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Clinical Medicine II-Spring 2012

Epidosde of abnl neuro fxn caused by abnl electrical discharge of brain neurons seizure
Condition of recurrent seizures d/t fixed condition epilepsy
Mechanisms of seizures nl inhibitory mechanisms like GABA fail which cause ↑ membrane excitability→intense, prolonged neuro discharge
Some causes of seizures MANY idiopathic, degenerative, infectious, metabolic, neoplastic, perinatal (infx, metabolic)
Some exambles of degenerative seizures MS, presenile dementia
Infectious causes of seizures meningitis, abscess, neurosyphilis
Metabolic causes of seizures hypoglycemia, hepatic failure, hyper/hypo-naturemia
Toxic causes of seizures theophylline, lidocaine, tricyclic antidepressants, cocaine
When does pre-eclampsia become eclampsia when seizures occur
Two major categories of seizures Generalized and Partial (focal) seizures
Types of generalized sizures grand mal, petit mal (absence), myoclonic, results in LOC
Two types of partial seizure simple partial and complex seizure
Near-simultaneous activation of entire cerebral cortex, Generalized seizure
What is a tonic-clonic seizure Grand Mal seizure “convulsions”
Characteristics of a grand mal seizure Abrupt LOC, falls down and fully extended (tonic phase)~30s, followed by rhythmic jerking of trunk and extremities (clonic phase), w/ apnea, cyanosis, tongue-biting, Urine incot, last <2m
What follows a grand mal sz? post-ictal phase, pt remains unconscious, flaccid, confused, usually for many mins-1hr, Todd’s paralysis can also occur: transient postictal focal paresis
Characteristics of a petit mal (absence) seizure Abrupt LOC, blank stare, eyelids may twitch, no response, lasts only seconds, frequent >100/day, usually in school-aged kids, unusual in adults
If adults look like they’re having a petit mal seizure what is it most likely a partial seizure
What is a myoclonic seizures LOC associated w/ isolated extremity jerking
Electrical discharges beginning in localized region of brain, can spread though Partial (focal) Seizures, can lead to generalized
What is usually the cause of a partial seizure focal structural brain lesion, tumor, AVM, scar tissue, CVA, head injury
Characteristics of a simple partial seizure no alteration of consciousness, manifestations: motor:tonic/clonic movement but aware of it or sensory: weird taste, smell(hallucinations), numbness, paresthisia,
Characteristics of complex partial seizures alteration of consciousness, visceral sx, hallucinations, memory distubances, dream-like states, automatisms, mood/affective disorders
AKA: psychomotor or temporal lobe sz complex partial sz
What are some consequences of have the dx of sz employment: driving, pilot, insurability, long-term meds
What need to be r/o as sz mimics syncope, narcolepsy, movement disorders, hyperventilation syndrome, psychogenic seizures (faking)
How do we r/o b/w sz’s and syncope syncope usually have signs prior to passing out, and will wake up right after it occurs, no post-ictal phase
How to r/o b/w psychogenic sz’s and real sz response to emotional upset, only happen when other ppl are around, no incontinence, protect themselves from noxious stimuli, no post-ictal (not gradual), nl EEG during attack
If we r uncertain if it was a sz, do we put it on the chart? no, don’t dx unless sure
What important hx ?’s should we ask post sz HA, recent head trauma, DM: glucose, cancer, electrolyte disturbance: diuretic? Drug/etoh use, family hx
If sz disorder present, but pt is having a sz what ?’s do we ask them compliance to meds, change in meds, sleep deprivation, recent illness, recent EtOH
What labs should we order on our sz pt’s ALWAYS glucose, lytes, BUN/Cr, Ca, Mg, PO4, LP if meningitis suspected, Tox screen, anticonvulsant level w/ sz pt’s, 1st time: CT, or possibly MRI, EEG
Identifies and locates abnl electrical findings EEG
Does a nl inter-ictal EEG r/o epilepsy no, they can be nl when not having a sz
Tx of an acute sz protect pt. from injury (away from a wall etc), pt on side reduce aspiration, assure airway w/ jaw thrust, >5m consider benzodiazepines
When do we start meds for 1st time sz usually if a previous neuro illness or abnl PE is present, if everything nl post sz, usually monitor and watch: refer to neuro
Drugs for generalized, simple partial, and complex partial phenytoin, carbamezapine, valproic acis, phenobarbital
Drugs for Petit mal sz’s Valproic acid, ethosuximide
Tx for alcohol-withdrawl sz’s benzodiazepines to manage all acute withdrawal sxs, no chronic anticonvulsants used
Limitations post first-time sz’s no driving, operating dangerous machinery, heights, unsupervised swimming, in general 6m sz free
Status epilepticus Continuous sz activity >30m or two or more sz’s w/o return of consciousness in b/w
Serious issue w/ status epilepticus prolonged brain hypoxia >30-60mins neuro injury
Tx for status epilepticus O2, via facemask, (intubation?) large-bore IV, GLUCOSE→give D50 if hypoglycemic,1: benzo’s, 2.phenytoin, then 3. phenobartibal, 4. Lidocaine, anesthesia? maximize each prior to moving on
Causes of status epilepticus CNS infx, Trauma, Anoxia, noncompliance to meds, stroke, metabolic derangements
What should we check for post status epilepticus Check serum CK for rhabodomylosis: caused by muscle breakdown results in renal failure
Created by: streetsmarts
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