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Seizure

Neurology

QuestionAnswer
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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