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Seizure
Neurology
| Question | Answer |
|---|---|
| EEG 3/sec spike and wave = | Absence |
| Most common cause of tonic-clonic in pts (onset < 30 yo) is: | idiopathic epilepsy |
| Clonic seizures: | usually in childhood; impaired consciousness, followed by asymmetric bilateral jerking |
| Most common seizure type: | complex partial |
| complex partial: etiology may be: | 10-30 yo; common post-head trauma; 50% abnml CT/MRI; 50% mesial temporal sclerosis; 20% hamartoma |
| complex partial: 30-60 yo: etiology may be: | brain tumor? |
| complex partial: >60 yo: etiology may be: | stroke? |
| Seizure: labs | EEG most important. Glucose; lytes; AED levels; LP if suspect meningitis; EtOH/tox screen; ABG if suspect hypoxia; poss CXR, CT; MRI study of choice for epileptogenic lesions |
| Status epilepticus: does not apply to: | continuous simple partial seizures |
| EtOH withdrawal seizure: | onset 6-48 hr after last drink; often primary generalized, often have Todd’s |
| Tx after single seizure if: | there is a structural lesion or recognized abnormal EEG |
| Remission: | usu within 3 yrs of first seizure; prolonged remission in 60% of such pts |
| Factors against remission | FH; psych comorbid; febrile seizure hx; more seizures; age |
| Seizure etiology | CNS dysfn, metabolic/lytes, febrile (peds), trauma, CVA, AVM, SAH, mass, infxn, hepatic enceph, drugs, EtOH WD, hyperthermia, idopathic (most common) |
| Motor (type of simple partial) = | focal rhythmic extremity twitching; involved area may enlarge due to increased neuron recruitment -> "Jacksonian march" (increased motor deficit) |
| Todd paralysis = | postictal hemiparalysis, may persist up to 36 hrs |
| Continuous seizure activity w/o interictal return to baseline for >15-20 minutes = | status epilepticus (medical emergency) |
| status epilepticus mgmt | O2/tele. Labs & neuro assessment. Thiamnin and D50. Ativan 0.02-0.03mg/kg (or Valium 0.3 vs Versed 0.1). Dilantin load up to 50mg/min |
| If status epilepticus persists despite Dilantin: | increase by 5-10mg/kg; consider phenobarbital 50-100/min (max 25 mg/kg). If >60 min, pentobarbital 5-15mg/kg or propofol |
| complex partial sz | may have aura, then impaired consciousness |
| simple partial sz has no: | impairment of consciousness |
| Most common cause of tonic-clonic in pts (onset < 30 yo): | idiopathic epilepsy |
| Clonic seizures: | usu in childhood; impaired consciousness, followed by asymmetric bilateral jerking |
| Most common seizure type: | complex partial |
| complex partial sz: | 10-30 yo; common post-head trauma; 50% abnml CT/MRI; 50% mesial temporal sclerosis; 20% hamartoma |
| complex partial sz: etio by age | 30-60 yo: poss brain tumor; >60 yo: more likely stroke |
| Status epilepticus dx does not apply to: | continuous simple partial seizures |
| EtOH withdrawal seizure: | onset 6-48 hr after last drink; often primary generalized, often have Todd paralysis |
| Sz remission: | usu within 3 yrs of first seizure; prolonged remission in 60% of such pts |
| Factors against sz remission | FH; psych comorbid; febrile seizure hx; more seizures; age |
| Todd paralysis = | post-ictal focal weakness in part of body, confined to L or R, usu arms/legs |
| Anti Epileptic Drugs: titration | Start low & gradually increase; initiate with 1/3-1/4 of anticipated maintenance dose & increase over 3-4 weeks |
| when Anti Epileptic Drugs may be dc'd: | If onset btw age 2-35 & normal EEG; seizure-free period 2-4 yrs; complete ctrl within 1 yr; very gradual taper over 6 mos; relapse usu within first few mos after withdrawal; f/u in 5 yrs if no problems |
| Concomitant dysphasia, hemianopia, or focal epilepsy suggests a lesion located: | supratentorial |
| epilepsy that has failed two medications is | medically intractable epilepsy |
Created by:
Abarnard
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