Clinical Care- Seizures

Question 1

What is the definition of a seizure?

Answer 1

an abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons.

Can have various manifestations.

Question 2

different etiologies of seizures, young adults (18-35)

Answer 2

trauma

metabolic disorders (alcohol withdrawal, uremia, hyper/hypoglycemia)

CNS infection

Question 3

etiology of seizures older adults

Answer 3

Older adults (>35)

CVD 
Brain tumor
metabolic disorders 
degenerative disorders (alzheimers) 
CNS infection

Question 4

two types of partial seizures:

Answer 4

focal seizure with retained awareness

focal seizure with impaired awareness

Question 5

presentation of focal seizures with retained awareness

Answer 5

formerly known as simple partial seizure
only one part of the brain is affected
presentation depends on the focal area involved.

Question 6

presentation of focal seizure with impaired awareness

Answer 6

formerly known as complex partial seizure

only on part of the brain is affected

patient appears to be awake but not in contact with other in environment and do not respond normally to instruction or questions.

no memory of what occurred during the seizure

automatisms (facial grimacing, gesturing, lip smacking, chewing)

Question 7

presentation of generalized seizures

Answer 7

involves the entire brain

may or may not lead to alteration of consciousness

Most common is the tonic-clonic seizure (AKA grand mal)

Question 8

characterizations of tonic-clonic seizures

Answer 8

tonic phase characterized by sudden muscle stiffening

clonic phase characterized by rhythmic jerking
(tongue biting is common)

episodes usually last 1-2 minutes

Question 9

besides tonic clonic, what are other types of seizures

Answer 9

absence seizures
clonic seizures
atonic seizures (loss of tone in all the muscles)

Question 10

characteristics of postictal phase of a tonic clonic seizure

Answer 10

somnolence, confusion of headache that may occur for several hours

patient often have no recollection of event

weakness of limbs may occur (todd paralysis)

Question 11

How do you diagnose a seizure

Answer 11

Video EEG monitoring

Question 12

management and treatment of seizures: first aid

Answer 12

clear the room, maintain airway if needed.
for partial seizures, redirect gently
start IV cath

blood work: elecrolytes, LFT, CBC, finger stick glucose

Question 13

treatment for active seizures

Answer 13

Diazepam 5 mg IV/IM q5-10 min. do not exceed 30mg

MEDEVAC immediately

Question 14

What is a life threatening complication of seizures

Answer 14

status epilepticus (EMERGENCY)

Question 15

definition of status epilepticus

Answer 15

single seizure lasting more than or equal to 5 min or 2 or more seizures between which there is an incomplete recovery of consciousness

Question 16

treatment of status epilepticus

Answer 16

diazepam 5mg IV/IM q5-10 min; do not exceed 30mg

valporic acid 30 mg/kg

correct any underlying problem that may be contributing to seizure

intubation

Question 17

differences between psychogenic nonepileptic seizures and epileptic seizure

Answer 17

PNES episodes usually last longer than 2 min
patients eyes are closed during PNES events
Incontinence is less common in PNES
usually there is no postictal phase in PNES

Question 18

how are diagnosis made of PNES

Answer 18

diagnosis is made with video EEG (no changes in electrical activity)

Question 19

treatment of PNES

Answer 19

psychotherapy with cognitive behavioral therapy or interpersonal therapy.