Epilepsy Flashcards
What are the signs of epileptic seizures?
The symptoms of seizures are “positive phenomnena”, meaning they are the presence of something not usually experienced by normal people. Visual and auditory hallucinations are possible as well as motor signs including tonicity, spasms and clonus. Additionally, there may be changes of behavior or alteration of consciousness as in complex seizures.
What are the various etiologies of an epileptic seizure?
The most common etiology of epilepsy is cryptogenic, meaning an unknown cause or origin
Children: Genetic predisposition or disease involving the cortex, Infection (often febrile), Trauma, Congenital, Metabolic disturbances
Adults: Tumors, Trauma, Stroke, Infection
Elderly: Stroke, Tumor, Trauma, Metabolic disorder, Infection
What are the two major types of seizures?
Focal/Partial. Includes subtypes of simple and complex
Generalized. Includes subtypes of Tonic-Clonic Seizures,Tonic Seizures, Atonic Seizures, Myoclonic Seizures, Absence Seizures
What are the differences between a generalized tonic‐clonic seizure and a focal seizure that evolves into a convulsive seizure?
Focal: In a localized region. Also known as partial seizure. Starts in 1 area of the brain but can “spread” can cause a secondary generalized seizure. In a SIMPLE focal seizure, conscious awareness and memory are intact, but there may be motor, sensory, autonomic and psychic changes. COMPLEX focal seizures have impaired consciousness
Generalized Tonic-clonic: Diffusely around the cortex. Characterized by alternating stiffening and jerky movement of the body.
How do you differentiate between a focal seizure with impaired consciousness and an absence seizure?
A COMPLEX focal seizure has impaired consciousness and memory, usually with a confused post-ictal state. It often preceded by a seizure aura. A SIMPLE focal seizure does not have impaired consciousness. During the seizure, the patient may display automatisms, which is the spontaneous production of purposeless motor or verbal behavior without conscious control. These seizures often last about a minute. It originates from a localized area of the brain often (but not always!) in the temporal lobe.
In contrast, a primary generalized absence seizure starts diffusely from many areas of the brain, but only affects the afferent layers of the cortex. It presents as blank staring for several seconds without a motor component. Patients are usually children, about 60% of whom outgrow the seizures. These can be precipitates by hyperventilation. Like complex partial seizures, these patients often have no memory of the event.
Define seizure
Episodic events which is unexpected and sudden resulting from abnormal and excessive activity of neurons. Affects electrical functions of the brain
Define Epilepsy
Chronic disease of recurrent unprovoked seizures. 2 or more unprovoked seizures separated by greater than 24 hours or 1 seizure with studies suggesting further risk for seizures
Differential diagnosis of a seizure
- Circulatory: Inadequate vasoconstrictor mechanisms, Hypovolemia, Reduced venus return to heart, Reduced caridac output
- Altered States of Blood: Hypoxia, Anemia, Hypoglycemia
- Movement Disorders
- Stroke/TA
- Migraine
- Sleep Disorder
- Psychogenic/Behavioral: Daydreaming, Hyperventilation, Hysterical fainting, Psychogenic seizures, Panic attacks
How do you classify seizures?
Based on EEG or appearance of seizure
Based on what is causing the seizure
How to use medications for seizures
Within 5 minutes: Lorazepam or diazepam
Between 6 and 10 minutes: Repeat Benzo dose
10-20 minutes: Phenytoin (Dilantin)
21-40 minutes: Phenobarbital (After dosing with this, patients will be unlikely to participate in neuro exam)
> 40 minutes: Midazolam (Versed), Propofol, Valproic acid
o This is refractory SE!
Non medication treatments
Ketogenic Diet: Starvation induced ketosis, and the diet maintains a state of ketosis. Diet is mostly fat with just enout protein and carbs to allow growth. Mostly used in children and has a lot of adverse affects
Vagal Nerve Stimulation: Used in chronic intractable seizures. Implantation device in chest wall stimulates vagus nerve in neck. Takes up to 18 months to have affect. Can cause temporary changes in voice, cough, shortness of breath and rarely vocal cord paralysis and infection
