4- Seizures Flashcards
How is epilepsy defined?
At least 2-3 seizures w/o clear precipitating factors
75% of new seizures occur when?
Childhood
What metabolic states can cause seizures?
Hypoglycemia
Hyponatremia
Hypo/ hypercalcemia
Uremia
Reye’s syndrome
What factors have been shown to trigger seizures or lower seizure threshold?
Stress
Strong emotions
Intense exercise
Loud music
Flashing lights
Fever
Menses
Sleep deprivation
What is defined as repetitive, flexion/ extension movements?
Clonic
What is defined as rigid posturing/ continuous muscle tension?
Tonic
A factor that lowers seizure threshold is defined as what?
Epileptogenic
What is defined as having the appearance of seizure activity (spikes on EEG)?
Epileptiform
Focal onset seizures arise from a focal area in the brain and progress in a manner consistent with the area of irritation. How can you differentiate between a simple vs complex partial seizure?
Simple partial- no alteration in consciousness
Complex partial- impaired consciousness (unable to respond to visual/ verbal commands, reduced awareness of ictal period)
In what type of seizure is a pt able to interact with others during the event and recalls the event but is unable to stop the motor/ sensory sxs?
Focal aware
(aka simple partial)
Pt exhibiting clonic movements starting in the hand/ foot and progressing to the whole limb, in addition to a brief period of temporary paralysis (Todd’s paralysis) following seizure is concerning for a focal aware (aka simple partial) seizure in what area of the brain?
Motor cortex
(aka Jacksonian seizure)
Pt experiencing paresthesias and numbness of the limb/ face is concerning for a focal aware (aka simple partial) seizure in what area of the brain?
Sensory cortex
Pt experiencing deja vu and epigastric discomfort is concerning for a focal aware (aka simple partial) seizure in what area of the brain?
Temporal lobe
Pt experiencing visual changes such as flashing lights is concerning for a focal aware (aka simple partial) seizure in what area of the brain?
Occipital lobe
What type of seizure is defined as a combination of focal motor and focal sensory activity with alteration of consciousness and may begin with an aura?
Focal impaired awareness seziure
(complex partial)
Pt exhibiting bizarre behavior/ emotions, episodic fluctuations in attitude/ attention/ behavior/ memory, and epigastric/ abdominal sensations in concerning for what type of seizure?
Focal impaired awareness seziure
(complex partial)
What is the most common type of seizure in adults with epilepsy?
Focal impaired awareness seziure
(complex partial)
What is typical of the ictal phase of a focal impaired awareness seizure (complex partial)?
Sudden behavioral arrest/ motionless stare
Automatisms- involuntary, automatic behaviors
What is typical of the postictal phase of a focal impaired awareness seziure (complex partial)?
Confusion, amnesia, HA, somnolence
Are simple and complex partial seizures uni or bilateral?
Unilateral
What is defined as a bilateral generalized electrical discharge arising from both cerebral hemispheres simultaneously?
Generalized onset seizure
What type of generalized onset seizure is considered generalized non-motor?
Absence
(generalized tonic-clonic, myoclonic, atonic, tonic ALL generalized motor)
Pt experiences sudden brief LOC w/o loss of postural control (absent to higher cortical functioning) that lasts a few seconds. Consciousness returns promptly and there is no postictal confusion. It appears as if they are “daydreaming”. What are you concerned for?
Generalized non-motor seizure (absence)
EEG shows a generalized spike and wave pattern. What type of seizure is indicated?
Generalized non-motor seizure (absence)
What type of seizure almost always begins in childhood/ early adolescence and may occur hundreds of times per day?
Generalized non-motor seizure (absence)
What is the most common type of generalized seizure AND the most common type of seizure due to metabolic problems?
Generalized motor seizure, tonic- clonic (grand mal)
How does a generalized motor, tonic- clonic seizure (grand mal) typically begin?
Abruptly, w/o warning
What sxs/ findings would you expect to see during the tonic (10-40 sec) phase of a generalized motor, tonic-clonic seizure?
Generalized tonic contractions- body rigid, jaw clenched, moan/ cry, eyes roll back
Increased BP/ HR/ pupil size, cyanosis
What sxs/ findings would you expect to see during the clonic (30 sec -3 min) phase of a generalized motor, tonic-clonic seizure?
Muscle groups relax/ contract, jerky movements
Froth at mouth
Lose B/B control
What sxs/ findings would you expect to see during the postictal (min-hrs) phase of a generalized motor, tonic-clonic seizure?
Confused, sleepy, HA/ body ache, amnesia
What type of seizure exhibits sudden, brief generalized muscular contraction of limbs/ trunk and is most commonly seen in metabolic disorders, degenerative CNS diseases, and anoxic brain injury?
Generalized motor- myoclonic
What are the sudden jerking movements experienced by some normal people as they are falling asleep?
Benign form of myoclonus
What type of seizure is characterized by a sudden loss of postural tone lasting 1-2 seconds, briefly impaired consciousness, and no postictal confusion?
Generalized motor- atonic
(possible brief head drop/ nodding movement)
What type of seizure is characterized by sudden stiffening of the body with loss of balance for a very brief duration and what is it often a/w?
Generalized motor- tonic
A/w significant brain disease, poor prognosis
What is the key diagnostic test for seizures?
EEG
What is included in the lab eval of a pt with seizures? (6)
CBC, UA, CMP, serum Mg, toxicology screen, serology (syphilis)
When should imaging studies be ordered for seizures?
(cranial CT/ MRI, CXR)
All new onset seizures
What special dx test is indicated in certain pts with refractory seizures?
PET or SPECT
What is included in the acute/ immediate tx of a seizure? (4)
Protect pt (head) from injury but do not restrain
Do NOT try to put anything in pts mouth
Roll pt on side as seizure subsides
Time the seizure, call 911 if > 5 min
When should you call 911 if a pt is having a seizure? (8)
Person does NOT have epilepsy
Seizure > 5 min
2nd seizure before recovery from 1st seizure
Regular breathing does not return
Hx of DM
Seizure occurs in water
Pregnant
Person was injured during seizure
What is defined as continuous seizures w/o regaining consciousness?
Status epilepticus- medical emergency
(can be more subtle as they last longer)
Pt with status epilepticus will experience irreversible brain damage after how long?
2 hrs
What is included in the management for status epilepticus? (4)
IV anticonvulsant (phosphenytoin, phenytoin)
Glucose + thiamine
Cardiac monitoring
IV benzos (lorazepam, diazepam)
What is included in the management for status epilepticus if continued seizures?
Phenobarbital IV
Midazolam infusion
(medically induced coma)
What is included in the chronic tx for seizures? (3)
Tx underlying/ avoid precipitating factors
Antiepileptic drug therapy (AED tx)
Neurologist consult
How is AED therpay started?
With a single drug, titrated upwards
What med is considered 1st line for tx of chronic seizures?
Valproic acid
What is considered for tx of refractory seizures?
Surgery
- Temporal lobectomy
- Lesionectomy
- Corpus callostomy
Vagal nerve stimulation (VNS)- for partial seizures
