37 Seizures

Workup

  • blood work for electrolytes
  • cardiac syncope can mimic seizure
  • brain imaging for tumors/strokes
  • LP: meningitis, encephalitis

EEG

Types

  • simple: motor contraction, abnormal sensation
  • complex: motor, sensory, consciousness altered
  • petit mal: common in children, loss awareness of surroundings briefly
  • grand mal: classic seizure, collapse, shake
  • atonic: stiff once, then flaccid, collapse, mimic cardiac syncope
  • myotonic/myoclonic: rhythmic jerking of a certain area, drop objects, twitches, not as severe as tonic clonic
  • clonic tonic clonic: jerk once, multiple jerks fuse into clonic, then tonic, then clonic
  • secondary generalized: starts out as partial then become generalized

  • hippocampal sclerosis: loss neuron in hippocampus
  • MRI: white spot on right side of temporal hippocampus

Symptoms

.

  • muscles can contract, relax, spasm
  • feel, see, smell things not there
  • mild: loss of awareness for a few minutes, aka absence seizures
  • severe: pt collapse and shakes

  • classic: epigastric rising, precede temporal lobe epilepsy
  • piloerection: skin standing on edge

  • in reality, simple, partial seizures

  • especially after grand mal or tonic
  • differentiate from cardiac syncope: faint from heart problem, become immediate aware after gain of consciousness
  • seizure: period of confusion

Causes

  • most don't have chronic seizure disorders
  • lack of sleep: can have single seizures

Juvenile Myoclonic Epilepsy

  • wake up in morning, one of muscles jerking

Childhood Absence Epilepsy

  • stare into space for moments
  • good prognosis
  • classic presentation: child appear to not pay attention
  • know EEG

Febrile

Eclampsia

  • late pregnancy

Treatment

  • status epilepticus: emergency, can cause other symptoms
  • prevent frequent seizures

Breaking Seizures

  • if lorazepam not working, administer phenytoin, fosphenytoin
  • if still not working, phenobarbital
  • last line: general anesthesia

Preventing

  • oral drugs to take chronically
  • Na necessary for depolarization of neurons

Carbamazepine

  • always monitor drug levels

  • misdiagnosed as URI

Ethosuximide

  • very unique MOA

Phenobarbital

Phenytoin

  • low dose: small rise in lvls, drug quick to metabolize
  • both inducer and metabolized by P450
  • 0 order kinetics

Valproic Acid

Levetiracetam

  • very effective
  • phenytoin and levetiracetam most common

Others

  • Gabapentin: first thought to affect GABA, but actually affect Ca

  • Topiramate: also migraine drug, causes foggy mind, more Ca in urine = stones

Drug SE

Teratogenicity