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Seizures - seizures Joseph Breuner MD Goals How to work up...

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seizures Joseph Breuner, MD 6/24/03
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Goals How to work up first seizure in an adult how to order an eeg which drugs for which seizures status
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How to work up first seizure in an adult Objectives 1. Was it a seizure? What kind? 2. Does the patient have epilepsy
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How to work up first seizure in an adult Is it a seizure? A seizure is a sudden change in  behavior that is the consequence of  brain dysfunction. Learn the following 3 typical and most  common seizures
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Auras =simple partial seizures Affect enough of the brain to cause symptoms does not impair consciousness--simple does not affect the whole brain--partial
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Auras =simple partial seizures Can precede complex partial seizure can evolve to secondarily generalized seizure implies epilepsy as opposed to physiologic nonepileptic seizures--more on this later
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Auras =simple partial seizures Long list(50) of typical symptoms, symptom depends on which part of the cortex is disrupted most common: jerking of an extremity, epigastric discomfort, fear, or an unpleasant smell I like: foot stomping, spacing out, psychic experience, deja and jamais vu
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Complex partial seizure Most common type in epileptic adults appear to be awake consciousness is impaired
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Complex partial seizures stare into space/engage in automatisms, such as grimacing, gesturing, chewing, lip smacking last 3 minutes or less post-ictal: somnolence, confusion, headache for up to several hours
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Generalized tonic-clonic seizure No aura tonic phase x 10-20 seconds: sudden LOC, loss of posture, arms flex, eyes deviate upward extension of back, neck, arms, legs involuntary crying out ends with tremors which merge c clonic phase
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Generalized tonic-clonic seizure Clonic phase x 90 seconds: brief, violent, generalized flexor contractions alternating with progressively longer muscle relaxation cyanosis cheek or tongue biting, salivation loss of bowel, bladder control
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Generalized tonic-clonic seizure Post ictal phase x minutes to hours headache mild confusion sore muscles may sleep and feel refreshed
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How to work up first seizure in an adult Is it a seizure?
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