Bloch: Epilepsy Flashcards
What is a seizure?
paroxysmal, excessive and disorderly discharge of neurons
What are the components of a seizure?
aura
ictus *during seizure
post-ictal *immediately after seizure
Epilepsy is defined as a syndrome of (blank) seizures
recurrent
Is epilepsy a benign disease?
no
- psychosocial factors
- hospitalization, medications, lost work
Just because you have one seizure, does this mean you have epilepsy?
No…
What age groups are most likely to have epilepsy?
60+ *trauma, stroke, general damage to axons
0-9 *children can be genetically predisposed, but outgrow it as they myelinate their axons
What are some classifications of seizures?
partial
generalized
status epilepticus
non-epileptic seizures
Two types of partial seizures?
simple
complex *impairment of consciousness
T/F: Partial seizures can evolve to secondarily generalized seizures
True
What are some types of generalized seizures?
typical absence seizures *brief period of staring myoclonic *brief shock-like jerks clonic *flexed limbs tonic *extended limbs tonic-clonic atonic *loss of all muscle tone
What are some causes of localization-related epilepsy?
vascular *stroke, venous thrombosis infectious *meningitis tumor degenerative *MS trauma congenital
80% of seizures begin in the (blank) lobe
temporal
What factors can help you identify the type of epileptic syndrome?
history EEG etiology inheritance response to anti-epileptic meds
What do these clues favor?
Pt never witnessed having a seizure
Provoked by emotional stress
Variable presentation from one event to the next
Screaming or vocalizing through the whole event
Prolonged event (greater than a few minutes)
Sudden termination of event
No post-ictal confusion
Induced by suggestions
Responsive during event
non-epileptic event or syndrome
What are some things that can provoke seizures?
massive sleep deprivation excessive use of stimulants withdrawal from sedatives or alcohol high fever hypoglycemia electrolyte imbalance hypoxia hormonal variations trauma stress
What happens to the eyes during a real seizure? What about during a non-epileptic seizure?
eyes open; eyes closed
What are some lab tests you might perform after an unprovoked single seizure?
routine lab tests: electrolytes, CBC, glucose
toxicology screen *pts aren’t always honest
CT *if urgent or MRI *preferable
EEG
lumbar puncture *ONLY if you suspect infection (fever, AIDS)
What are bed rail seizures? What type of pt do they usually occur in?
seizures that occur when a child’s body temp increases and their under-myelinated axons cannot respond appropriately; occur in young children *usu grow out of these
What is mesial sclerosis?
sclerosis of hypocampus (didn’t develop normally or damaged from infection, etc) *provokes seizures
After a single seizure, when would you want to start a pt on meds?
structural lesion on MRI infection of CNS or meninges history of epilepsy in sibling childhood seizures head trauma age over 60 when first seizure occured todd's paralysis status epilepticus
What is status epilepticus?
any seizure type that does not stop w/i 5 minutes or continuous pattern of seizing and recovering for 10min *likely to cause perma brain damage
When would you NOT use meds after a single seizure?
alcohol withdrawal drug abuse seizure from hypoglycemia provoked by sleep deprivation post-impact seizure
When to stop using seizure meds?
If seizure free for 2yrs
**over 60, keep em on it
If easily controlled on one drug at low dose
Normal EEG and neuro exam
No previous unsuccessful attempts at withdrawal
Implantable device, like a pacemaker, for seizures. It stimulates left peripheral vagus nerve.
vagus nerve stimulator
