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18 Cards in this Set

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what labs do you order in first-time seizures?
glu
Ca++
Mg+
CBC
renal fx tests
tox screen
do you order tests for porphyria?
in certain instances with high suspicion
what lab abnormalities can be caused by seizures? what do you do?
metabolic acidosis
leukocytosis

repeat the labs
is checking for serum prolactin useful?
limited use; serum prolactin MAY rise after generalized tonic-clonic seizures and some partial seizures

check levels 10 to 20 min after event and then compare to baseline 6hrs later
what is the best use for prolactin levels after a seizure?
differentiating tonic-clonic and partial complex seizures from psychogenic seizures when pretest probability is >50%
is an LP useful to evaluate first-time seizure?
only if infection or metastatic CA is in the differential
what does an abnormal EEG confirming epilepsy tell you?
increases the likelihood that pt will experience a seizure in the next 2 years
when should an MRI be done in pts with first-time seizure?
if pt's first seizure was not a physiologic NES, then check for cortical dysplasias, infarcts or tumors
when do you start anti-epileptic therapy?
when there is evidence of permanent injury to the brain, such as with cortical stroke, abscess or tumor

anti-epileptic therapy should be started on pts with increased chances of second seizure
what type of pts are most likely to develop refractory seizures?
those with structural abnormailities of the brain
what are 6 risk factors for a recurrent seizure?
1. hx of serious brain injury (LOC, neuro findings)
2. brain lesion on CT or MRI
3. focal abnormalities found on neuro exam
4. mental retardation
5. partial seizure as first seizure
6. abnormal EEG (epileptiform discharges present)
what type of seizures are most likely to be recurrent?
1. absence
2. myoclonic
3. atonic
chances of recurrence of seizures in adults at 1, 3, 5yrs?
1yr: 14%
3yr: 29%
5yr: 34%
what 4 factors are included in a model to evaluate risk for recurrence?
1. 2 or 3 seizures at presentation
2. 4+ seizures at presentation
3. underlying neurologic disorder (or deficit, LD or developmental delay)
4. abnormal EEG
first line drug for partial epilepsy?
lamotrigine
first line drug for generalized epilepsy?
valproate
4 principles when starting anti-epileptic tx?
1. monotherapy
2. gradually titrate doseage; start low and go slow
3. monitor tx regularly
4. polytherapy only when pt failed 2 adequate, sequential monotherapy trials
what are some possible seizure triggers?
1. stress
2. sleep deprivation
3. alcohol
4. menses