epilepsy

Question 1

def. epileptic seizure

Answer 1

• transient occurance of signs and Sx

- due to abnormal excessive syncronous neuronal brain activity

Question 2

def.epilepsy

Answer 2

• disorder of the brain with an enduring predisposition to seizures
• patient has had at least one seizure

Question 3

def. focal seizure

Answer 3

originating within networks limited to one hemisphere

- can be discretely localized or more widely distributed

Question 4

def. generalized seizures

Answer 4

originating at some point in the brain and rapidly engaging bilaterally distributed networks

Question 5

*** 3 types of focal seizures

Answer 5

1. no impairment of consciousness
   - simple partial
   - subjective Sx only, or observable motor features only
2. with impairment of consciousness or awarness
   - complex partial
3. eveolving to bilateral convulsive seizure
   - secondary generalized

Question 6

6 types of generalized

Answer 6

1. tonic-clonic
2. abscence
3. clonic - full body
4. tonic - seize up
5. atonic
6. myoclonic - very short

Question 7

what does 3Hz spike and slow wave indicate

Answer 7

absence epilepsy

Question 8

DDx for a “spell” (7)

Answer 8

1. seizure
2. cardiac
3. migraine
4. stroke/TIA
5. decerebration
6. movement disorder
7. psychogenic non-epileptic event

Question 9

3 patient Hx questions

Answer 9

1. warning with siezure
2. preciptating factors
3. health at seizure onset

Question 10

what to ask for to see if there is a previous seizure

Answer 10

many PTs unaware

• positive phenomenology
• flashin lights
• aura
• post-ictal confusion
• tonguq biting
• bed wetting

Question 11

5 possible predisposing factors

Answer 11

1. birth insult
2. febrile seizures
3. meningitis
4. traumatic brain injury
5. fam Hx of epi

Question 12

why is close questioning important

Answer 12

50% of “1st” seizures will have had one before

Question 13

what are acute precipitants

Answer 13

1. drugs
2. withdrawal
3. metabolic
4. meninggitis
5. brain abscess
6. vascular

Question 14

5 investigations

Answer 14

1. general and neuro exam
2. labs
3. EKG - long QT, brugada
4. EEG
5. neuroimaging

Question 15

why EEG? 2

Answer 15

1. helps diagnose - tells if consistent with Sx

2. help prognosticate - if +ve, 50% chance risk of seizure in next 5 years

Question 16

what is sens of interictal epiletiform changes

Answer 16

intial EEG - seen in 20-55%
repeat - seen in 80-90%
negative EEg doesn’t rule out

Question 17

use of imaging

Answer 17

• significant problem in 10%

- should always do unless known primary epilepsy

Question 18

5 predictors of recurrent sizure

Answer 18

1. epiletiform on EEg
2. know etiology is symptomatic
3. post-ictal todd’s paralysis
4. prior seizure
5. multiple seizure in first 24 hours NOT predictove

Question 19

what to be cautious about with meds

Answer 19

triggering a seizure

Question 20

what are cautions for GTC, partial, myclonic, absence, atonic/clonic

Answer 20

GTC - ETX
partial - ETX
myclonic - ETX, PHT, CBZ, OXC, LTG
absence - PHT, CBZ, OXC

Question 21

what are good drug for fast dosing

Answer 21

• pheytoin
• valproate
• gabapentin
• levetircetem

Question 22

what is phenytoin use for

Answer 22

emerg. and maintance

Question 23

AE of phenytoin

Answer 23

CNS - mystagmus, cognition, encephalopathy, movement disorders
GI - give with meals
chronic - cerebellar, peripheral neuopathy, cosmetic

Question 24

when to use and not use carbemazepine

Answer 24

good - partial onset, generalized tonic/clonic

bad - JME

Question 25

carbemazepine SE

Answer 25

nausea, GI | neuro - dizzy, sedation, HA, ataxia

Question 26

how to give valproic acid

Answer 26

emergency loads, then gradually titrate loads up

Question 27

main caution in valpoate

Answer 27

teratogenticity

Question 28

SE of levetiracetam

Answer 28

- somnolence, dizzyness - behav. mood distubances - hypersensitivity

Question 29

what is best drug for seizure control

Answer 29

vaproic acid

Question 30

what is Juv. myoclon epi

Answer 30

triad of absence, generalized convulsions, and myoclinc seizures - high rate of remission with AED - life long therapy - traditionally valproate

Question 31

what is caution with valproate

Answer 31

teratogenicity | - can give folic acid

Question 32

6 meds that are high risk for contraceptive failure

Answer 32

1. phenobarbital 2. primidone 3. phenytoin 4. carbamazpine 5. oxcarbazepine 6. topriamate

Question 33

def. status epilepticus

Answer 33

- 5 mins or longer of continuous seizure | - or 2 or more discrete seizures without complete recovery of consciousness

Question 34

4 types of status

Answer 34

1. generalized tonic-clonic 2. nonconvulsive - absence, partial 3. focal motor status 4. myoclonic

Question 35

what is mort. of SE

Answer 35

17-23%

Question 36

what does mort depend on (4)

Answer 36

1. etiology - alc. better 2. duration (best predictor) 3. age - worse older 4. treatment adequacy

Question 37

morbidity of SE

Answer 37

- neuro delay in kids - speech deficits - 10-23% of pts with SE are left disabled

Question 38

what is important with timing in SE

Answer 38

need to treat ASAP

Question 39

mgmt step in SE (4)

Answer 39

1. ABCs 2. check glucose, thiamine if giving glucose 3. anticonvulsants 4. diagnose and treat underlying cause

Question 40

what are anticonvulsants for sE

Answer 40

1st line - benzos 2nd line - if fail - phenytoin 3rd line - ICU for general anasthetic

Question 41

etiology of SE in order

Answer 41

1. stroke 2. med change/non-compliance 3. EtOH/ drugs

Question 42

def. refractory epilepsy

Answer 42

- not well controlled after 2 trials of drugs - 20-40% - after 2, send for speciality care

Question 43

def. psychogenic non-epiletic seizures

Answer 43

- form of conversion disorder | - most commonly masquerade as medically refactory epi

Question 44

features of psedo seizures

Answer 44

- multiple ill defined and illdescribed - tongue bite on tip, not sides - paradoxical response to drugs - other Psych - tearing/crying during seizure

Question 45

what is concept of surgery

Answer 45

- remove the zones that begin the seizure | - epileptogenic zone

Question 46

what is rate of cure for surg

Answer 46

70-80% | - mortality ration of 2-5%

Question 47

when to refer

Answer 47

when there has not been appropriate seizure control by neurologist in 9 months - takes average of 20 years