Seizures & Epilepsy Lecture

Question 1

difference between seizures and Epilepsy

Answer 1

Seizure is single 24 hour period of provoked/unprovoked episodes

Epilepsy is 2 or more unprovoked seizure episodes

Question 2

simple partial - what type of seizure?

Answer 2

Partial (focal) seizure

Question 3

what type of seizure? - complex partial

Answer 3

Partial (focal) seizure

Question 4

what type of seizure?- secondarily GTC

Answer 4

Partial (focal) seizure

Question 5

eyes deviated to one side, what does this tell us

Answer 5

maybe dealing with a focal seizure

Question 6

eyes looking forward, what does this tell us

Answer 6

maybe dealing with a generalized seizure

Question 7

what type of seizure? - GTC

Answer 7

Generalized seizure

Question 8

what type of seizure? - Absence

Answer 8

Generalized seizure

Question 9

what type of seizure? - Myoclonic

Answer 9

Generalized seizure

Question 10

what type of seizure? - clonic

Answer 10

Generalized seizure

Question 11

what type of seizure? - Tonic

Answer 11

Generalized seizure

Question 12

what type of seizure? - Atonic

Answer 12

Generalized seizure

Question 13

what kind of seizure where they just drop to the floor from loosing all muscle tone (typically need the helmet to prevent more trauma)

Answer 13

Atonic

Question 14

what term describes

Motor or sensory
No alteration in consciousness
often describes an “aura”

Answer 14

Simple

Question 15

What type of seizure descriptor

Alteration in consciousness

May be able to continue activity, but with slowed response time

often involves staring or automatisms

duration 25 sec to 3 min

Answer 15

Complex

Question 16

weakness of one extremity (usually one sided) brief and temporary

Answer 16

Todd’s paralysis -

Question 17

what seizure type can be mistaken for ADHD

Answer 17

Absence seizures

Question 18

Drug of choice for absence seizures

Answer 18

Ethosuximide

Question 19

why do you medicate for absence seizures

Answer 19

the more they happen the more likely they are to have a generalized tonic clonic

seizures can effect development

Question 20

stiffening of all extremities without the clonic phase

Answer 20

tonic

Question 21

brief shock little jerks of extremities

can occur in clusters

with or without postictal confusion

Answer 21

myoclonic

Question 22

these seizures have postictal confusion, somnolence, with or without transient local deficit

Answer 22

generalized tonic clonic

Question 23

bowel/bladder incontinence

seizure

Answer 23

generalized tonic clonic

Question 24

tongue biting

seizure

Answer 24

generalized tonic clonic

Question 25

EEG for absence seizure

Answer 25

3 Hz spike and wave

Question 26

occur in clusters upon awakening | seizure

Answer 26

Infantile spasms

Question 27

contraction of trunk with extension of arms most common | seizure

Answer 27

infantile spasms

Question 28

treatment for infantile spasms

Answer 28

ACTH or Vigabatrin

Question 29

classification of epilepsy due to known abnormality on MRI or lab studies

Answer 29

symptomatic

Question 30

classification of epilepsy due to unknown cause, MRI and labs all normal

Answer 30

Cryptogenic

Question 31

classification of epilepsy due to unknown cause, MRI and labs all normal

Answer 31

Cryptogenic (we think we know the cause, but we dont really know the cause)

Question 32

what class of seizure is absence

Answer 32

idiopathic

Question 33

when is the best time to obtain a EEG after a seizure like event

Answer 33

1-2 weeks | so swelling has time to resolve for best results

Question 34

malformation of cortical development could lead to what type of seizure

Answer 34

focal

Question 35

Tuberous Sclerosis leads to what type of seizures

Answer 35

multi-focal

Question 36

what imaging and tests for seizures

Answer 36

EEG - what type of seizure | MRI- is there a cause

Question 37

labs to order for status epilepticus treatment (0-4 min)

Answer 37

blood glucose chemistry to include Ca, Mg, Ph, CBC, consider anemia of chronic disease levels

Question 38

labs to order for status epilepticus treatment (0-4 min) what else should be done?

Answer 38

blood glucose chemistry to include Ca, Mg, Ph, CBC, consider anemia of chronic disease levels ``` vitals ekg monitoring o2 oral airway suctioning ```

Question 39

status epilepticus treatment for 5-9 min

Answer 39

PIV with NS Treat hypoglycemia, hypocalcemia, hypomagnesemia Ativan 0.1mg/kg and repeat in 2-3 min to max of 8mg

Question 40

status epilepticus treatment for 10-30 min

Answer 40

fosphenytoin 20mg/kg (150mg/min max) repeat fosphenytoin 5-10mg/kg if persists call for EEG and alert ICU likely to require pressor support

Question 41

31-60 min status epilepticus treatment

Answer 41

phenobarbital 20mg/kg (max rate 100mg/min) Consider valproic acid 20mg/kg Drips: Pentobarbital coma - 5-10mg/kg load until burst suppression then 0.5-5mg/kg/hr Diazepam drip 2mg/kg/hr versed drip 0.2mg/kg load then 0.05-0.5mg/kg/hr Propofol: 1-2mg/kg iv bolus and repeat if needed. Infuse 5-10mg/kg/hr Taper drips slowly

Question 42

what qualifies as refractory epilepsy and what are other management techniques

Answer 42

tried 3 or more AEDs daily and still having seizures Try Vagus nerve stimulator ketogenic diet surgical if focal

Question 43

ages and peak ages for febrile seizures

Answer 43

6mos and 5 yrs | peak at 18mos

Question 44

most febrile seizures are

Answer 44

simple febrile

Question 45

what qualifies febrile seizures as complex

Answer 45

greater than 15 min recurs within 24 hours focal

Question 46

temp for a simple febrile seizure

Answer 46

greater than 101.5

Question 47

what age group would you get an LP for a febrile seizure workup

Answer 47

<3 months - yes 6-18 mos - maybe > 18 mos - no 2-5% of kids with meningitis present with fever and a seizure

Question 48

seizure rescues

Answer 48

rectal Diastat | intranasal midazolam

Question 49

prognosis of febrile seizures vs infantile spasms

Answer 49

2% of febrile will continue with epilepsy infantile spasms - almost half will battle life long with neuro deficits and learning impairments.

Question 50

psychogenic non-epileptiform seizures diagnosis

Answer 50

EEG

Question 51

definition of status epilepticus

Answer 51

> 30 min continuous