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