37 Seizures
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Workup
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- blood work for electrolytes
- cardiac syncope can mimic seizure
- brain imaging for tumors/strokes
- LP: meningitis, encephalitis
EEG
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Types
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- 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
![](https://photos.thisispiggy.com/file/wikiFiles/dXh2YT1.jpg)
- hippocampal sclerosis: loss neuron in hippocampus
- MRI: white spot on right side of temporal hippocampus
Symptoms
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![](https://photos.thisispiggy.com/file/wikiFiles/Btr9gZ4.jpg)
- 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
![](https://photos.thisispiggy.com/file/wikiFiles/haZCyZ9.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/7fmchgw.jpg)
- classic: epigastric rising, precede temporal lobe epilepsy
- piloerection: skin standing on edge
![](https://photos.thisispiggy.com/file/wikiFiles/NQPjIOK.jpg)
- in reality, simple, partial seizures
![](https://photos.thisispiggy.com/file/wikiFiles/WqUjFOf.jpg)
- 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
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- most don't have chronic seizure disorders
- lack of sleep: can have single seizures
![](https://photos.thisispiggy.com/file/wikiFiles/YYf3W9F.jpg)
Juvenile Myoclonic Epilepsy
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- wake up in morning, one of muscles jerking
Childhood Absence Epilepsy
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- stare into space for moments
- good prognosis
- classic presentation: child appear to not pay attention
- know EEG
Febrile
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Eclampsia
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Treatment
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- status epilepticus: emergency, can cause other symptoms
- prevent frequent seizures
Breaking Seizures
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- if lorazepam not working, administer phenytoin, fosphenytoin
- if still not working, phenobarbital
- last line: general anesthesia
![](https://photos.thisispiggy.com/file/wikiFiles/MIN34Fl.jpg)
Preventing
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- oral drugs to take chronically
- Na necessary for depolarization of neurons
Carbamazepine
![](https://photos.thisispiggy.com/file/wikiFiles/lms4sDo.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/8RQyd5R.jpg)
- always monitor drug levels
![](https://photos.thisispiggy.com/file/wikiFiles/yYCMUp5.jpg)
Ethosuximide
![](https://photos.thisispiggy.com/file/wikiFiles/89o4W6r.jpg)
Phenobarbital
![](https://photos.thisispiggy.com/file/wikiFiles/rFf12ay.jpg)
Phenytoin
![](https://photos.thisispiggy.com/file/wikiFiles/hT6doy2.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/YBsdoAl.jpg)
- low dose: small rise in lvls, drug quick to metabolize
- both inducer and metabolized by P450
- 0 order kinetics
Valproic Acid
![](https://photos.thisispiggy.com/file/wikiFiles/FxJPQsE.jpg)
Levetiracetam
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- very effective
- phenytoin and levetiracetam most common
Others
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- Gabapentin: first thought to affect GABA, but actually affect Ca
![](https://photos.thisispiggy.com/file/wikiFiles/FkoBnUo.jpg)
- Topiramate: also migraine drug, causes foggy mind, more Ca in urine = stones
Drug SE
Teratogenicity
![](https://photos.thisispiggy.com/file/wikiFiles/9kort3l.jpg)
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