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