Changes

==Seizure==

==Seizure==

*H&P: Aura, can have a guttural cry at onset, symmetrical rhythmic convulsions, eyes remain open and deviate towards contralateral side during focal phase, lateral tongue lacerations, bowel/bladder incontinence, post-ictal state, post-seizure myalgias, can have transient weakness that mimics stroke (Todd paralysis)

*H&P: Aura, can have a guttural cry at onset, symmetrical rhythmic convulsions, eyes remain open and deviate towards contralateral side during focal phase, lateral tongue lacerations, bowel/bladder incontinence, post-ictal state, post-seizure myalgias, can have transient weakness that mimics stroke (Todd paralysis)

*Dx: EEG. Categorize as focal (simple and complex) versus generalized (grand mal, petit mal, myoclonic, atonic). '''Juvenile myoclonic epilepsy has bilateral polyspike and slow wave EEG pattern in interictal period, myoclonus within 1 hr of waking, eventual progression to generalized tonic-clonic'''. Differential includes metabolic (hepatic encephalopathy, hyponatremia, hypomagnesemia, hypercalcemia, hypoglycemia), infectious (meningitis), intoxication (e.g. INH, Bupropion), EtOH withdrawal, neoplastic (brain tumor), vascular (aneurysm, stroke, hemorrhage, dissection). To evaluate for secondary causes, get CBC, BMP, LFTs, EtOH level, urine tox screen, AED levels, consider MRI in an adult with first-time seizure.

*Dx: EEG. Categorize as focal (simple and complex) versus generalized (grand mal, petit mal, myoclonic, atonic). '''Juvenile myoclonic epilepsy (JME) has bilateral polyspike and slow wave EEG pattern in interictal period, myoclonus within 1 hr of waking, eventual progression to generalized tonic-clonic'''. Differential includes metabolic (hepatic encephalopathy, hyponatremia, hypomagnesemia, hypercalcemia, hypoglycemia), infectious (meningitis), intoxication (e.g. INH, Bupropion), EtOH withdrawal, neoplastic (brain tumor), vascular (aneurysm, stroke, hemorrhage, dissection). To evaluate for secondary causes, get CBC, BMP, LFTs, EtOH level, urine tox screen, AED levels, consider MRI in an adult with first-time seizure.

*Tx: [[AEDs]] (no first line agent, decide on a case-by-case basis). For [[status epilepticus]], ABCs, give IV lorazepam, fosphenytoin if seizure persists, consider induced coma if all else fails.

*Tx: [[AEDs]] (no first line agent, decide on a case-by-case basis). For [[status epilepticus]], ABCs, give IV lorazepam, fosphenytoin if seizure persists, consider induced coma if all else fails.

| Lamotrigine || Broad (also mood stabilizer) || SJS

| Lamotrigine || Broad (also mood stabilizer) || SJS

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| Valproate || Broad (also Juvenile Myoclonic Epilepsy) || Teratogenic, weight gain, hair loss, tremor, '''thrombocytopenia''', '''pancreatitis''', liver failure

| Valproate || Broad (also JME) || Teratogenic, weight gain, hair loss, tremor, '''thrombocytopenia''', '''pancreatitis''', liver failure

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| Topiramate || Broad (also migraine ppx) || Cognitive impairment, weight loss, kidney stones

| Topiramate || Broad (also migraine ppx) || Cognitive impairment, weight loss, kidney stones