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Neuro Behavioral Med I > 5 - Seizures > Flashcards

5 - Seizures Flashcards

1
Q

What are seizures?

A
  • Vague term used to describe a variety of sudden, catastrophic events
  • Synonyms: fits, Spells, Attacks
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2
Q

What are epileptic seizures?

A
  • Typically result from abnormal electrical discharges in the cerebral cortex
  • Caused from abnormalities in the Na/K/Ca channels in the brain (“channelopathies”)
  • Generated by cortical neurons
  • May be idiopathic or symptomatic
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3
Q

What are myoclonic seizures?

A

Myoclonic seizures are epileptic seizures that may have a sub-cortical focus

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4
Q

What is an EEG?

A

A way to measure electrical activity in the brain

Put receptors on the skull to read the electrical activity

A generalized seizure will look like big huge jumps (kind of looks like a fib)

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5
Q

What is epilepsy?

A
  • Recurrent seizures (if you’ve only had one, you don’t have epilepsy)
  • Means “to take hold of” in Greek
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6
Q

Describe the occurrence of epilepsy

A
  • Common - affects 1-2% of the general population
  • More common in females than males
  • Overall incidence of seizures is higher (5% - any type of seizure)
  • Increased incidence with developmentally delayed patients, psychosis patients, and people in the prison population
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7
Q

Describe the general functioning of epileptics

A
  • 80% epilepsy patients function normally
  • Only 60% of epileptic patients are free of seizures on medical therapy
  • At least half of all patients report side effects from medications
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8
Q

What is an aura?

A

Aura – seizure prodrome, may be recalled by the patient

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9
Q

What is a convulsion?

A

Convulsion – motor manifestation of seizure

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10
Q

What is postictal state?

A

Postictal state – time from end of seizure to brain recovery

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11
Q

What is status epilepticus?

A

Status epilepticus – continuous (30 min or more) or recurrent seizures without waking up

Can be life threatening

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12
Q

Describe morbidity in epilepsy

A
  • Recurrent seizures (seizures cause more seizures)
  • Head trauma/body injury (falling, low glucose in brain during seizure, etc.)
  • Social ostracism
  • Learning/behavioral difficulties
  • Endocrine problems (women particularly)
  • Pregnancy problems
  • Treatment side effects (many)
  • Osteoporosis
  • Death (SUDEP = sudden unexplained death in epilepsy)
  • about 1% of epileptics (theory is cardiac death)
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13
Q

What are the two classifications of epileptic seizures?

A
  • ILAE classification of epileptic seizures

- International classification of epilepsies and epileptic syndromes

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14
Q

What does the ILAE classification system depend on?

A
  • Anatomical classification of the seizure
  • Each seizure is a symtpom, not a disorder
  • First you classify the seizure, then you look at it in the patient and cause
  • Then you can look at the treatment options accordingly
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15
Q

What does the international classification system depend on?

A

Depends on localization of seizures and patient characteristics

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16
Q

What are the types of generalized seizures?

A 
Generalized seizures affect both cerebral hemispheres
A. Tonic
B. Clonic
C. Tonic – clonic (grand-mal)
D. Absence (petit-mal)
E. Myoclonic
F. Atonic / Akinetic
G. Infantile spasms

80% are partial or focal
20% are generalized

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17
Q

Describe the types of things you will see with each type of generalized seizures

A

A. Tonic (flexed)
B. Clonic (jerky)
C. Tonic – clonic (grand-mal) (both flexed and jerky)
D. Absence (petit-mal) (a generalized seizure which begins in kids, loose awareness for a few seconds, blinking, no tonic-clonic, may be repetitive (10-15/hour), only type that depends on an EEG to diagnose)
E. Myoclonic (when you’re drifting off to sleep and jerk - one is fine, many is a seizure, often part of another type of disorder such as hypoxia)
F. Atonic / Akinetic (born with a brain disorder - atonic they fall to the ground, akinetic they freeze)
G. Infantile spasms (slam the door and the baby freezes up and stiffens, bad sign)

18
Q

What are the type of partial seizures?

A
  • Partial simple (focal)
  • Partial complex
  • With secondary generalization

It stays on one side of the brain

19
Q

Describe all the types of simple partial seizures you can have

A
  • Motor
  • Sensory (usually with motor - a “weird” feeling that is unrealistic)
  • Autonomic (sweating, piloerection, usually with motor/sensory)
  • Psychic (especially in temporal localized)
20
Q

Describe partial complex seizures

A

Altered consciousness

  • They don’t remember it
  • They don’t lose consciousness, just altered
  • Also have the motor, sensory, autonomic or psychic manifestations
21
Q

Describe a partial seizure with secondary generalization

A

The important part is how this seizure begins

If it starts as a partial and goes general - this is what we call it

22
Q

What is the third class of seizures?

A

Unclassified

We think they are having seizures, but we can’t find anything abnormal that can be identified

23
Q

Once you classify the seizure, you take the information and put it together with the patient…

A
  • Idiopathic
  • Symptomatic
  • Symptomatic/cryptogenic
24
Q

How do we recognize seizure episodes?

A
  • Episodic behavioral changes
  • Stereotypy of events
  • Automatisms
  • Post-event confusion
  • Episodes similar from event to event
  • Non-directed behavior (there is not control over movement during a seizure)
  • Recurrent, unexplained obtundation or confusion that resolve spontaneously over minutes or hours

Typically patients will have similar seizures each time with similar behaviors

25
Q

What happens after a seizure

A

A period of time when the brain recovers (a few minutes up to 24 hours)

Typically confusion

26
Q

What are the symptoms of convulsive seizures

A
  • Single or multiple body jerks (myoclonus)
  • Stiffening / posturing of part or whole body
  • Jerking / twitching movements of part or whole body
  • Sudden truncal flexion
  • Drop attacks
  • Tongue biting
  • Bowel / bladder incontinence
27
Q

What are the symptoms of non-convulsive seizures

A
  • Altered awareness
  • Staring, blinking
  • Chewing, swallowing
  • Picking at objects
  • Repetitive movements
  • Head or body turning
  • Posturing of extremities
28
Q

What types of symptoms suggest a behavioral event and not an epileptic event?

A
  • Continuous aberrant behavior
  • No post-event confusion
  • Variable behavior
  • Directed aggression
  • Identifiable emotional trigger
  • Secondary gain
  • Not responsive to treatment (because it is not epilepsy)
29
Q

What do you do in the patient workup for an epileptic evaluation?

A

Didn’t go over this

History and Physical exam

  • Seizure onset / precipitating event
  • Family history
  • Trauma

Laboratory tests
- Blood chemistries, Lumbar Puncture

Brain Scan
- MRI, CT

EEG

30
Q

What is the “first aid” protocol for seizures?

A
  • Position patient
  • Remove eyeglasses
  • Clear harmful objects
  • Loosen neck clothing
  • Minimal restraint
  • Turn on side
  • Head dependent
  • Nothing in mouth
  • Secure airway (nasal tube)
  • Observe until seizure over
  • Call for help (prolonged seizure or repetitive seizures)
  • Postictal reassurance
  • No meds unless in status
31
Q

What is the treatment for epilepsy?

A
  • Prophylaxis (avoid head trauma/helmet)
  • Treat causative factors (infection, temperature, intoxicant, etc.)
  • Anticonvulsant therapy
  • Dietary management (Ketogenic diet - 80% calories from fat)
  • Surgery (seizure focus resection, brain stimulation, corpus callosum transection)
  • Vagus Nerve Stimulator
  • Psychosocial support
32
Q

What are the therapeutic goals for epileptics?

A
  • Complete seizure control
  • Few adverse events
  • Improved quality of life (not “just living” but life with meaning, relationships, and within the community)
  • Affordable treatment
33
Q

What are the principles of treating seizures in anticonvulsants

A
  • Appropriate diagnosis*** (choose right med for patient/epilepsy/seizure)
  • Lowest effective dose
  • Switch meds if ineffective or unacceptable side effects
  • Avoid polypharmacy if possible
  • Monitor compliance, effectiveness and side effects
34
Q

What are some side effects of anticonvulsants?

A
  • Sedation
  • Cognitive
  • Behavioral
  • Rash
  • Weight gain / loss
  • Hirsutism
  • Hepatic toxicity
  • Hematologic toxicity
  • Teratogenesis
  • Dizziness / Ataxia
  • Tremor
  • Nausea
  • Hair loss
  • Menstrual irregularities
  • Diarrhea
  • Peripheral neuropathy
35
Q

Describe the drug interactions of anticonvulsants

A
  • Influenced by absorption, protein binding, hepatic enzymes
  • Increase of toxic effects
  • Can actually cause seizures
  • May lower levels of anticonvulsants
  • Lower effectiveness of birth control, warfarin, etc.
36
Q

What is the mechanical way to control seizures?

A

Vagus nerve stimulator

37
Q

Describe the restrictions on driving?

A
  • Patients with active epilepsy at risk for accidents
  • Little risk with controlled or purely nocturnal seizures
  • As safe as patients with uncontrolled Diabetes of Heart disease
  • Epileptics are safer drivers than people with Obstructive Sleep Apnea
38
Q

What are the restrictions in Iowa?

A
  • Driving is a privilege, not a right - restriction for loss of consciousness
  • 6 month seizure free period required to maintain driving privileges

Exceptions:

  • No loss of consciousness, nocturnal / isolated sz
  • Periodic physician statement
  • No mandatory reporting
39
Q

Describe the work and insurance problems that epileptics face

A

Work

  • Might not be suitable for patients to drive, work with machinery and at heights
  • May need time off to manage breakthrough seizures or chronic illness
  • Need to deal with effects of seizures and medications

Insurance restrictions

  • “Pre-existing conditions”
  • Coverage for medications (generics)
  • Epileptic clinics and advanced treatment option availability
40
Q

Describe some of the specific problems that women epileptics face

A
  • Endocrine problems (affect menstrual cycles, PCOD)
  • Birth control ineffective
  • Pregnancy concerns (seizures, teratogenesis)
  • Breast feeding on anticonvulsants (less risk)
41
Q

What happens if a woman wants to become pregnant and is an epileptic on anticonvulstants?

A
  • Try to switch to anticonvulsant medications that have less risk of teratogenesis
  • Some data is collected from a self reporting registry of birth defects
42
Q

What are concerns with epileptics playing sports?

A
  • Swimming
  • Head trauma with various sports
  • Heights / Gymnastics
  • Effects of exertion on Seizures
  • Coordination / cognitive effects of seizures and medications

Neuro Behavioral Med I (15 decks)

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