Seizure Signatures
This seizure is characterized by lasting more than 5 min or multiple seizures without recovery for 5 min.
What is status epilepticus?
This antiepileptic medication can also be used for migraine prophylaxis.
What is valproate (valproic acid) or topiramate (topamax)?
Patient presents with muscle weakness, loss of sensation, and visual field defects. Seizure or imposter?
Imposter - Stroke
This obscures/causes overlapping in the brain waves in a tonic-clonic seizure on EEG.
What is muscle artifact?
The most common brain lobe associated with complex partial seizures.
This seizure may result in unilateral, tonic-like movements limited to one extremity without impaired consciousness.
What is simple partial seizure?
This is when meds are typically discontinued in reference to seizures.
What is after being 2 years seizure free?
A 32-year-old female presents to the emergency department after a witnessed episode of unresponsiveness with full-body shaking that lasted 2 minutes. She has no postictal confusion and recalls the entire event. Her eyes were closed during the episode, and the movements were variable in intensity. Continuous EEG monitoring during similar episodes shows no epileptiform activity. Routine labs and brain MRI are unremarkable.
Seizure - psychogenic non-epileptic seizure?
Absence seizures produce this distinct feature on EEG.
What is bilateral symmetric 3 Hz spike?
This is the most common seizure that occurs between the ages of 6 months and 6 years.
What is febrile seizures?
This seizure characterized by lip smacking and eye twitching is often misdiagnosed as ADHD.
These are the first, second, and third-line treatments for status epilepticus.
What are
First-line: Benzodiazepines (lorazepam, diazepam, midazolam)
Second-line: Fosphenytoin IV. Or phenytoin IV (18-20 mg/kg) 50 mg/min
Third-line: Phenobarbitol
A 3-year-old child with a known history of epilepsy is playing patty cake with a caregiver. During the game, the child suddenly stops moving, has a blank stare, and her body becomes limp, causing her to fall to the floor. After approximately 10 seconds, she regains consciousness, opens her eyes, and appears alert without any confusion.
Seizure - Atonic seizure
Most commonly in the temporal lobe, this type of seizure has activity that remains in one fixed point.
This is the difference between clonic and myoclonic seizures.
Clonic- Rhythmic jerky movements affecting both sides of body (typically last longer vs myoclonic)
Myoclonic- muscle jerks affecting one or multiple muscle groups
This physical exam finding of the eyes will be different between a tonic clonic seizure and a psychogenic nonepileptic seizure.
What is eyes are closed in psychogenic nonepileptic seizure and open in tonic clonic seizures?
Febrile seizures occur after an increase in body temperature. This is what they are often treated with.
Supportive care (antipyretics and parent reassurance).
Sarah, PA student, is working late when she suddenly notices a shimmering, zigzagging light in her vision that doesn’t go away when she looks away. After about 20 minutes, she has uncontrolled eye movements, nausea, vomiting, and diaphoresis.
Imposter - Migraine with aura
This seizure will have an unremarkable EEG.
What is psychogenic non-epileptic seizure?
This is a brief period of temporary paralysis that can occur following a seizure.
What is Todd's paralysis?
These are the vital sign changes in seizures.
What is an increase in HR, BP, and RR, but a decrease in O2?
These medications may be avoided in the treatment of generalized seizures due to the risk of worsening symptoms? (Name at least 2)
Carbamazepine, Gabapentin, Phenytoin, Pregabalin
A patient with known alcohol use disorder presents to the ED with severe confusion, tremors, tachycardia, hypertension, and diaphoresis.
Imposter - Delirium tremens
These are the symptoms most associated with temporal lobe seizures.
What is déjà vu, sudden fear or anxiety, unusual smells or tastes before the seizure, confusion, blank stare, or engaging in automatisms (lip-smacking or hand rubbing)?
This is associated with focal seizures in the motor cortex that involves spread of clonic activity through contiguous body parts on the same side.
What is Jacksonian march?