg IV each minute up to 0.1 mg/kg.
   Keep giving lorazepam!
5. Phenytoin 20 mg/kg IV at 50 mg / min (if lorazepam
   did not work or to prevent future seizures)
6. Phenobarbital / General anesthesia (if lorazepam
   and phenytoin didn’t work)

Question 7

Epilepsy treatment?

Answer 7

• Valproic acid (Depakote)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Carbemazepine (Tegretol)
• Oxcarbazepine (Trileptal)

DVLA

Question 8

Presentation of pyschogenic non epileptic seizures?

Question 9

Diagnosis

Question 10

Tx

Question 11

Ix for syncope