All right, so moving along with the neurosection, we're going to talk about seizures today. Decent amount of material for you to know. I do have some mnemonics in there to help you remember the important stuff. So thank you as always for the support, the really nice comments. I do appreciate every single comment and everything. I just really appreciate the support, So thank you so much for that. Let's talk about seizures. So first let's go over
the definition. The official definition would be a sudden change in behavior caused by electrical hypersynchronization of neuronal networks in the cerebral cortex. So that's a lot of different words. Let's actually talk about what that means. So neurons are synchronously active, so all the neurons they're firing together. They're not supposed to be.
Whether this is caused by too much excitation, caused by problems with the NMDA receptors, too little inhibition with defective GABA receptors, the effect is the same. You have neurons firing inappropriately NonStop, which causes a number of clinical manifestations. Will go over. Now, there's some causes of seizures that you should be aware of. I don't expect you to re memorize all of these.
But there is anemonic that I've come across that's not my own, but it's called vitamins, and it stands for some of the more common causes of your provoked seizure. So vitamin stands for v vascular, so vascular malformation, stroke, I stands for infections, meningitis, and cephalalitis. T stands for trauma, so like a traumatic brain injury, a autoimmune think lupus. M stands for metabolic, so I think low blood sugar. Most low electrolytes can
cause seizures, so hypocalcemia hyponatremium. I stands for ingestion, so whether it's ingestion of toxins like drugs which lead to the seizure, or withdrawal from ingestion of certain toxins like alcohol withdrawal which can lead to seizures. ND stands for neoplasms like brain tumor. And then the S stands for the second letter in psych so psychogenic. So non epileptic seizures think conversion disorder. Now let's talk
about the different types of seizures. The first thing that I wanted to go over is the definition of epilepsy because we're going to be thrown around that word a lot. So to make the diagnosis of epilepsy, there's some criteria to meat and most cases, though epilepsy just means you've had recurrent seizures, but the official diagnostic criteria is either two or more unprovoked seizures occurring more than twenty
four hours apart. Unprovoked means it wasn't caused by one of the vitamins we just went over, so it wasn't a low blood sugar or an infection that caused it, etc. Another criteria would be one unprovoked seizure and a high risk of recurrence. So a patient that only had one seizure but has a high risk of second seizure can be diagnosed with epilepsy and high risk meaning they had a stroke, traumatic brain injury, brain tumor things that are going to
put them on a high risk for a second one. And then the third one is kind of nonspecific identifiable epilepsy syndrome, So this is either genetic or idiopathic epilepsy. So that's epilepsy. Now let's talk about different specific types of seizures. So most seizures can be categorized by either focal or generalized depending on
where they affect. So when just one hemisphere of the brain is affected, just half the brain, or even just one low this is called a focal seizure, and then in generalize seizures both sides of the brain are affected simultaneously. Focal seizures can be categorized further depending on whether or not consciousness is altered during the event, so you have focal seizures with retained awareness. These used
to be called simple partial seizures. He may still hear them, being called that the presentation will be unique in each patient with this type because it really all depends on the part of the cortex that's affected at the onset of the seizure. So if it affects the occipital cortex, it may result in flashing lights. The frontal lobe can cause sudden speech difficulties. There may be changes
in hearing and taste. It's possible to have involuntary movements or jerking movements the key though, as the name suggests, generally they will retain awareness or their consciousness during the episode, so they should have retained awareness during this type of focal seizure. The other type of focal seizure is impaired awareness, used to be called complex partial. So during a typical focal seizure with impaired awareness, the patients may appear to be awake, but they're not going to respond to
normal and struggles or questions. They may stare into space, they may remain motionless, engage in repetitive behaviors. These are called automatisms. They can include facial grimacing, lip smacking, etc. So their behavior is altered in some way. And then afterwards, most of the time these patients are going to enter what's called the post Ichtl phase and during this time they may have confusion headache for up to several hours. All right, so let's talk about generalized
seizures now. So if generalized seizures, again, both hemispheres of the brain are going to be affected and in most cases these types of seizures will involve some degree of altered consciousness. Not always but most cases. So there's different types of generalized seizures. The most common, though by far the most common, type of generalized seizure is going to be one called a tonic clonic, also known as a grand mall seizure. So most common generalize seizure. It's
basically what everyone thinks of when they think of the classic seizure presentation. So let's go over what that involves. So, tonic clonic grandmall seizures, what does this mean? So first let's understand what the terms tonic and chlonic mean. Tonic means rigidity or a sudden muscle stiffening. The muscles get stiff. Sometimes they can stay contracted or stiff up to a minute or two during this tonic phase. And then the second part of this is the klonic phase,
which means rhythmic jerking muscle contractions. It's usually going to be of the arms, neck, and face. So a tonic chronic seizure, you put those together, usually begins with an abrupt loss of consciousness. This is followed by the tonic phase where all the muscles become stiff. Then after a minute or so, the muscles begin to jerk twitch for an additional one to two minutes, and that's your klonic phase. And this is normally followed by a post
Ichtl phase. All right, so a tonic chronic that's the big one you need to focus on. Let's talk about some other types of generalize seizures that may come up. So myoclonic. Myoclonic is normally going to involve either a single muscle, sometimes a group of muscles, and it's just a brief contraction, like a just a quick jerking motion, a really quick contraction of a
muscle, then it stops. Most commonly it's going to involve the arms, and consciousness is usually not impaired in this type klonic just like we went over in time klonic seizures. Chlonic portion causes rhythmic jerking and muscle contractions that usually involve the arms, neck, and face. Tonic, just like we just went over, usually a sudden muscle stiffening, so the muscles get stiff,
often associated with a loss of consciousness. The way that I used to remember what tonic meant, because there's so many different names, sometimes you can get confused. So as soon as I see tonic seizure, I think of a gin and tonic, and the gin in tonic is a stiff drink. So as soon as you see tonic, think of a gin and tonic, which you know as a stiff drink, and then it helps you remember tonic seizures cause muscle stiffening. And then the next type is called an atonic seizure.
So if you can remember what a tonic seizure is, you can remember what an atonic seizure is because it's the exact opposite. So atonic means the muscles basically turned to jello, so the opposite of stiffening like in tonic. So these individuals with atonic seizures will have a sudden loss of control of the muscles. Commonly, this is going to involve the legs and it's going to cause these patients just to collapse. They'll be conscious in most cases, they'll just
lose control of their muscles and just drop to the ground. And that's why you sometimes hear these being called drop seizures because their legs turn to jello and they just drop to the ground. So if you can remember what tonic is, you can remember what a tonic is, and you can knock out two right there. And then the last one is something known as absence seizures or absent seizures. I think the correct way is absons, though these used to
be called petite mall seizures. Usually you're going to see these in children. And what happens in these children is they'll be in class, they'll be at home, they're doing fine, no issues, and then all of a sudden, they'll just be staring. They'll have the state of impaired consciousness. They won't respond to any verbal or tactile stimuli. During these episodes. They may also have eyeblinking and lip smacking. This can occur hundreds of times per day,
and typically each episode will last between five to ten seconds. A lot of times it's misdiagnosed as ADHD. So again absence seizure, no loss in muscle tone, but impaired consciousness for just brief periods. No Abson seizures. Very well, You're going to be tested on this because it has a unique presentation and has a specific first line med which will go over and like all unique things with specific first line meds, you're always going to get tested on
them. So make sure you know abs on seizures. I have a little mneumonic for you to remember the treatment too when we go over that. And then the last type of seizure or not so much a specific type of seizure, more just a seizure that lasts two damn long is status epilepticus. So the official diagnosis or the official definition of status epilepticus is an unremitting generalized convulsive seizure lasting longer than five minutes, or multiple bilateral convulsive seizures without a return
to baseline level of consciousness. So either this patient has a single seizure the lasts over five minutes, or they have more than one seizure without recovery between each episode. Some medical neurological emergency neurons are firing NonStop, they're essentially frying their brain. Have to board the seizure quickly, and these patients are going to need prompt treatment, and we'll go over the treatment protocol in a minute. This is another one that you really need to know now diagnosis. So
with diagnosis, you're obviously going to start with a very thorough history. It a lot of times this will be obtained from a friend or family member that witnessed the seizure. You'll need to find out was there any trauma, is there any drug or alcohol use. Most patients with epilepsy, though, are going to have a fairly unremarkable clinical history, and then of course you want to have a very thoroughphysical exam, including a neuroexam, and then let's talk
about your initial lab work. So your initial laboratory tests. You're definitely gonna get a rapid blood glucose. You want to make sure this isn't hypoglycemia. You're going to get a CBC. CBC you're looking for signs of infection. You want to get a CMP, and the CMP you're checking electrolytes. You want to make sure this wasn't from hypocalcemia hyponatremia. You're also checking your renal function with this your LFTs, and then you want to do your analysis in
a toxicology screen. So a lot of different things basically to search for those vitamins we went over earlier. You're looking for a potentially reversible cause, so be aware of those different lab tests. I wouldn't say to memorize all of them, just have a general overview. One lab though, that I do
want to go into a little bit more detail about is serum lactate. So cerum lactate is a good lab to obtain in a patient who had an unwitness transient loss of con bousness, so no one to say that, yeah, they were seasoned convulsive flowling their arms, et cetera, that you suspect may have had a seizure because a serum lactate, if it's elevated in the first two hours after the event, this essentially confirms that it was a generalized seizure
rather than some other cause, just like a regular syncople episode or a psychogenic non epileptic seizure. So another one that you may have you may hear of is serum prolactin. It's another lab that you can use, but it's not as sensitive or specific as a serum lactate and it's usually not recommended as part of the routine eval. But cerum lactate is definitely an important one that you
should know. Neural imaging, so whether this is an MRI or CT in a patient with their first seizure, you have to get some imaging of the brain. You want to make sure there isn't any brain abnormalities intracranial neoplasma, et cetera. MRI is going to be preferred, it's the better test, but CT is another alternative. And then let's talk about our egs. So once you've ruled out your vitamins, this isn't from you know, vascular stroke,
confection, meningitis and cephalitis, et cetera. You want to obtain an EEG and electron cephalography. It's not one hundred percent sensitive, but if it is abnormal, it can help support the diagnosis of an epileptic seizure, and it can also help distinguish between generalized or focal seizures. General there's not a lot to know about the specific findings for an EG except from one thing. If you see an avignette they mention a three hurts, spike and wave pattern
right away, be thinking absent seizure. I wouldn't worry so much about why. Just know if you see three hurts, spike and wave pattern a vignette, the answer is absent seizure. As you're done, so remember that. So if your diagnostic studies again, remember three things. Neuroimaging MRI I preferred over CT, your labs, checking electrolytes, blood, glucose, etc. And then an EEG. That's the three main things to focus on for diagnosis.
Let's talk about treatment now. So with anti elleptic medications, there's really no first line meds quoted from up to date, no single anti seizure medication is clearly the most effective or best tolerated. So in general they're not going to list four or five different seizure meds and say which one would you pick. There is some exceptions. I'm going to go over those, So this isn't one hundred percent like an absence will go over. There is a first
line MEN obviously, and there's some other specific circumstances I'll go over. But in general, there's really been a lot of studies and they don't really find one seizure men to be better than another. Again, there are some exceptions. The most important thing though about anti seizure medication is knowing specific adverse drug
reactions, so they could ask you something related to that. It's not so much again about which med's going to work best to prevent the patient seizure, but which med will be safest considering the patient's comorbidities and things like that. Now, most patients with their first seizure, they're not going to require anti elliptic medication. These patients that you're going to start on anti elliptic medications are
specific specific patients. So for instance, patient with two or more seizures, because then by definition, these patients have epilepsy and each treatment or a patient that you would start anti seizure medications with only one seizure their first seizure are patients that have a high risk for a second. So again like we went over before, they have a high risk finding like maybe a brain tumor, they had a stroke, head trauma, abnormal neuroexam with focal findings, and
abnormal EEG. These are all high risk findings and if these patients it'd be acceptable to start them on meds with just one seizure. Another situation where you'd start a patient on anti seizure medications with just one seizure would be if they wound up going into status epilepticus, because these patients are at very high risk for a number of problems. So those are the patients you'll start most patients, so with their first seizure, you're not going to start on anti seizure
medications. Just be aware of some of those circumstances where you would. So let's first talk about two types of seizures where there is a specific first line therapy, So there's a couple different meds that you need to know for these and these different types of seizures are really the ones that you need to focus on for your exam because these are likely where a lot of your questions will come from when we're talking about medications. So the first one we need to
go over. It is probably the most important type of seizure for you to know. Questions always seem to be asking about this, and that's absent seizures. So for absent seizures, you have a first line medication you absolutely have to know, and that's Etho sucks a mine. That's your first line med Etho sucks, Etho sucks and mine, however you want to pronounce it. That is your first line medication for absent seizures. Second line med would be
valpro eight. I normally don't recommend memorizing a second line med just because you have so many medications memorize anyways. But the thing is that I was asked in school, so I feel like you should probably know it because maybe it'll come up for you too, And I do have a way for you to remember both. So an absence seizures, your first line again, it's going to be Etho sucksomides. Second line is going to be valpro eight. The
way that you remember that hopefully you've heard this expression. But there's an expression that's known vanishing into the ether. And it's like when you're just gone, you're absent, somebody like disappear. They vanished into the ether. So the way that I remember absent seizures medication regimen is I remember if you're absent, like absent seizure. If you're absent into the ether, you will vanish. If you're absent, like in an absent seizure, into the ether, you
will vanish. And that sentence is in order because ether comes first and ether is the first three letters in Etho sucks amine. So ether you will vanish and then vanish. The second word is your second line med and that's valpro eight, So that's va and vanish. That's your first couple of letters of valpro eight. So if you're absent into the ether, you will vanish. And that's how you remember your first and your second line meds for absent seizures.
Remember again Atho suximide, first line, Valpro eight, second line. If you're absent into the ether, you will vanish. Then the second thing that you really need to know a specific medication regiment is for status epilepticus. Remember status epilepticus, a seizure, then I went on for two dam long. So the first thing, first med first line medication for status epilepticus is going to be your benzo diazepines. So if you don't remember anything else for
status, remember benzos. They're your main treatment and they're the best treatment because of the rapid on set. The three most commonly used is going to be diazepam, lorazepam, and medazzo lamb. Lurazepam is usually preferred for the IV route. So with benzos, you're going to give them their first dose when
they're in status epilepticus and then reassess in about five to ten minutes. If they're still seizing at this point, you hit them with another round of benzos, and then if they're still seizing at this point, in addition to getting a neuroconsolate in EG, you're going to ramp up the meads and then next in line. There are some options, but second line will generally be with a fenny toone, so phos fenny tone, fenny tone. That's your second
line for status epilepticus. Again, there are some other options. Valpro eight levitoractam, which is capra but generally for exams. For exam purposes, I would remember the fenny tones as your second line and then third line. If they're still seizing at this point, after you've given their fenny tones, they need to be intubated. They're going to be on mechanical ventilation. And as far as treatment, you do have some options, but pental barbital is the
one you'll usually see tested on for your third line. It's really like your last option. Their brain is cooking, you need something. That's when you use pental barbital. Some guidelines will suggest propofol continuous infusion with Medazzo lamp. At this point you're basically putting them into a drug induced coma as save them. But again for the boards, I would tell you to focus on your third or your last line treatment as pental barbital. That's normally what was tested
on, That's what I was tested on. And just an fyi, you may have heard of phenobarbital being used for status, but pental barbital has replaced it due to being more efficacious. It has better brain penetration and a shorter half life. So let's go over that. So for status epilepticus, you need to remember three lines of medications. You need to remember your benzos as your first and that's what I would really focus on. If you don't remember,
If you don't want to remember all three, remember benzos. That's likely what you'll be tested on because your first line, there's not a lot of options. It's really just benzos. Like that's what everybody gets with status. So if you want to remember one thing, remember benzos. But if you want to remember all three, I do have your way for you to remember that. So did you want to think of when you're thinking of status epilepticus is as soon as you see status epilepticus, you want to think of a
guy named Ben who update his tetanus status. So think of this sentence when you see status epilepticus, think of this. He had to update his tetanus status when Ben caught his toe in some barbed wire, so status epilepticus. He had to update his tetanus status when Ben caught his toe in some barbed wire. So what that stands for as he had to update his tetanus status, that helps you remember status epilepticus. When Ben Ben stands for benzodiazepines.
Remember that's the first word in this sentence or the first part of this sentence, and that's your first line treatment. Caught his toe in t o i n because that's the part of the word fenny toin or foss fenny toen. So caught his toein. That helps you remember your second line fenny toen some barbed wire. That helps you remember pentobarbital. So again remember status epilepticus, first, second and third line meds. He had updated his tetanus status status
epilepticus when ben first line benzodiazepines caught his toe in. Second line fennyten some barbed wire line is going to be your pental barbital and that's your treatment regimen for status epilepticus. Now with the rest of the meds, again, you're likely not going to be asked to pick the best men because there's really not one. With some exceptions I'll go over it's basically really just considering the contraindications for the meds, the cost its, ceterup. This is really individualized and
really it's going to be up to a neurologist to decide this. But let's go over some of the more common meds go over a few pneumonics and things you should know for each. So I'm going to focus on the medications that I always tested on, the ones that always seem to come up. So the first one you need to know carbon maazopine. Carbon mazopine is a good med for both focal and generalized seizures, can be it can cause Stevens Johnson
syndrome. Like almost all anti eleptic meds. I have a way for you to remember all those at the end, But the indications that you need to know for carbon maazepine, the first line that it's for is trigeminal neuralgia. It's a first line med for trigeminal neuralgis. Remember that about carbon maazepine. I said generally not first line meds for seizures, but that's not a seizure, it's trigeminal neuralgia. So if you know car amazopine is first line for
trigeminal neuralgia, that's an important thing to remember. Second thing I would know for carbon mazopine is it's MOA and it blocks sodium channels. And then the third thing I would be aware of for carbon mazopine is one of the higher yield ADRs, and that's that it increases your LFTs. It's hepadotoxic. So again the three things for carbon maazepine. Remember it's first line medication for trigeminal neuralgia. Second thing to know it blocks sodium channels. And third is that
it increases your LFT's your liver function test. It's apadotoxic. So the way that you remember those three things is as soon as you see carb amazepine carbamazepine, think of some salty carbs. So salty carbs like fries, and I want you to remember the sentence lift up some salty carbs and chew on them until your cheeks hurt. So as soon as you see carbamazepine, think of salty carbs, think of the sentence, lift up some salty carbs and chew
on them till your cheeks hurt. So what that stands for lift up is LFT up because remember your LFTs go up, So lift up LFT up helps you remember it's apatotoxic. LFTs go up some salty carbs salty because that helps you remember it block sodium channel. Carbs is carbon maazopine and chewing them until your cheeks hurt. Your cheeks are hurting because remember this patient has trigeminal arauga and carbon mazopine is first line for trigeminal neralga. I remember you have that
pain in the face from the nerves being affected. So again, carbon mazopine. Think of salty carbs. Lift up some salty carbs and chewing them till your cheeks hurt. Lift up your LFTs. Go up salty carbs because it blocks sodium channels and chewing them till your cheeks hurt. First line med for trigeminal nerauja. That's how you remember what you need to know for carbon maazopine. Moving on to valproic acid also known as valproe. So, this is
a broad spectrum anti elliptic medication, very commonly used. It is a very good med It's really effective for both focal and generalized seizures. I know, I said, there's not really any first line seizure meds outside of the exceptions we talked about, but in some literature you will see this being used as first line for juvenile myoclonic epilepsy. Also, as we went over before, valproic acid can be used as a second line for apps on seizures. All
just really FYI. The stuff generally is not going to be tested on. It's more again for neuro to decide the are the things that you need to know for valprooc acid are really about the adverse drug reactions. This is the important stuff. There's a few key things that you need to know about it. So what you're going to be tested on, these are the ones that
I would focus on. First, valpro gacid is toteratogenic. Now, most anti elliptic anti elliptic medications are territogenic to an extent, but valproic acid by far is the worst and associated with the highest rate of triritogenicity of all marketed anti seizure medications. And for that reason, that's the one that they're going to test you on. They're going to give you a pregnant patient, ask which mad you should avoid in this patient. It's going to be valpro it
So remember turritogenic, the worst of all the other anti seizure medications. You need to know that second thing. Pancreatitis In real life, it's not that common, but for some reason it's always seems to get tested on, So remember a Q Pancreatitis is a possible complication of proetherapy. The third thing you need to know a patotoxic so acute padle cellular injury can occur in valproa.
This is usually within the first six months of starting this medication. Some cases can actually be associated with fulminate liver failure in death, so definitely know that too. So three things you need to remember for valproic acid. Three things that are generally tested on. That's pancreatitis, patotoxicity, and toteratogenic. How you remember that is valproic acid valproic acid VPA. The V stands for vertical
transmission. This helps remember the toteratogenic effects of the med. I know vertical transmission generally first to a pathogen going from the mother to the baby, but in this case it's going to help you remember the med taken by the mother affects the baby. So again not exactly what a vertical transmission means, but whatever gets your mind to helping you remember the toteratogenicity will help you. So V vertical transmission helps you remember this is the worst med for pregnant patients.
Second thing VPA, the p stands for pancreatitis, and then the A stands for acute padle cellular injury. So again, valproic acid VP a vertical transmission aka tatogenic p pancreatitis a acute hepato cellular injury. Moving on to fenny toin. So ifenny toe's been around since the nineteen thirties, we're still using it today. It's a good men for focal and generalized seizures. It's good for
statocepilepticus as we know, it's second line after benzos. There's a laundry list of adverse drug reactions from fenny toin, but the important ones, the main systemic side effects that you need to remember are one hersotism, which you remember. Herstotism is an excessive hair growth in women. Two gingerable hypertrophe which is an abnormal overgrowth of gingerable tissues. And three folic acid depletion. It inhibits
folic acid absorption. The other thing too, which again i'll go over at the end a way for you to remember this, but it can also cause Stephen Johnson's syndrome. So fenny toin what I want you to think of when you think of fenny toin is a toe in your mouth. So fenny toen, think of a toe in your mouth, and I want you to think of this sentence. If you put a hairy toe in your mouth and lick it, you'll get gingervitis. If you put hairy toe in your mouth and
lick it, you'll get gingivitis. That helps you remember the three things that you need to know. So if you put a Harry, Harry helps you remember hersutism toein obviously that's from fenny toen and lick it, lic lick it. That helps you remember full lick acid depletion. So Harry hersutism toein fenny toin, lick it full lick acid depletion. And then and then you'll get gingervitis. That helps you remember of the gingerbal hypertrophe. So again you've put
a hairy toe in your mouth and lick it, you'll get gingervitis. Hairry hersutism toin, fenny toin, lick it full like acid depletion and gingervitis. That would be gingerbal hypertrophe. And that's fenny toine. Okay, So a few other ones that I just wanted to mention. You know, fosuximide we already went over. Just know it does block calcium channels, that's its MOA. And then of course you know that it's the first line for absince seizures.
Really that's the only use for this drug. Actually, it's a really narrow spectrum medication. So remember first line for absince seizures. I keep repeating that because you're gonna get a question and it, I promise you. And then of course you remember that because you know when you're absent into the ether you will vanish. And then also causes Stephen Johnson syndrome surprise, surprise,
pentobarbital. The main thing that you need to know for this, really the only thing that you need to know this for this, Like we went over before, it's last line treatment for status eplepticus after Fanny toe Leavitt Taractam, which is keepra. It's another broad spectrum anti eleptic medication, commonly used because its side effect profile is pretty favorable compared to some of the other options, doesn't have as many adverse drug reactions compared to some of the other mets we
went over. There's some other anti elliptic medications. Lamotrigene, TOPIRAMATEE. There's just not a lot of high old in photo no for those. And I didn't cover every anti elliptic medication. There's over twenty five of them, so that would be crazy to cover all of them. But again I did focus on the high old ones, the ones that have unique ADRs, the ones that are often tested on. So know those ones that I went over,
remember those nemonics. One last little tip, not so crucial enough for seizures in general, but good overall knowledge for the pants for some thing that does come up from time to time. So, most anti elliptic meds can cause Stephen Johnson syndrome. As we went over Steven Johnson syndrome. If you're not familiar with it, it's a severe mucocutaneous reaction. It's commonly triggered by medications. It can cause necrosis, detachment of the epidermist. It's pretty serious,
so you need to know the meds that can cause it. Again, most anti elliptic mads can cause this, but there's some non anti elliptic meds that can cause it too. It's fairly important to know of these meds. Again, you're likely going to get a question on this at some point. So the way that you remember them, that you'll remember the heavy hitters, the main meds it will cause this are by remembering that Stephen Johnson syndrome. I
want you to think of Steve Jobs created Apple PCs. So Stephen Johnson, the first few letters of that is also the first few letters of Steve Jobs. So as soon as you see Stephen Johnson syndrome, ods you to think of Steve Jobs and what did Steve Jobs do? He created Apple PCs. So Stephen Johnson syndrome, think Steve Jobs created Apple PC's and Apple PC stands
for all of the main meds that cause Steven Johnson syndrome. So A allopurinol P fenny tooin P, phenobarbital, al lamotrigene, e ethosuximide, P, penicillans, C, carbon, mazopines, and s sulfonamides. So again, Steve Jobs created Apple PC's alipuranol fenny tooin phenobarbital, lamotrigene, ethosuximide, penicillans, carbon, mazopine, and sulfonamides. That's how you remember you're Stephen Johnson synder medications. Let's do five quick high old questions and then we will wrap
this up. Question one, a nine year old male presents to the office accompanied by his mother. His mother states that he the boy has had frequent episodes where he will zone out and stare off into space for a few seconds, multiple times per day. The mother states the boys unresponsive to her voice or tactile stimulation during the episodes. The patient has an EEG performed during one of the episodes in the office which displays a generalized three hurts, spike and
wave appearance. What is the first line medication for the likely diagnosed in this patient? So we know that is going to be ethosuximide. So this patient has classic findings of an APPS on seizure, so sudden impairment of consciousness lasting seconds, occurring multiple times per day. In addition, we have the classic findings on the eg that three hurt spike and wave pattern. We know first line med for APPS on seizures is ethosuximide because you remember, if you're absent
into the ether, you will vanish. Question two. Sixty four year old homeless man is brought into the emergency room by fire rescue. The paramedic state he has been actively seizing for the entire ride over, which has been over fifteen minutes. On physical exam, you note a rhythmic jerking of the bilateral extremities. What is the first line medication class that should be initiated in this
patient? So that is going to be benzodiazepines. So this is status epilepticus, which is defined as either a single seizure that lasts over five minutes or if they have more than one seizure without recovery between each episode. This patient meets that criteria because we see he's been actively seizing over fifteen minutes. So we know the first line med for status epilepticus is benzos, So that's going to be diazepe and lorazepam, medazolam if that doesn't work. Next line we
know our if any tones, and then finally pental barbital. Remember he had to update his tetanus status when ben caught his toin some barbed wire. Question three, which type of generalized seizure is described by sudden muscle stiffening often associated with impaired consciousness. So sudden muscle stiffening, remember that is a tonic seizure. Remember a gin and tonic is a stiff drink that helps you remember a tonic seizure is a seizure evolving stiffness and rigidity of muscles. Question four,
which anti elliptic medication works by blocking sodium channels? And his first line for trigeminal neuralgia. So again, remember that is carbamazepine. Because remember carbamazepine, lift up some salty carbs and chewing them till your cheeks hurt. Remember cheeks hurt, that's trigeminal neuralgia. This is your first line treatment for trigeminal neuralgia.
Question five, what is the most common type of generalized seizure? So the most common type of generalize seizure is going to be your toniclonic, your grandmall seizure. So tonic clonic again, starts with your tonic phase. All the muscles become stiff after a minute to the chronic phase begins where the muscles begin to jerk and twitch for an additional one to two minutes. All right, that is seizures. Thank you so much for listening, and thank you
again so much for the support and good luck in PA school. Good luck and your pants your panory. You're rs.