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Questions and Answers
What does a standard EEG demonstrate in the context of diagnosing epilepsy?
What conclusion can be drawn if a post-ictal EEG result is negative?
What is the first-line treatment for focal onset seizures?
Which of the following EEG tests is specifically mentioned for further evaluation of epilepsy?
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Which drug is listed as a second-line treatment for generalized tonic-clonic seizures?
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What should be the focus regarding drug combinations in the treatment of epilepsy?
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In evaluating the cause of epilepsy, which of the following factors is most relevant?
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Which of the following statements about epilepsy diagnosis is accurate?
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Which of the following is an alternative, non-drug treatment for epilepsy?
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What lifestyle advice should be given to patients with seizures?
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Which of the following should be prioritized first in the management of status epilepticus?
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What type of samples should be sent for analysis during the management of status epilepticus?
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Which of the following is NOT a necessary action in the initial management of status epilepticus?
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When managing a patient with status epilepticus, why is it important to monitor respiratory rate?
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In the management of status epilepticus, which laboratory test is essential for understanding the patient's metabolic state?
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What occupations are typically restricted for individuals with a history of epilepsy?
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Which of the following conditions must be considered during the differential diagnosis of epilepsy?
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Idiopathic generalized epilepsy is characterized by what presumed basis?
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Which condition described is specifically associated with seeing blood or similar stimuli?
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What is a distinguishing factor between pseudoseizures and typical epilepsy seizures?
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What is the recommended action if seizures continue for more than 5 minutes?
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Which of the following medications is administered first for ongoing seizures after 30 minutes if seizures persist?
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What should be monitored continuously during the IV infusion for ongoing seizures?
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What is the next step if seizures still continue after 30-60 minutes?
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What is the initial dosage of sodium valproate when commencing longer-term anticonvulsant medication?
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Study Notes
Management of Status Epilepticus
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Initial Management:
- Secure airway and provide oxygen to prevent cerebral hypoxia.
- Assess vital signs including pulse, blood pressure, and respiratory rate.
- Establish intravenous access for medication administration.
- Perform blood tests to evaluate glucose, electrolytes, calcium, magnesium, liver function, anti-epileptic drug levels, and complete blood count.
- Consider alternative treatments like epilepsy surgery or vagal nerve stimulation.
- Use minimal number of drugs in combinations.
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First-Line Anti-Epileptic Medications (AEDs):
- Focal Onset Seizures: Lamotrigine, Levetiracetam, Carbamazepine, Oxcarbazepine, Sodium Valproate.
- Secondary Generalized Tonic-Clonic Seizures: All of the above, plus Gabapentin, Phenobarbital.
- Generalized Tonic-Clonic Seizures: Sodium Valproate, Lamotrigine, Topiramate, Carbamazepine, Phenytoin, Levetiracetam.
- Absence Seizures: Ethosuximide, Sodium Valproate, Lamotrigine, Clonazepam (resolves with age by 12 years).
- Myoclonic Seizures: Sodium Valproate, Levetiracetam, Lamotrigine, Clonazepam, Phenobarbital.
Lifestyle Advice
- Avoid Activities with Risk of Injury: Patients should avoid activities where they might place themselves or others at risk during a seizure.
- Driving Restrictions: Driving regulations vary globally, and patients should be aware of their country's specific laws.
- Occupational Restrictions: Certain occupations, like firefighter or airline pilot, are typically prohibited for individuals with epilepsy.
Differential Diagnosis of Epilepsy
- Syncope: Consider syncope as a differential diagnosis, especially if triggered by seeing blood or experiencing an emotional event.
- Hypoglycemia: Blood glucose levels should be checked as a mandatory part of the assessment.
- Transient Ischemic Attack (TIA): May present with seizure-like symptoms.
- Pseudoseizures: Consider the possibility of psychogenic nonepileptic seizures (PNES).
Idiopathic Generalized Epilepsy
- Genetic Basis: This term indicates a presumed genetic origin for the epilepsy.
Initiating Treatment
- Treat Metabolic Triggers: Address any underlying metabolic causes such as hypoglycemia.
- Diazepam Administration: If seizures persist beyond 5 minutes, administer diazepam 10mg intravenously (IV) or rectally. Repeat only once after 15 minutes if necessary.
Ongoing Management
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Continued IV Infusion: If seizures continue after 30 minutes of IV infusion with cardiac monitoring, consider one of the following:
- Phenytoin 15mg/kg at 50mg/min.
- Fosphenytoin 15mg/kg at 100mg/min.
- Phenobarbital 10mg/kg at 100mg/min.
- Close Monitoring: Maintain close monitoring of cardiac function, pulse oximetry, neurological status, blood pressure, and respiration.
- Intensive Care Transfer: If seizures persist after 30–60 minutes, transfer the patient to intensive care.
- Refractory Status Epilepticus Treatment: Initiate treatment for refractory status epilepticus with intubation, ventilation, and general anesthesia using propofol or thiopental. Continuous EEG monitoring should be used.
Controlling Status Epilepticus
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Longer-Term Anticonvulsant Medication: Once status epilepticus is controlled, commence longer-term AEDs using one of the following:
- Sodium valproate 10mg/kg IV over 3–5 minutes, followed by 800–2000 mg/day orally.
- Carbamazepine 400mg nasogastric tube, followed by 400–1200mg/day orally.
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Description
This quiz covers the essential management strategies for status epilepticus, including initial treatment protocols and first-line anti-epileptic medications. It details the necessary assessments and considerations for effective intervention. Test your knowledge on the drugs used and their categorizations.
