Epilepsy Flashcards
Define idiopathic
“that idiot doctor can’t figure out why it’s happening”
no evidence of an underlying cause; can only be used after ruling out all potential other causes through Hx, PE, and diagnostic testing
Define seizure
a single episode consisting of paroxysmal transient disturbances of the brain function that may be manifested as episodic impairment of loss of consciousness, abnormal motor phenomena, and sensory disturbances
Define epilepsy
a combination of different seizure episodes
Define status epilepticus
continuous ongoing seizures
Symptomatic vs idiopathic epilepsy
symptomatic epilepsy has an identifiable cause, but idiopathic does not; idiopathic is the more common of the two in dogs
What happens in the brain during a partial seizure
one neuron (or a small group of focal neurons) is stimulated to discharge electrical impulses; the electrical activity remains within this small group of neourns
What happens in the brain when a generalized seizure occurs?
the electrical activity from one neuron/a group of focal neurons spreads throughout the rest of the cerebral hemisphere
List and describe the 3 phases of a seizure
- Pre-ictal –> period of time immediately prior to ictus where the patient may be nervous or pace
- Ictus –> period of actual seizure activity that can last 2-3mins
- Post-ictal –> a time period post seizure where pet may be tired, lethargic, confused, ravenous or anorexic; lasts a few hours up to a day
What is the typical presenting signalment and Hx of a patient with idiopathic epilepsy?
young to middle age dog (1-5yr old) that otherwise appears healthy upon PE; O may describe P as not being “quite right” because O missed the seizure but notices the post-ictal phase
4 Important questions to ask when a patient presents during or after a seizure
- Can you describe the nature of the event?
- Is this a first time event for this patient?
- Was there any potential expsoure to anything unordinary?
- Was there any exposure to anything considered “normal” or “safe”?
General characteristics of generalized seizures
- loss of consciousness
- loss of bladder/bowel control
- tonic-clonic movements
- jaw snapping
- post-ictal phase may be short or long in duration
- seizure usually lasts 1-3min
General characteristics of syncope (fainting)
- loss of consciousness
- can lose bladder/bowel control
- may paddle trying to rise
- usually no rhythmic tonic/clonic movements
- may be slightly disoriented post syncopal episode; usually short duration
- event lasts <1min
List 4 things that can be done as an RVT when a patient presents during a seizure
- Take patient to the back and direct client to a quite room (with another staff member to gather more info if possible)
- Take TPR after making sure a DVM knows a seizing patient has arrived
- Place IV catheter if enough hands are available
- Gather a blood sample for serum blood glucose (and PCV/TP/BUN if enough blood obtained)
When should cooling methods be initiated on a seizure patient?
if temp >104
List 2 ways to administer diazepam to an active seizing patient.
- Per rectum via syringe without needle or red rubber catheter
- IV only if an IV cath has already been placed
What happens if Diazepam is given extravascularly?
Nothing truly bad happens, but it doesn’t act nearly as fast as per rectum or direct IV
Aside from a PE, list 4 non-invasive diagnostic tests that can be performed to evaluate a patient that has had a seizure
CBC
Serum chemistry
UA
Fasting & post-prandial bile acids
List 3 more invasive diagnostic tests that can be done to evaluate a patient that has has a seizure
Cerebrospinal fluid (CFS) tap
CT
MRI
What is a seizure diary and what should go in it?
a place to document info regarding seizures
- date, time, and length of each episode
- unusual behavior or occurrences that may indicate a pre-ictal period of a trigger for the seizure
- medication administration
When is a patient considered a candidate for medical therapy of epilepsy?
when it has multiple seizure episodes hours, days, weeks, or months apart
What is “steady state level” as it pertains to anticonvulsant meds?
when the drug has finally reached a constant level in the blood
Why is steady state important/what happens if it gets disrupted?
-You can’t draw blood to check levels until after the steady state has been reached because you won’t get an accurate answer; if the medication is not given correctly steady state will not be achieved making bloodwork results inaccurate
What are the two common oral anticonvulsants meds used in dogs with idiopathic epilepsy
Phenobarbital
KBr