Epilepsy Flashcards
A seizure is a discrete, time-limited alteration in brain function that includes what changes?
motor activity, autonomic functioning, consciousness, sensations
Abnormal and excessive discharge of a group of neurons within what?
cerebral cortex
What are some clinical manifestations?
indescribable bodily sensations, pins and needles, smells/sounds, fear/depression, hallucinations, head nods, staring with loss of awareness, convulsive movements
This is a specific type of seizure where the attack is primarily manifested by involuntary muscular contractions.
Convulsion
A condition characterized by recurrent seizures unprovoked by any immediately identificable cause.
Epilepsy
Subjective disturbance of perception that represents the start of certain seizures
Aura
The actual seizure itself.
Ictus or ictal phase
Period after the seizure where the individual may be sleepy, confused, disoriented or may experience temporary neurological dysfunction.
Post-ictal phase
Describe the imbalance in neurotransmitter processes in the brain.
Decreased GABA - inhibitory
Enhanced Glutamate - Excitatory
Involvement of a localized area of the brain at seizure onset, begin in one hemisphere of the brain.
Focal
Involvement of both hemispheres of the brain at seizure onset.
Generalized
What causes a focal seizure?
injury to the brain,( tumor, trauma, neurodengerative disease)
See tonic/clonic movements with which seizure?
focal without impairment of consciousness
Sensory seizures are what type of seizures?
focal without impairment of consciousness
What is the duration of a focal without impairment of consciousness?
30 seconds or less
A focal seizure without impaired consciousness that may precede a focal seizure with impaired consciousness or progression to a generalized seizure
Aura
What is the duration of a focal seizure with impairment of consciousness?
1-3 minutes
Repetitive motor activities such as mumbling, picking clothing, lip smacking are signs of?
Automatisms seen in focal seizure with impairment
Confusion, lethary, altered behavior, amnesic for event are of what phase?
Postictal
EEG findings: local contralateral discharge starting over the cortical area.
Focal without impairment
EEG findings: unilateral or bilateral discharge in the temporal or frontotemporal regions.
Focal with impairment
May progress through several stages reflecting spread of discharge to different brain areas.
Evolving to a bilateral, convulsive seizure
Seizures begins in both hemispheres. Loss of consciousness.
Generalized seizures
Loss of consciousness followed by sudden fall to ground. muscles become rigid, clonic movements of head, legs, arms.
Generalized tonic-clonic
What is the duration of Generalized tonic-clonic?
2-5 minutes
Patients with primary GTC seizures occur most commonly when?
awakening and lesser extent in evening when relaxing
Brief episodes of staring with impairment of awareness and responsiveness that begin without warning and end suddenly.
Absence
What is the duration of an absence seizure?
10-45 seconds
EEG of 3 per second spike and wave pattern.
Absence
Sudden and total loss of muscle tone and postural control that causes eyelids to drop, head to nod, and patients drop to the ground.
Atonic
What is the duration of an atonic seizure?
10-60 seconds
Sudden, brief, shock-like jerk of a muscle often occurs in healthy people as they fall asleep.
Myoclonic
Sudden bilateral stiffening of the body, arms, or legs. More common during sleep.
Tonic
Rhythmic, repetitive, jerking muscle movements.
Clonic
ACTH, prednisone and vigabatrin can be used to treat?
Infantile spasms
Convulsions brought on by a fever greater than 102F. What seizure and how do you treat?
Febrile seizure
Diazepam orally or rectally
Triad of intractable seizures, mental and developmental retardation, and slow spike and wave pattern.
Lennox-Gastaut Syndrome
Myoclonic seizures begin around puberty in early morning. What seizure and how do you treat?
Juvenile myoclonic epilepsy
Treat: valproic acid
What other conditions may look like epilepsy?
pseudoseizure, syncope, breath holding spells, narcolepsy, hemiplegic migraines, drug toxicity, transient ischemic attack
What factors define epilepsy?
abrupt onset, loss of consciousness, brief duration, rapid recovery, stereotypic episodes
What are some underlying causes of seizures?
hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia, withdrawal, sleep deprivation, fever, stimulants
What tests should be ran?
CBC, LFT, serum albumin, urinalysis, serum electrolytes, EEG, MRI
What are signs of need for immediate medical attention?
Seizure lasting 10 minutes or more Difficulty rousing in 20 minutes Vision complaints Vomiting Persistent Headache after rest period Unconsciousness with failure to respond Unequal size pupils or excessively dilated
What are the nonpharmacologic treatments for seizures?
Surgery - temporal lobectomy
Vagal nerve stimulation
Ketogenic diet
What are the toxic effects of AED?
somnolence, fatigue, dizziness, vision changes, nystagmus, ataxia, tremor, GI, difficulty thinking, behavioral disorders
Chronic adverse effects of AED long term therapy?
connective tissue, endocrine, GI, hematologic, neurologic disorder
Fetal hydantoin syndrome is associated with which drug? Manifestations?
phenytoin
Cranial facial abnormalities, cleft lip/palate, wide mouth, prominent lips, digit hypoplasia, mental retardation
What should be given to pregnant women?
Folic acid 1-4mg daily
Vitamin K during 8th month
Recurrent epileptic seizures without full recovery of consciousness before next full seizure begins.Continuous clinical or electrical seizure activity lasting more than 30 minutes, regardless of consciousness.
Status epilepticus
Continuous seizure activity lasting more than 5 minutes. two or more seizures without complete recovery of consciousness
Status epilepticus
Persistent state of impaired consciousness and motor/sensory seizure without impaired consciousness.
Non-Convulsive Status Epilepticus
Involves the entire brain. Full body tonic-clonic motor seizures. Impaired consciousness.
Generalized Convulsive Status Epilepticus
What can cause status epilepticus?
CNS tumor or infection, trauma, hypoxia, stroke, metabolic disorder, chronic alcohol abuse, drug toxicity, AED change in levels
What drug is given first for SE?
Thiamine 100mg + Glucose if hypoglycemic
What drug is given in 10 minutes for SE?
Lorazepam 0.1mg/kg IV OR Diazepam 10mg PR OR Midazolam 0.2mg/kg IM
What drug is given in 10-30 minutes for SE?
Phenytoin 15-20 mg/kg IV
What drug is given in 30-60 minutes for SE?
Additional phenytoin bolus 5-10mg/kg
OR
Phenobarbital 20mg/kg
What drug is given in 60 minutes for SE?
Bolus phenobarbital 10mg/kg Valproate sodium 20mg/kg Midazolam 2mg/kg Bolus Propofol 1mg/kg bolus pentobarbital 10-15 mg/kg
