Term
| __ of pple with one seizure never have one again. |
|
Definition
|
|
Term
| Highest rate of seizures is in those less than __. |
|
Definition
|
|
Term
| Clinical condition in which one has recurrent seizures not related to reversible stressors: |
|
Definition
|
|
Term
| Nonepileptic seizure are provoked by a temporary disorder or stressor like: |
|
Definition
- metaabolic d/o
- CNS infection
- cardiovascular d/o
- drug toxicity
- EtOH
- fevers (kids) |
|
|
Term
| Sympatomatic secondary seizures are due to a known cause like a __ or __. These are most common in __ and ___. |
|
Definition
- tumor or stroke
- infants and elderly |
|
|
Term
| Psychogenic seizures aka __. These symptoms just simulate a seizure= psych patients. |
|
Definition
|
|
Term
| common causes of seizures by age: |
|
Definition
Before age 2: Developmental defects, birth injuries, and metabolic disorders
Ages 2 to 14: Idiopathic seizure disorders
Adults: Cerebral trauma, alcohol withdrawal, tumors, strokes, and unknown cause (in 50%)
The elderly: Tumors and strokes |
|
|
Term
| Rare disorder where seizures are triggered by a predictably external stimulus like lights, video games, or touching certain part of body: |
|
Definition
|
|
Term
| Partial seizures are aka: |
|
Definition
|
|
Term
| 3 types of simple/partial seizures: |
|
Definition
- Simple
- Complex
- Secondarily generalized |
|
|
Term
| Main 2 categories of seizures: |
|
Definition
- Partial/focal
- Generalized |
|
|
Term
|
Definition
- Absense (petit mal)
- Myoclonic
- Tonic-clonic (grand mal)
- Tonic
- Atonic (drop attack) |
|
|
Term
| Attacks entire cortex of both hemispherres from onset, LOC: |
|
Definition
|
|
Term
| Generalized seizurs have a __ state. |
|
Definition
| postictal state (deep sleep, confused, HA, muscle soreness- minutes to hours) |
|
|
Term
|
Definition
might occur after a generalized seizure
weakness of the limb contralateral to the seizure focus |
|
|
Term
|
Definition
- sudden flexion of trunk and adduction of arms
- few seconds several times/day
- often have developmental defects |
|
|
Term
| Typical absense seizures (petit mal): |
|
Definition
-10-30 sec of lost consciousness
- eyelid fluttering
- axial muscle tone may be lost
- DO NOT FALL OR CONVULSE
- no postictal
- genetic
- mainly in kids
- normal neurological and cognitive exam |
|
|
Term
| Atypical absense seizures are usually a part of __ __ syndrome. |
|
Definition
Lennox-Gastaut syndrome- severe form of epilepsy occuring before age 4
Atypical absense
- last longer
- jerking movments
- loss of awareness is complete
- hx of damage to nervous sytem/other seizures/developmental delay |
|
|
Term
| Atypical absense seizures usually __ into __. |
|
Definition
|
|
Term
|
Definition
- kids usually
- part of Lennox-Gastaut syndrome
- brief complete loss of muscle tone and consciousness
- children fall/pitch to the ground |
|
|
Term
| atonic seizures, atypical absense seizures, and tonic seizures are part of : |
|
Definition
|
|
Term
| Tonic seizures occur most in children during __. |
|
Definition
sleep
- cause is usually Lennox-Gastaut
- contractions start axial> peripheral
- 10-15 seconds |
|
|
Term
| MC result from structural abnormalityh; |
|
Definition
|
|
Term
| How is a simple partial seizure diff from complex partial seizure? |
|
Definition
simple- no LOC
complex- reduced LOC |
|
|
Term
Secondary generalization occurs when a partial seizure spreads and activates the entire cerebrum bilaterally
may occur so rapidly that the initial partial seizure is not clinically apparent or is very brief |
|
Definition
|
|
Term
|
Definition
| focal motor symptoms begin in one hand and march up the arm |
|
|
Term
| Complex partial seizures: |
|
Definition
Consciousness is impaired, but patients have some awareness of the environment (ie, purposefully withdrawing from noxious stimuli). The following may also occur:
Often preceded by aura; pts may stare
Oral automatisms (involuntary chewing or lip smacking)
Limb automatisms (ie, automatic purposeless movements of the hands)
Utterance of unintelligible sounds without understanding what they say
Resistance to assistance
Tonic or dystonic posturing of the extremity contralateral to the seizure focus
Head and eye deviation, usually in a direction contralateral to the seizure focus
Bicycling or pedaling movements of the legs if the seizure originates from the medial frontal or orbitofrontal head regions |
|
|
Term
| Complex Partial Seizure after: |
|
Definition
Motor symptoms subside after 1 to 2 min
confusion and disorientation may continue for another 1 or 2 min
Postictal amnesia is common
Patients may lash out if restrained during the seizure or while recovering consciousness if the seizure generalizes. However, unprovoked aggressive behavior is unusual |
|
|
Term
| Left temporal lobe seizures can cause: |
|
Definition
|
|
Term
| Right temporal lobe seizures can cause: |
|
Definition
| visual spatial memory abnormalities |
|
|
Term
| Bilateral tonic posture seizure is likely from which site? |
|
Definition
|
|
Term
| simple movements (Jacksonian/limb twithces)originate from which site? |
|
Definition
| contralateral frontal lobe |
|
|
Term
| chewing moving, salivation, and speech arrest originate from what site/ |
|
Definition
|
|
Term
| visual formed hallucinations originate from? |
|
Definition
| posterior temporal lobe or amygdala-hippocampus |
|
|
Term
| unformed visual hallucinations originate from: |
|
Definition
|
|
Term
| Febrile seizures occur with __ and in absense of __ __. |
|
Definition
- with fever
- absense of intracranial infection |
|
|
Term
|
Definition
| - brief solitary generalized tonic clonic in appearance |
|
|
Term
| Complicated febrile seizures: |
|
Definition
focal
greater than 15 minutes
recur 2 or more times in 24 hours |
|
|
Term
| Status epilepticus requires one of the following: |
|
Definition
- tonic clonic lasting greater than 5 to 10 minutes
- 2 or more seizures in between which consciousness is not regained |
|
|
Term
| Generalized seizures lasting longer than __ __ may result in permanent brain damage. Longer lasting seizures may be fatal. |
|
Definition
|
|
Term
| Causes of generalized convulsive status epilepticus; |
|
Definition
- withdrawal of anticonvulsants
- head trauma |
|
|
Term
| Complex partial status epilepticus and absense status epilepticus often manifest by prolonged episodes of __ ___ __. __ usually required for dx. |
|
Definition
|
|
Term
generalized muscular activity and lack of response to verbal stimuli
may at first glance suggest generalized tonic-clonic seizures
clinical characteristics can help r/o legitimate seizure
last longer (several minutes or more)
Postictal confusion tends to be absent
Typical tonic phase activity, followed by clonic phase, usually does not occur
The progression of muscular activity does not correspond to true seizure patterns (ie, jerks moving from one side to the other and back [nonphysiologic progression]) exaggerated pelvic thrusting)
Intensity may wax and wane
Vital signs, including temperature, usually remain normal
Patients often actively resist passive eye opening |
|
Definition
|
|
Term
| Drugs are given to prevent seizures if head injurcy caused structural changes or a GlasGow coma scale of less than __. |
|
Definition
|
|
Term
| Antiseizure meds for head trauma reduce risk of seizures during first week, but do not prevent permanent ____ ___ |
|
Definition
|
|
Term
| With head trauma, seizure meds should be stopped after __ __ unless seizures occur. If seizures begin greater than __ __ after head trauma, long term treatment is required. |
|
Definition
|
|
Term
| __ __ can lower the seizure threshold. |
|
Definition
|
|
Term
| Risk factors for seizures: |
|
Definition
- prior head trauma/CNS infectin
- neurologic disorders
- drug use/withdrawal
- alcohol withdrawal
- nonadherence to anticonvulsants
- family history |
|
|
Term
| Vital signs just after seizure: |
|
Definition
tachypnea
tachycardic
mildly elevated temp
low O2 saturation |
|
|
Term
| Tremors after a seizure make you think: |
|
Definition
|
|
Term
|
Definition
| weakness of 1 extremity or complete hemiparesis lasting upto 24 hours after seizure |
|
|
Term
| Patient comes into ER after a seizure. They have a known seizure disorder. What do you do? |
|
Definition
- check blood anticonvulsant levels and sugar
- if nothing has changed from baseline> discharge and follow up in office |
|
|
Term
| New onset seizures or new abnormal physcial exam results require ___. |
|
Definition
|
|
Term
| Patients with new onset seizures are evaluated in the __ and discharged after thorough eval. |
|
Definition
|
|
Term
| Patients that have symptoms or signs of a treatable disorder such as trauma, infection, or a metabolic disorder---require further workup |
|
Definition
|
|
Term
| __ __ (if indicated) is usually done immediately after seizure to rule out mass and hemorrhage. |
|
Definition
|
|
Term
| If meningitis or CNS infection is suspected, do a __ __ first. If this is negative, a __ __ is required. |
|
Definition
- head CT
- lumbar puncture |
|
|
Term
| In a febrile seizure whos neuro stats return to normal, do you need a CT? |
|
Definition
|
|
Term
| If indicated an __ is done if the CT was negative. This allows for better resolution of brain tumors and abscesses and can detect cortical dysplasias, cerebral venous thrombosis, and herpes encephalitis. |
|
Definition
|
|
Term
| An epilepsy protocol MRI of the brain uses __ __ ___ and __ __, which can detect __ atrophy and sclerosis. |
|
Definition
- high resolution coronal T1 and T2 sequences
- hippocampus |
|
|
Term
| If metabolic cause of seizures is suspected, whats the work up/ |
|
Definition
- Chem 8
- Calcium
- Magnesium
- Phosphate
- Liver function test
- drug screens |
|
|
Term
| __ is critical for dx of epileptic seizures particularly complex partial or absense status epilepticus. |
|
Definition
|
|
Term
| Epileptiform abnormalities may be bilateral and generalized in patients with generalized seizures and may be localized in patients with partial seizures |
|
Definition
|
|
Term
| Epileptiform abnormalities: |
|
Definition
| temporal lobe foci between seizures (interictal) in complex partial seizures originating in the temporal lobe |
|
|
Term
| Interictal symmetric bursts of 4-7 Hz epileptiform activity in __ ___ __ __ seizures. |
|
Definition
| - primary generalized tonic clonic seizurs |
|
|
Term
| Focal epileptiform discharges; |
|
Definition
| secondarily generalized seizures |
|
|
Term
| Spikes and slow wave discharges at a rate of 3/second: |
|
Definition
|
|
Term
| Slow spike and wave discharges at a rate of less than 2.5/second: |
|
Definition
| atypical absense seizures |
|
|
Term
| Bilateral polyspike and wave abnormality at a rate of 4 to 6 Hz: |
|
Definition
| Juvenile Myoclonic Epilepsy |
|
|
Term
A normal EEG cannot exclude the diagnosis of epileptic seizures, which must be made clinically
EEG is less likely to detect abnormalities if seizures are infrequent
The initial EEG may detect an epileptiform abnormality in only 30 to 55% of patients with a known epileptic seizure disorder |
|
Definition
|
|
Term
| __ __ may detect epileptiform abnormalities in 80-90% of epileptic patients. |
|
Definition
|
|
Term
| What can you do to increase chances of detecting epileptiform abnormalities on the EEG in pts with epileptic seizures? |
|
Definition
- serial EEGs with extended recording times
- tests done during sleep deprivation |
|
|
Term
| Most sensitive EEG testing for differentiating b/w epileptic vs nonepileptic seizures: |
|
Definition
| Inpatient combined video-EEG monitoring (2-7 days records EEG and clinical behavior simultaneoulsy) |
|
|
Term
| Advanced imaging testing for when surgical resection is being considered for seizures: |
|
Definition
- Functional MRI
- Magnetoencephalography (MEG)
- Single Photon emission CT (SPECT) |
|
|
Term
| This test can identfiy the the functioning cortex and guide surgical resection when an EEG and MRI do not clearly identify the seizure focus: |
|
Definition
|
|
Term
| Magnetoencephlography (MEG) with EEG is aka: |
|
Definition
| Magnetic Source Imaging (MSI) |
|
|
Term
| Magnetoencephalography (MEG) with EEG (called magnetic source imaging, or MSI) may localize the lesion, avoiding the need for invasive intraoperative mapping procedures |
|
Definition
|
|
Term
| This test can be performed during the perictal period and can detect increased perfusion to the seizure focus to localize the area to be removed. This test requires injection of contrast at the time of the seizure. Thus patients must be admitted for continuous EEG vidoe monitoring. |
|
Definition
| Single Photon Emission CT (SPECT) |
|
|
Term
| SPECT must be done in the ___ period, so patients have to be monitored and given contrast when seizure starts. |
|
Definition
|
|
Term
| Acute Treatment Seizure Drugs first line: |
|
Definition
Benzodiazepines
LORAZEPAM
Diazepam
Midazolam
rapid onset and offset |
|
|
Term
| Acute seizure treatment second line: |
|
Definition
- Phenytoin
- Fosphenytoin
- Phenobarbitol |
|
|
Term
| Advantages/disadvantages of Fosphenytoin: |
|
Definition
- less side effects
- IM usage
- administer faster
Disadvantage- expensive |
|
|
Term
| Side effects of phenobarbital: |
|
Definition
hypotension
respiratory depression |
|
|
Term
| If 2 or more seizure drugs are not controlling seizurs, consider: |
|
Definition
|
|
Term
| Usefulness of anticonvulsants after a single seizure is controversial, and risks and benefits should be discussed with the patient. Because the risk of a subsequent seizure is low, drugs may be withheld until a 2nd seizure occurs, particularly in children. In children, certain anticonvulsants cause important behavior and learning problems |
|
Definition
|
|
Term
| Generalized tonic clonic seizures basic care; |
|
Definition
- loosen clothing around neck
- pillow under head
- do NOT try to protect tongue
- patient on left side to prevent aspiration |
|
|
Term
| Drugs that could cause seizures: |
|
Definition
- illicit drugs: cocaine, phencyclidine, amphetamines
- Rx: haloperidol, phenothiazines |
|
|
Term
| Appropriate dose of antiseizure drugs is the __ dose possible that stops all seizures and has fewest side effects, regardless of blood level. |
|
Definition
|
|
Term
If toxicity develops before seizures are controlled, the dose is reduced to the pretoxicity dose. Then, another drug is added at a low dose, which is gradually increased until seizures are controlled
Patients should be closely monitored because the 2 drugs can interact, interfering with either drug's rate of metabolic degradation. The initial, ineffective drug is then slowly tapered and eventually withdrawn completely
Use of multiple drugs should be avoided if possible because incidence of adverse effects, poor adherence, and drug interactions increases significantly
Adding a 2nd drug helps about 10% of patients, but incidence of adverse effects more than doubles. blood levels of anticonvulsants is altered by many other drugs, and vice versa |
|
Definition
|
|
Term
Long-term treatment:
Once seizures are controlled, the drug should be continued without interruption until patients have been seizure-free for at least 2 yrs
stopping the drug may be considered
Most of these drugs can be tapered by 10% every 2 wk |
|
Definition
|
|
Term
| Relapse is more common with the following: |
|
Definition
- seizures since childhood
- need for greater than 1 drg
- previous seizures while on meds
- partial or myoclonic seizures
- underlying static encephalopathy
- abnormal EEG in last year |
|
|
Term
| Of patients who relapse, __ do this in the first year, and __ within the second year. If relapse occurs when not on meds, __ __. |
|
Definition
- 60%
- 80%
- treat indefinitely |
|
|
Term
| New long term treatment anticonvuslants for partial and generalized tonic-clonic seizures: |
|
Definition
clonazepam---KLONOPIN
felbamate---FELBATOL
lamotrigine---LAMICTAL
levetiracetam---KEPPRA
oxcarbazepine---TRILEPTAL
pregabalin---LYRICA
tiagabine---GABITRIL
topiramate---TOPAMAX
zosinamide---ZONEGRAN
no more effective than the established drugs
have fewer adverse effects and to be better tolerated |
|
|
Term
| 3 types of seizurs that are difficult to treat: |
|
Definition
- infantile seizures
- myoclonic seizures
- atonic seizures |
|
|
Term
| Infantile spasms, atonic seizures, and myoclonic seizures treatment: |
|
Definition
- Valproate (Depakene)
- followed by Clonazepam (Klonopin) |
|
|
Term
| For infantile spasms, __ for 8-10 weeks are often effective. |
|
Definition
|
|
Term
| Treatment of Juvenile Myoclonic Epilepsy is life long, drug options: |
|
Definition
- Carbamazepine- Tegretol
- Oxcarbazepine- Trileptal
- Gabapentin- Neurontin |
|
|
Term
| Kids less than 12 months with seizures and suspect infection: |
|
Definition
|
|
Term
| MCC recurrent primary seizures: |
|
Definition
| sub therapeutic med levels |
|
|
Term
|
Definition
|
|
Term
| Recent evidence (febrile seizure) supports only doing LP on child less than 12mo if CNS infection suspected or hx of recent abx usage. |
|
Definition
|
|
Term
| Seizure and syncope can appear similar – seizure: retrograde, amnesia, preceding aura, incontinence, tongue biting and prolonged postictal state |
|
Definition
|
|
Term
For seizures due to alcohol withdrawal, long term drugs are not indicated.
Instead, treat the withdrawal syndrome with ___. |
|
Definition
|
|
Term
| Pregnant eclampsia pts with seizures give: |
|
Definition
| Magnesium sulfate 4-6 mg IVP then 1-2g/hour |
|
|
Term
| Newer antiseizure drugs are category _ in pregnancy. |
|
Definition
| C (teratogens in animal but effect not know in humans) |
|
|
Term
| Fetal antiepileptic drug syndrome: |
|
Definition
- cleft lip
- cleft palate
- cardiac defects
- microcephaly
- growth retardation
- developmental delay
- abnormal facies
- limb/digit hypoplasia
occurs in 4% of children whose mom was taking anticonvulsants |
|
|
Term
| Uncontrolled generalized seizures during pregnancy can lead to fetal injury and death therefore tx is generally advised |
|
Definition
|
|
Term
| __ supplementation should be recommned to all women of child bearing age on anticonvulsants to reduce risk of neural tube defects. |
|
Definition
|
|
Term
| Oxcarbazepine (Trilpetal) side effects: |
|
Definition
- TEN (toxic epidermal necrolysis)
- Steven Johnson Syndrome |
|
|
Term
| Carbamazepine (Tegretol) side effects: |
|
Definition
- aplastic anemia
- agranulocytosis
- toxic epidermal necrolysis (TEN)- cautin in Asian pts
HLA B1502 allele |
|
|
Term
| Phenobarbital side effects; |
|
Definition
| - respiratory and circulatory depression |
|
|
Term
| __% of seizure pts have intractable seizures and are surgery candidates. |
|
Definition
|
|
Term
| If seizure focus is in a focal resectable area, resection surgery helps a lot. |
|
Definition
|
|
Term
| If the focus is in the __ __ lobe, resection eliminates seizures in __% of patients. |
|
Definition
anteromesial temporal lobe
60% |
|
|
Term
| For epilepsy pts that are not candidates for surgery and have intractable seizures, __ __ stimulation of the __ __ __ via an implantable pacemaker can be done. |
|
Definition
- vagus nerve stimulator
- left vagus nerve |
|
|
Term
|
Definition
This procedure reduces the number of partial seizures by ≥ 50% in about 40%
patients can activate it with a magnet to abort an imminent seizure—sends signal to brain
Adverse effects include deepening of the voice during stimulation, cough, and hoarseness, complications are minimal and effective duration is unlcear |
|
|
Term
with treatment--seizures are eliminated in one third of patients with epileptic seizures, and frequency of seizures is reduced by > 50% in another third
About 60% of patients whose seizures are well-controlled by drugs can eventually stop the drugs and remain seizure-free |
|
Definition
|
|
