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23 Cards in this Set
- Front
- Back
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Questions to ask a pt who presents with seizures
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1. birth hx
2. age of seizure onset 3. hx of febrile seizures 4. any hx of head trauma? 5. the pt should also describe the seizures and if there is "any warning signs" 6. how long do the "warning signs" last 7. How long do the "target seizures" last? |
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Questions to ask a pt who presents with seizures 8-13
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8. When was the pts last seizure
9. how often do the seizures occur on avg? 10. does anything make the frequency of the seizures better or worse? 11. does anyone in the family have seizures? 12 med hx 13. hx of injury due to seizures |
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questions for pts in whom you suspect non epileptic seizures
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1. ask for hx of sexual or physical abuse
2. does the pt know anyone with seizures? 3. Ask about life stresses 4. Can pt stop the seizures? |
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When to order and EEG?
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1. new seizure, or suspicion of new seizure
2. considering to taper off seizure meds 3. suspect sub clinical seizures 4. non convulsive statues epliepticus 5. dementing illness 6. brain death exam (ONLY if clinical exam is unreliable |
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EEG in primary seizures
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-expect to see a generalized spike and wave pattern
-in the absence seizures you will typically see the 3 Hz spike and wave pattern |
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EEG in JME or other forms of generalized epilepsy
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-often see a polyspike and wave appearance
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EEG in complex partial seizures or simple seizures interictally
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-you may see a spike or sharp, typically from the area from which the seizure came from
-to increase the yield of obtaining a spike or sharp wave you should ask for a sleep deprived EEG -can also use hyperventilation and photic stimulation -may not have any epileptiform abnormalities on a 20 min EEg. This DOES NOT mean that hte pt does not have a seizure! |
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wile there mat not be a spike from the are that is responsible for the seizure you may have...
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slowing in the region!
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Medical mgmt depends on...
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1. seizure type
2. pts age 3. other medical illnesses/condition 4. drug interaction 5. pts sex (in women in the reproductive age you must choose the "most benign" drug category avail. At this time it is Cat C (small risk in controlled animal studies)! 6. side effect profile |
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Further mgmt of the pregnant pt
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-f/u with an epileptologist and a high risk OBGYN
-levels of AEDs should be followed on monthly bases as these can change with a change in volume distribution -make sure to supplement with folic acid |
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Most common side effect profile of the antiepileptic drugs
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1. cognitive
2. movements (tremors) 3. wt gain/loss 4. dizziness 5. renal stones 6. bone loss 7. Steven Johnson |
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Supplementation
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-folic acid
-calcium citrate with Vit D if pt had osteopenia |
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AED failure
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-about 40% of pts are seizure free after one AED
-an additional 20% are seizure free on 2 AEDs -other 40%, introduce a 3rd AED, respective surgery |
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How to evaluate for respective surgery
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Phase I: video EEG monitoring + 1 supportive imaging modality (MRI) = skipped candidate if EEG finds seizure onset and an anatomical lesions is found
II: invasive electrodes -advant- better seizure localization -disadvant- infxs, hemorrhages |
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WADA test
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-needs to be done before pt goes to surgery
-consists of behavioral testing after the injection of an anesthetic into the rt of lt internal carotid artery -Depending on the quantity of the injection we have a certain amount of time during which the activities of one of the cerebral hemispheres are suspended. -other hemisphere can be tested (memory and language) |
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Status epilepticus
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-one continuous seizure or recurrent seizure without regaining consciousness between seizures for >30 min
-many drs believe that 5 min is enough to damage neurons -2 categories: convulsive and non convulsive |
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Mgmt of Status epilepticus
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1. ABC
2. Establish IV access 3. Give thiamine 4. Labs: CBC, Chem-7, LFTs, UTOX, Ca, Mg 5. Benzos 6. Dilantin (hook pt up to cardiac and BP monitor; check vital q5min 7. Call anesthesia, secure airway and ventilate 8. admin 3rd AED (if this doesnt work--> refractory status epilepticus) |
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Seizure precautions
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1. bed at lowest position
2. side rails up & padded 3. pt should ambulate to BR only w/supervision 4. only axillary temp should be measured 5. pt should be supervised when using sharp objects 6. Oral airway, O2 and suction should be at bedside |
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Living with epilepsy
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1. Driving: depends on state laws; in NY pt cannot drive for 1 yr after his/her last seizure
2. Working: similar rules should apply to jobs that require working on heights, holding a gun or any other dangerous object (stoves) |
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pt with seizures should be screened for...
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...depression!
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Non epileptic seizures
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-about 20-30% of pts that are seen at epilepsy centers for intractable seizures
-very prevalent |
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sx of pseudo seizures
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1. pelvic thrusting
2. closed eyes 3. head turning from side to side 4. seizures that occur with suggestion and can stop by suggestions |
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How to dc non epileptic seizures (NES)
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1. EEG video monitoring
-upon dx pt is usually referred to a psychiatrist |
