CH 25 Neurologic & Muscular Disorders Flashcards
seizure disorders
sudden transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic or psychic phenomena alone or in combo with alteration/loss of consciousness
epilepsy
two seizures that are separated by at least 24 hours, a single seizure associated with greater than 60% risk of recurrence or the diagnosis of an epilepsy syndrome.
clinical findings of seizures and epilepsy
get detailed history of event. feeling of fear, numbness or tingling in fingers, or bright lights in visual fields before seizures. (dejavu suggests temporal lobe onset). Postictal sleeping is common but not after generalized absence seizures. loss of speech suggests LT hemisphere involvement. eyes may deviate. Motor activity without awareness suggests focal seizures
generalized seizures symptoms
acute loss of consciousness, tonic clonic activity, blinking, chewing, hand movements
Diagnostics for seizures
after 1st seizure do EEG and MRI. not emergent. routine labs dont usually help.
complications of seizure
psychosocial impact (depression, anger, guilt, inadequacy; increased risk of suicide; stigma; don’t reach full potential), cognitive delay (reduced cognition and memory, epileptiform activity in sleep, psychosis, pseudodementia), and Injury and death (head lacs requiring head gear, showering instead of baths and seizure precautions, death in medically uncontrolled seizures)
First aid treatment for seizures
First aid: protect against self injury, turn child to side to prevent aspiration. Don’t put anything in the mouth. may need at home rectal benzos (Diastat) or intranasal midazolam for seizures over 5 minutes.
AED therapy
choose appropriate drug and a treatment strategy especially if monotherapy doesn’t work. Treat until patient is seizure free for 1-2 years.
Alternative treatment for seizures
ACTH and corticosteroids (for infantile spasms, give extra potassium, guard against infections, give gi prophylaxis, follow for HTN, and watch for cushings appearance), ketogenic diet (fasting and diet high in fat and low in protein and carbs), vagus nerve stimulation (pacemaker like device that gives cyclic stimulation to the brain), surgery (for medically intractable partial epilespy)
status epilepticus
clinical or electrical seizure lasting at least 15 minutes or a series of seizures without complete recovery over a 30 minute period. after 30 minutes, hypoxia and acidosis occur with depletion of energy stores, cerebral edema, and structural damage. eventually high fever hypotension, resp distress, and even death may occur
floppy infant syndrome signs and symptoms
horizontal suspension (supporting infant with hand under chest) normally results in infant holding head up at 45 degrees or less, elbows and knees flexed, and the back straight. Floppy babies do the opposite and droop like an inverted U
floppy infant syndrome labs
if lower motor neuro neuron: serum CK, EMG/NCS, and /or muscle biopsy. Diagnose with clinical findings. If accompanied by language or cognitive delay, CNS or genetic disorder is likely and you should do MRI
floppy infant syndrome treatment
supportive. PT and OT. control seizures
diagnosing disorders affecting muscles
CK: normal or mildly elevated in myopathies, markedly elevated in muscular dystrophy (corticosteroids can mask this rise). Nerve conduction study and needle electromyography differentiate myopathies from nuerogenic processes, NCS normal in muscle disorders but show slowing in neuropathies. Muscle biopsy: use MRI or US to choose weaker muscles then biopsy since they will show more pathology, look for variation in size or shape and increase in connective tissue, fatty tissue and degeneration as signs for muscular dystrophies. Genetic testing: mutation analysis
