CM- Neuro -2- Seizures
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| What is a seizure | time limited abnormal, involuntary, unpredictable, rhythmic neuronal discharge in the brain
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| Are seizures a disease | NO they are a symptom of a disease
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| What disease is marked by spontaneous recurrence of two or more unprovoked seizures | Epilepsy
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| What predisposes a person to developing epilepsy | any alteration in structure or function of cerebral neurons presisposes a person to epilepsy
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| What is a provoked seizure | seizure brought on by a change in physiologic state IE hypo/hyper glycemia, hyponatremia, hypocalcemia, stroke, drug intoxication, alcohol withdrawal, infections, tumors, uremia, head trauma
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| What are some causes of Provoked seizures | hypo/hyper glycemia, hyponatremia, hypocalcemia, stroke, drug intoxication/ withdrawal, alcohol withdrawal, infection (meningitis/encephalitis), tumors, uremia, head trauma
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| What are two medications that are prescribed that can lower seizure threshold | Theophylline and tricyclic antidepressants
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| What is a common cause of seizures in children | high fever
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| What are some common structural problems/disease of the brain that predispose a patient to having seizures | Congenital defects, heterotopias, cortical dysplasia, degenerative diseases, alzheimer disease, infectious meningitis, enchephalitis, abscess, tumor, trauma, vascular malformation, stroke, subarachnoid hemorrhage
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| What is the tx difference between provoked vs unprovoked seizures | provoked seizures are tx by addressing underlying factor that triggered the seizure. Unprovoked seizures are treated with antiepileptic meds
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| When do you have the highest incidence of new cases of epilepsy | highest incidence of new cases is in elderly
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| Who is more likely to suffer from epilepsy males or females | M>F 1.2:1 so not that much higher
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| What is the most common cause of seizures worldwide | parasites
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| How are epileptic seizures divided | split into partial and generalized seizures classes and depends on symptoms observed during seizure
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| How are generalized seizures characterized | complete LOC, nonfocal in origin, EEG shows entire cortex involved; tonic clonic seiuzre, absence seizures, myoclonic seizures, atonic, atypical absence, infantile spasm
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| What is a tonic seizure | prolonged contraction of the body with the head and eyes deviating
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| What is a clonic seizure | repetitive jerks without the tonic element
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| What is an atonic seizure | sudden loss of postural tone that may not be associated with LOC
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| What syndrome is marked by spasms and developmental delay in infants age 4-8months and has interictal EEG pattern (hypsarrhythmia) and mental retardation | West Syndrome/ Infantile Spasms
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| What infantile spasms disorder is cuased by inherited ion channel disorder of potassium channels that lead to generalized seizures | Benign Familial Neonatal Convulsions
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| What childhood epilepsy generally begings ages 8-20 and accounts for 7% of all epilepsies and is characterized by jerky movements and some absence seizures | Juvenile Myoclonic Epilepsy
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| What type of seizure is marked by a conscious not impaired person who has a symptom reflected by the small area of the brain that is affected (ie motor, sensory or psychic symptom) | Simple Partial Seizure
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| Pt has only one neurologic modality affected during their seizure and have impaired consciousness what type of seizure are they likley having | Complex Partial Seizure
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| What is an absence seizure | seizure marked by staring, unresponsive, twitching muscles, blinking, automatisms that lasts 1-10 seconds.
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| What is an automatism associated with abscnece seizure | Repetitive purposeless movements (lip smacking, fiddling with clothes/buttons or repeating short phrases) they have abrupt onset and termination
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| What is an atypical absence seizure | absence seizure with gradual onset and termination that lasts longer and has more motor involvement
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| What is a primary generalized seizure | seizure that involves how brain has a tonic phase, clonic phase, biting and incontinence last 2-3 minutes followed by unresponsiveness/ confusion
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| Can partial seizures develop into generalized seizrures | yes
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| If a pt has a seizure and has a LOC what type of seizure are they most likely suffering from | Generalized seizure
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| Pt has a seizure but has not had a LOC but they have an altered state of consciousness what type of seizure are the likely having | Complex Partial Seizure
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| Pt has a seizure they have not a had LOC or decreased or altrered state of consciousness what type of seizure are they likely having | Simple Partial Seizure
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| What are the common toxins that cause seizures | PLASTIC; P-Pesticides (organoP, phencyclidine, phenothiazines), L- lidocaine, lindane, lithium, A- ETOH, amphets, anitcholines, antidepres, antihist; S-salicylates; T-theophylline; I-inderal, insulin, inh; C- caffeine, camphor, CO, cocaine
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| What is status epilepticus | repeated seizures without recovery lasting at least 30 min
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| What is the most common cause of status epilepticus | noncompliance with anti epileptic drugs
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| Apart from non compliance with antiepileptic drugs what are some common causes of status epilepticus | ETOH abuse, withdrawal, neoplasms, and drug overdose
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| Should you be concerned with a persone going into status epilepticus or not because it will just run its course and they will be fine once it is finished | status epilepticus is a medical emergency with a mortality rate of 3% in children 26% in adults and 38% in elderly
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| Pt is in status epilepticus what drugs are you likley going to give them to help bring them out of their seizures | Lorazepam, Diazepam, fosphenytoin, phenytoin or phenobarbital or midazolam (versed)
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| PT has come into the ED after suffering a seizure what do you want to look at during your PE | look for injury especially head/c spine, fractures, bruising, sprains especially posterior shoulder dislocations and tongue biting. Get a glucose determination and get vital signs looking close at temp
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| What may be noted on a neuro exam of a seizure pt postictally | positive babinski, todd's paralysis (extremity weakness) and pupils may be dilated
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| This epileptic syndrome is marked by seizures that often start as a child wakes up in the morning with tingling on one side of mouth, difficulty speaking, drooling. These focal seizure can develop into secondary generalized seizures | Benign Rolandic Epilepsy
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| This epileptic syndrome is generally lifelong epileptic encephalopathy that starts at age 3-5 years and is very similar to the west syndrome/infantile spasm seizures | Lennox- Gastaut Syndrome
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| if a pt complains of a seizure lasting 10-30minutes without LOC despite whole body jerking and especially pelvic thrusting movements what are they likely having | pseudoseizure
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| What are some sleep disorders that may be mistaken for seizure | night terrors, periodic limb movements, enuresis, Narcolepsy, cataplexy, sleep paralysis, hypnologic hallucinations
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| Why would you order a lumbar puncture in a seizure pt | if suspected CNS infection or subarachnoid hemorrhage you want to check this out and make sure this isn't causing seizures
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| What is the gold standard dx test for seizure disorders | MRI
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| Name 3 drugs that are typically prescribed for seizure disorders | Carbamazepine (Tegretol), Clonazepam (Klonopin), Ethosuximide (Zarontin), Phenobarbital (luminal), Phenytoin (Dilantin), Primidone (Mysoline), Valproic Acid (Depakote)
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| What is the tx of choice for infantile spasms | ACTH (adrenal corticotropin hormone)
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| What is the tx of choice for absence seizures | ethosuximide, or valproate
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| What is the tx of choice for Atypical Absence/ Atonic seizures | Valproate
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| What is the tx of choice fore Myoclonic seizures | valproate
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| What is the drug of choice for GTC/Tonic/Clonic seizures | carbamazepine, Phenytoin or valproate
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| What is the drug of choice for tx of partial onset (all types including secondarily generalized seizures) | All conventional anti epileptic drugs except ethosuximide
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| You place your pt on carbamazepine for seizures what s/e may the have | transient leukopenia, hyponatremia from SIADH, rare aplastic anemia and hepatitis
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| What s/e may a pt have on ethosuximide | Nausea, anorexia, HA, blood dyscrasias
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| what s/e may a pt have on felbamate | insomnia, weight loss, agitation, aplastic anemia, hepatitis must be monitored by surveillance lab testing
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| What s/e may a pt have on lamotrigine | rash and HA
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| what s/e may a pt have on oxcarbazepine | hyponatremia
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| What s/e may a pt have on phenobarbital | sedation, possible learning difficulties, depression, paradoxical hyperactivity in children
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| What s/e may a pt have on Phenytoin | gum hyperplasia, hirsutism, cerebellar ataxia, peripheral neuropathy, folate deficiency, hypersensitivity hepatitis
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| What s/e may a pt have on primidone | macrocytic anemia but less sedating than phenobarbital
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| what s/e may a pt have on topiramate | cognitive impairment and kidney stones (1%)
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| What are some common s/e of valproic acid | tremor, weight gain, alopecia, thrombocytopenia, benign elevation of LFTs, rare fatal hepatitis and pancreatitis, risk for neural tube defects
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| What s/e are common with zonisamide | impaired sweating in children, rare rash and blood dyscrasias and kidney stones
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| What are some common health maintenance concerns with antiepileptic patients | 30-50% have osteopenia, 2% have osteoporosis, depression is common, counseling about reproductive issues, consider dc meds after 3yrs seizure free
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| What is lesionectomy in regards to seizures | removing the focal area and some surrounding brain tissue from where someone's seizure arises. This is generally only successful in pts with focal seizures less localized seizures don't benefit as much from this surgery
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| When would you perform a temporal resection | can be performed in pts with temporal lobe epilepsy and is excellent in controlling seizures in 75-80% of pts but some pts may have post operative speech and memory problems
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| when would you perform a hemispherectomy | only in pts with extensive brain disease or disorder since birth or from a very young age that has uncontrollable seizures
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| When would you perform a corpus callosotomy | used in pts with lennox-gastaut syndrome and is only performed on children you are frequently injured during falls from seizures. Generally only remove 2/3 of corpus callosum if no lasting improvement other 1/3 can be removed
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| Pt has intractable partial seizures and is over the age of 12 what procedure can be performed that will allow them to possible short circuit a seizure before it starts | vagus nerve stimulator- insertion of a pacemaker like device that stimulates the vagus nerve 30sec every 5min and that can be manually activated when a prodrom is experienced to prevent or stop a seizure in progress
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| What type of diet may help children with epilepsy that hasn't responded to other tx | ketogenic diet- high fat low protein, low carb diet forces pt into starvation dehydration and creates excessive supply of ketones with seizure suppressing properties
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| What is a concern with a women with epilepsy getting pregnant | increased incidence of birth defects 1-2% higher than gen pop.
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