Master the board step 3

Neurology
Seizures
Only the management of status epilepticus is clear in seizure disorders. Status
epilepticus therapy is as follows:
1. Benzodiazepines, such as Ativan (lorazepam).
2. If the seizure persists after moving the clock forward 10–20 minutes, then
add fosphenytoin.
3. If the seizure persists after moving the clock forward another 10–20 minutes,
then add phenobarbital.
4. If the seizure persists after moving the clock forward 10–20 minutes again,
then add general anesthesia, such as pentobarbital, thiopental, midazolam,
or propofol.
Diagnostic Testing
Do the following tests on a patient having a seizure:
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Sodium, calcium, glucose, oxygen, creatinine, and magnesium levels
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Head CT urgently; MRI later if the initial testing shows nothing
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Urine toxicology screening
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Liver and renal function
Further Management
If the initial set of diagnostic tests does not reveal the etiology of the seizure,
then an electroencephalogram (EEG) should be performed. The EEG should
not be done first.
Potassium disorders do not
result in seizures.
Both liver failure and renal
failure cause seizures.
Neurology consultation should be ordered in any patient with a seizure after
initial testing is done. Consultations will always ask for your reason for the
consultation in 10 words or less.
CCS Tip: On CCS, consultants never say anything. CCS is testing your knowledge
of when you are expected to need help.
Treatment
Chronic antiepileptic drug therapy is generally not indicated after a single
seizure. There are several exceptions, however. Treat chronically after the first
seizure in the following circumstances:
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Strong family history of seizures
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Abnormal EEG
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Status epilepticus that required benzodiazepines to stop the seizure
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Non-correctable precipitating cause, e.g., brain tumor
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