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30 Cards in this Set

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Recurrent unprovokaed seizures that result from abnormal electrical activity

Epilepsy




(important to estimate whether first unprovoked seizure is likely to lead to further attack*)

Seizures are mc in young children & elderly. What are some risk factors for epilepsy?

Family hx


cerebral injury


neurologic dz


Trauma


Metabolic disorders


Tumor


Congenital abnormalities (infants)

_________seizures imply cerebral injury or lesion

focal seizures

___________ seizures involve only a restricted part (focal area) of the brain

Partial (focal) seizures:


Simple partial


Complex partial

In _________ seizures are limited to a focal circumscribed area of cortex & pts DO NOT lose consciousness*, often preceeded by AURAS




*pts can still interact during seizure, except for loss of specific localized fxn*




Tx?

Simple partial seizures




Tx: Carbamazepine, Phenytoin, Valproate

What is Todd's paralysis?

postictal depression following a simple partial seizure-->


transient REVERSIBLE neurologic deficit (focal weakness, numbness, paralysis) of specific area

In ___________ seizures are limited to a focal area of cortex & pts DO experience impaired consciousness, resulting in unresponsiveness, often preceeded by AURAS




Tx?

Complex partial seizures




Tx: Carbamazepine, Phenytoin, Valproate

___________ is an olfactory aura (foul smell) that may precede a complex partial seizure.




These auras have a high association w/ brain tumors*

Uncinate fits




(origin near the uncus of the medial temporal lobe)

__________seizures involve the ENTIRE cerebral cortex (both hemispheres simultaneously)




*begin diffusely


(no localized origin)

Generalized seizures:


Absence (petit mal)


Myoclonic


Tonic clonic (grand mal)


Atonic


Tonic (reflex)



__________ seizures begin w/ an abrupt LOSS of consciousness w/ bilateral tonic extension (tonic phase), often accompanied w, epileptic cry-->


followed by bilaterally synchronous jerking (clonic phase)-->


followed by flaccid coma


*urinary incontinence is common




Tx?

Tonic clonic (grand mal) seizures




Tx: Carbamazepine, Phenytoin, Valproate

What are some possible complications of generalized seizures?

Oral trauma (tongue laceration)


vertebral compression fracture


(Posterior) shoulder dislocation


Aspiration pneumonia

__________seizures are mc in children & involve a sudden momentary (< 10 sec) lapse in awareness (staring, rhythmic blinking)--->


Behavior & awareness return to normal immediately (no postictal period)


*Pt has NO recollection of seizure




Tx?



Absence (petit mal) seizures




Tx: Ethosuximide

________seizures involve rapid, recurrent brief muscle jerks

Myoclonic seizures

_______seizures mc occur in children w/ diffuse encephalopathies & involve sudden loss of musce tone-->


results in fall (possible self injury)

Atonic Seizures (Drop attacks)

________ seizures are the mc cause of convulsions in children




*have no long-term sequelae BUT do inc risk of future epilepsy


(do NOT cause mental retardation, behavioral problems, etc)




Tx?

Febrile seizures




Tx: anti-pyretics (NSAIDs, etc)


*anticonvulsants & prophylactic tx is NOT indicated

___________ is a common cause of pediatric epilepsy. Seizures usually begin btwn ages of 4-13 & primarily occur at night.




*seizures often disappear during adolescence

Rolandic Epilepsy

_______________ early childhood epileptic encephalopathy that results in;


-Physical brain abnormality


-Mental retardation


-Uncontrolled seizures

Lennox-Gastaut Syndrome

_________ is the mc epilepsy in adults & involves complex partial seizures:


aura followed by-->


staring, lip-smacking, repeated swallowing, making picking motions w/ fingers & loss of awareness of surroundings (30 sec- 2 min seizure)-->


postictal period of confusion

Temporal Lobe Epilepsy

Post-traumatic epilepsy may occur w/i 1 yr of ..................




Tx?

Head injury-->


Prolonged LOC, dura injury


(relate severity of injury)




Tx: phenytoin


*give prophylactically to all pts who suffer severe head injury

T/F


New onset seizures in adults > 30 suggest possible new intracranial lesions

TRUE

Focal features, reported as auras during or after seizures, suggest.......

structural brain lesions

Epilepsy (type, cause, etc) diagnosis is via....

EEG (most important tool*) followed by-->


MRI (detects lesions/ tumors, do in all pts > 18 & children w/ partial seizures)




(sleep deprivation can help bring on a seizure)

How are ongoing seizures tx?

1. IV lorazepam or diazepam to STOP seizure


2. Tx underlying cause


3. Oxygen


4. Cardiac monitoring

Anti-epileptics should be gradually increased until seizure is controlled.




If medication not stopping seizure, what should you do?

Select another medication if current one is not working, then add slowly until therapeutic level attained-->


then discontinue first drug

__________ is when seizures occur back to back w/o full recovery.




Why is this a medical EMERGENCY?




What mc causes this?

Status epilepticus




can cause permanent brain damage




mc caused by abrupt withdrawal of anticonvulsants

Status epilepticus: Tx

1. maintain airway


2. oxygen


3. thiamine & glucose (if hx of alcoholism)


4. IV Lorazepam or Diazepam (if needed)


5. IV phenytoin


6. IV midazolam (refractory control)


7. Pentobarbital

What should be given to prevent/tx alcohol withdrawal seizures?

Benzodiazepines (diazepam or lorazepam)




(antiepileptics are NOT indicated*)




*can also give thiamine & glucose

How can you differentiate Syncope from epilepsy?

Caused by a positional change*, vasovagal dysfxn, stress

How do you differentiate Psychogenic nonepileptic seizures (PNES)?

no abnormal brain activity (on EEG)

How do you differentiate Complex migraines (basilar artery migraine)?

can have lethargy, mood changes, confusion, disorientation, vertigo, bilateral visual disturbances, & alteration or LOC