CLINICAL MED- TYPES OF SEIZURES Flashcards
Generalized tonic clonic seizures
Duration
Phases
Duration: 1-5 minutes and followed by post ictal phase
Phases:
- Partial seizure that undergoes secondary generalization
- Onset of generalization characterized by forceful head movements (versive) or brief vocalization
- Pretonic clonic phase; irregular asymmetric clonic jerking of extremities
- Tonic phase; generalized sustained contraction ie body becomes rigid
- Clonic phase; slower jerking
- Post ictal phase; limp and in deep sleep from which he awakens with confusion, headache and muscle pain
Recollection in GTCS
In secondary generalization, the pt may remember aura
In GTCS of generalized onset or that which developed from complex partial seizure—> no recollection
Absence seizure onset
In childhood or adolescence
Typical absence seizure duration
Few seconds that start and end abruptly
Characteristics of absence seizure
- Unresponsiveness with fixed blank stare
- Eye fluttering, face twitching
- No falling (postural tone may be increased or decreased)
- Brief clonic jerks
- Automatisms
- Aware of attack?
- NO POST ICTAL PHASE
Myoclonic seizures
Sudden involuntary brief jerk of muscle or group +/- loss of consciousness
Myoclonic seizures affect who
Children or
YA—> JUVENILE MYOCLONIC EPILEPSY (syndrome)
Juvenile myoclonic epilepsy
In YA after stress of high dose caffeine
6-22 years
Jerks worse in morning
GTCS in morning
40%—>absence
Atonic seizure characterized by
Sudden loss of tone which causes pt to fall to the ground
Atonic seizures associated with
Mental retardation
Lennox-Gastaut syndrome (severe)
Partial seizures begin in
Focal brain area
most common type in adults
Motor manifestation of simple partial seizures
ie arise from motor cortex there4
- Head deviation to one side
- speech arrest or vocalization
- stereotyped limb, facial movements that are coordinated—> look purposeful
- Jacksonian march; spread from distal to proximal in seconds
- Todd’s paralysis; muscle weakness that persists for minutes, hours mistaken for TIA, stroke
Sensory manifestations of simple partial seizure
- Visual—>spots, starts, light
- Auditory—>ringing, musical sounds
- Somesthetic—>tingling,numbness, electric
- Olfactory—> burning rubber
- Gustatory—> acidic, sweet taste
- Vestibular—> vertigo
- Epigastric—> butterflies
- Primary sensory cortex—> primitive
- Higher level/ MESIAL temporal—> detailed
Simple partial seizure with nausea and epigastric symptoms that may cause pt tp lose consciousness and be generalized
Temporal lobe lesion/seizure?
Deja vu entendu
AUDITORY FAMILIARITY
Jamais vu/ jamias entendu
UNFAMILIARITY
What could happen in temporal lobe seizure
Autoscopy
Progression of seizures
SP—>CP—>GTCS
Left temporal lobe CPZ characteristics
Automative repetitive behavior
Simple—> lip smacking, fumbling, chewing, swallowing etc
Automative repetitive behavior with frontal lobe involvement
Complex
Bicycling, pelvic thrusting
MESIAL TEMPORAL LOBE EPILEPSY
Associated with
Complex partial seizure (symptomatic)
MESIAL TEMPORAL LOBE EPILEPSY
MRI findings
Hippocampal sclerosis
MESIAL TEMPORAL LOBE EPILEPSY
EEG features
Focal spikes
MESIAL TEMPORAL LOBE EPILEPSY therapy
Refractory to medicine, treated with epilepsy surgery
LENNOX GASTAUT SYNDROME
Occurs in
Children with poor prognosis
LENNOX GASTAUT SYNDROME
Associated with which seizure types
- GTCS
- Atypical absence (more prolonged and complex automatisms)
- Atonic
LENNOX GASTAUT SYNDROME
EEG findings
Slow spike and wave discharges
