Epilepsy

Question 1

Define idiopathic

Answer 1

“that idiot doctor can’t figure out why it’s happening”

no evidence of an underlying cause; can only be used after ruling out all potential other causes through Hx, PE, and diagnostic testing

Question 2

Define seizure

Answer 2

a single episode consisting of paroxysmal transient disturbances of the brain function that may be manifested as episodic impairment of loss of consciousness, abnormal motor phenomena, and sensory disturbances

Question 3

Define epilepsy

Answer 3

a combination of different seizure episodes

Question 4

Define status epilepticus

Answer 4

continuous ongoing seizures

Question 5

Symptomatic vs idiopathic epilepsy

Answer 5

symptomatic epilepsy has an identifiable cause, but idiopathic does not; idiopathic is the more common of the two in dogs

Question 6

What happens in the brain during a partial seizure

Answer 6

one neuron (or a small group of focal neurons) is stimulated to discharge electrical impulses; the electrical activity remains within this small group of neourns

Question 7

What happens in the brain when a generalized seizure occurs?

Answer 7

the electrical activity from one neuron/a group of focal neurons spreads throughout the rest of the cerebral hemisphere

Question 8

List and describe the 3 phases of a seizure

Answer 8

1. Pre-ictal –> period of time immediately prior to ictus where the patient may be nervous or pace
2. Ictus –> period of actual seizure activity that can last 2-3mins
3. Post-ictal –> a time period post seizure where pet may be tired, lethargic, confused, ravenous or anorexic; lasts a few hours up to a day

Question 9

What is the typical presenting signalment and Hx of a patient with idiopathic epilepsy?

Answer 9

young to middle age dog (1-5yr old) that otherwise appears healthy upon PE; O may describe P as not being “quite right” because O missed the seizure but notices the post-ictal phase

Question 10

4 Important questions to ask when a patient presents during or after a seizure

Answer 10

1. Can you describe the nature of the event?
2. Is this a first time event for this patient?
3. Was there any potential expsoure to anything unordinary?
4. Was there any exposure to anything considered “normal” or “safe”?

Question 11

General characteristics of generalized seizures

Answer 11

• loss of consciousness
• loss of bladder/bowel control
• tonic-clonic movements
• jaw snapping
• post-ictal phase may be short or long in duration
• seizure usually lasts 1-3min

Question 12

General characteristics of syncope (fainting)

Answer 12

• loss of consciousness
• can lose bladder/bowel control
• may paddle trying to rise
• usually no rhythmic tonic/clonic movements
• may be slightly disoriented post syncopal episode; usually short duration
• event lasts <1min

Question 13

List 4 things that can be done as an RVT when a patient presents during a seizure

Answer 13

1. Take patient to the back and direct client to a quite room (with another staff member to gather more info if possible)
2. Take TPR after making sure a DVM knows a seizing patient has arrived
3. Place IV catheter if enough hands are available
4. Gather a blood sample for serum blood glucose (and PCV/TP/BUN if enough blood obtained)

Question 14

When should cooling methods be initiated on a seizure patient?

Answer 14

if temp >104

Question 15

List 2 ways to administer diazepam to an active seizing patient.

Answer 15

1. Per rectum via syringe without needle or red rubber catheter
2. IV only if an IV cath has already been placed

Question 16

What happens if Diazepam is given extravascularly?

Answer 16

Nothing truly bad happens, but it doesn’t act nearly as fast as per rectum or direct IV

Question 17

Aside from a PE, list 4 non-invasive diagnostic tests that can be performed to evaluate a patient that has had a seizure

Answer 17

CBC
Serum chemistry
UA
Fasting & post-prandial bile acids

Question 18

List 3 more invasive diagnostic tests that can be done to evaluate a patient that has has a seizure

Answer 18

Cerebrospinal fluid (CFS) tap
CT
MRI

Question 19

What is a seizure diary and what should go in it?

Answer 19

a place to document info regarding seizures

• date, time, and length of each episode
• unusual behavior or occurrences that may indicate a pre-ictal period of a trigger for the seizure
• medication administration

Question 20

When is a patient considered a candidate for medical therapy of epilepsy?

Answer 20

when it has multiple seizure episodes hours, days, weeks, or months apart

Question 21

What is “steady state level” as it pertains to anticonvulsant meds?

Answer 21

when the drug has finally reached a constant level in the blood

Question 22

Why is steady state important/what happens if it gets disrupted?

Answer 22

-You can’t draw blood to check levels until after the steady state has been reached because you won’t get an accurate answer; if the medication is not given correctly steady state will not be achieved making bloodwork results inaccurate

Question 23

What are the two common oral anticonvulsants meds used in dogs with idiopathic epilepsy

Answer 23

Phenobarbital

KBr