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Neuro Rehab 2 > Epilepsy and Seizures > Flashcards

Epilepsy and Seizures Flashcards

1
Q

what is a seizure

A

“electrical storm in brain”

paroxysmal behavioral spell generally caused by an excessive, disordered discharge of cortical nerve cells

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2
Q

seizure vs epilepsy

A

sz is a sx of epilepsy
epilepsy is a dx

they are not synonymous

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3
Q

why do seizures all present differently

A

outward sx depend on where abnormal electrical activity occurring in brain

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4
Q

what are convulsions

A

involuntary muscle contractions and relaxation

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5
Q

convulsions vs seizure

A

convulsion are motor output from sz
- not always present during sz activity

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6
Q

what is epilepsy (aka what is the dx criteria)

A

syndrome of two or more unprovoked or recurrent sz on more than one occasion

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7
Q

what are intractable or refractory seizures and how common are they

A

sz uncontrolled by antiepileptic drugs

up to 30%

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8
Q

what is the function of glial cells and what are 2 examples

A

physiologically support health of neuron

ex: astrocytes, oligodendrocytes

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9
Q

what is the pathophysiology behind a sz

A
  1. abnormal electrical activity
  2. imbalance b/w excitatory and inhibitory neurotransmitters -> NET EXCITATION -> INC ACTIVATION AND NEURONAL FIRING
  3. much faster neuronal firing compared to normal
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10
Q

what role can glial cells play w seizures

A

glial cell changes may affect neuronal signaling enough to contribute to a seizure

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11
Q

what pt populations has an inc susceptibility to sz

A

infants and elderly

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12
Q

what are general etiologies of seizures (6)

A

acquired
idiopathic
meds
vaccines
drugs
genetic abnormality

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13
Q

what are 7 acquired etiologies for seizures

A

TBI
stroke
brain tumor
infections
abscess
hypoxia
high fevers

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14
Q

onset of idiopathic epilepsy

A

usually starts in childhood or adolescence

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15
Q

what is the relationship of seizures and brain tumors

A

sz can be the first sign of brain tumors
- get imaging after a sz and discover tumor

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16
Q

what population is febrile sz common in

A

infants/young children
temp >103-104

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17
Q

what meds can cause sz (7)

A

anesthesia
antibiotics
anticholinergics/antipsychotics
antidepressatns
antivirals
chemo
antihistamines

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18
Q

what are 2 vax that can cause sz

A

measles
pertussis

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19
Q

what is the prevalence of sz caused by vax today

A

was documented in 40s-50s

have since changed formula
- removed some additives and preservatives
- don’t see cluster sz cases anymore

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20
Q

how can drug use cause sz

A

alcohol, illicit drugs (meth, cocaine)
- see acutely w high doses

or in withdrawal

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21
Q

what is an example of a genetic abnormality that can cause sz

A

photosensitivity
- flashing/strobe lights cause sz

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22
Q

at what points in your lifetime are you most likely to have a seizure and why

A

age 0-1
- brain in early infancy isn’t well myelinated, inc likelihood of abnormal electrical activity

age 75+
- aging, metabolic disturbances, atrophy in brain

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23
Q

what is the incidence of epilepsy in the US

A

3rd most common neurologic condition
- 1. alzheimers, 2. stroke

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24
Q

what are 2 sz syndromes

A

psychogenic non-epileptic seizures (PNES)

provoked seizures

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25
Q

what is a psychogenic non-epileptic seizure (PNES)

A

sz w/o abnormal EEG
- no abnormal brain activity detected

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26
Q

how do you treat psychogenic non-epileptic seizures

A

doesn’t respond to epilepsy meds

treat psychologic condition, stress, trauma

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27
Q

what are potential causes of provoked seizures (6) and what are the 3 most common

A

high fever
*hypoglycemia
*hyponatremia
alcohol and drugs
light
*stress

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28
Q

what are the 2 types of seizures

A

focal or partial
generalized

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29
Q

what are focal/partial seizures and what is a common sx

A

occur in isolated region of brain

auras

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30
Q

simple vs complex focal seizure

A

simple = no LOC
complex = LOC (usually brief), repetitive strange behaviors or feelings

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31
Q

what are auras and when are these usually experienced

A

illusion of some sort of sensation
- odors, tastes & sensations, memories, intense feelings or emotions, abnormal sensations in stomach

seconds to min before a focal sz
- can give them a forewarning so can set themselves up safely

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32
Q

what are generalized seizuures

A

occurs in both hemispheres
may happen after focal sz
- my start in local part of brain and then spread

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33
Q

3 common sx seen in generalized sz

A

LOC
falls
ms spasms

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34
Q

what are 6 types of generalized seizures

A

petit mal (absence sz)
tonic
myoclonic
clonic
atonic
tonic-clonic (grand mal)

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35
Q

petit mal seizures: sx, duration

A

staring, ms jerking/twitch
- stare off into space and not respond
- can be very subtle, look for pattern happening repeatedly
- tend to cluster, happen over and over

typically last <20sec

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36
Q

tonic seizures: sx, duration

A

sudden onset of tonic extension or flexion
- could be just upper or just lower body

short lived, few seconds

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37
Q

myoclonic seizures: sx, duration, possible secondary consequence

A

brief arrhythmic, jerking mvmt
- like a spasm, brief burst of ms contraction
- often don’t remember

typically las <1sec, cluster within few min

can lead to SCI, head injury

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38
Q

what are clonic sz

A

repetitive jerking of ms bilaterally
-> sustained ms contractions

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39
Q

atonic sz: sx, sequelae, duration, management

A

loss of normal ms tone
drop attack - unconscious

brief - but clustered together in rapid succession

wear a helmet
aggressive medical management is important

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40
Q

tonic-clonic seizures: sx, post-sz sx, duration

A

grand mal
mix of motor behavior
generalized tonic extension followed by clonic rhythmic mvmts

post-ictal (after sz) weakness
- can be pretty severe
can have significant neurologic damage

severe and prolonged

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41
Q

what is the definition of epilepsy

A

more than 2 sz that are provoked w/o pinpointed reason (ie metabolic, cause)

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42
Q

what term is epilepsy synonymous with

A

sz disorder

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43
Q

what 5 characteristics are epilepsy syndrome based on

A

presentation (behavior)
age of onset
location of origin
etiology
EEG

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44
Q

what is status epilepticus (SE)

A

continuous epileptic activity for >30min or 2+ more serial sz w/o return to normal state of consciousness b/w sz

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45
Q

what are the potential consequences of status epilepticus

A

permanent damage to neurons d/t prolonged abnormal firing can result in long term disability

high mortality rates

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46
Q

what are 3 reasons for high mortality rates in status epilepticus

A

cardiac dysrhythmia
metabolic dysfunction
aspiration

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47
Q

what are medical evaluations done in the ED after a sz and what is the main reason for these tests (6)

A

imaging
blood glucose
blood counts
electrolyte panel
lumbar puncture
toxicology screen

try to find a cause of the seizure

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48
Q

what are medical evaluations done in the ED after a sz and what is the main reason for these tests (6)

A

imaging
blood glucose
blood counts
electrolyte panel
lumbar puncture
toxicology screen

try to find a cause of the seizure

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49
Q

what imaging is preferred after a seizures and what is the imaging looking for

A

MRI preferred or CT

help r/i/o stroke, tumor

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50
Q

why is blood glucose taken in the ED after a seizure

A

if metabolic changes caused the seizure

51
Q

why are blood counts taken in the ED after a seizure

A

changes in blood counts can provoke a sz

52
Q

what electrolyte level do we care especially ab in the panel taken in the ED after a sz

A

sodium

53
Q

who is a lumbar puncture appropriate for after a sz

A

if febrile
- determine if infectious cause

54
Q

who is a toxicology screen appropriate for after a sz

A

suspicion of substance use/abuse

55
Q

when do you and do you not call 911 after a sz

A

if dx w epilepsy and consistent w past sz - don’t need to call 911

if lasts longer or presents differently from other sz, then call 911

56
Q

what are dx tools for epilepsy (4)

A

EEG*
neuroimaging
LP/CSF sampling
blood work

57
Q

what is the gold standard for epilepsy dx

A

EEGs

58
Q

what is an EEG and what is a consideration of its use

A

electroencephalogram

records brain wave forms and electrical activity

non-invasive, but can be noxious as trying to induce sz

59
Q

what neuroimaging is used (6) and what info can it tell

A

MRI, CT, PET, fMRI, SPECT, TMS

localize source of abnormal electrical charges

60
Q

why is LP/CSF sampling done for dx

A

infection likely if marked elevation in WBC
- culture and try target medical intervention to infectious agent to minimize impact on neuro tissue

61
Q

what bloodwork is done and why for dx

A

CBC, chemistry panel

identify potential trigger
- infection, anemia, hypoglycemia

assess liver and kidney function - may affect pharm interventions

62
Q

what is the effectiveness of anti-epileptic drugs (AEDs)

A

control sz effectively for 70% affected pts

63
Q

what is the biggest side effect of AEDs

A

suicidal ideation (SI)

64
Q

what is the most common AED prescribed

A

phenytoin (dilantin)

65
Q

what is phenytoin effective for

A

partial and generalized sz, except for absence sz

66
Q

what are considerations of phenytoin

A

small therapeutic range
- need to be monitored closely
make sure taking proper dosage
- high levels can be toxic

67
Q

what are s/sx of phenytoin toxicity (5)

A

sedation
nystagmus
diplopia
cog decline
death

68
Q

what are potential adverse effects of phenytoin (4) and how common are they

A

many people don’t tolerate well

gingival hyperplasia
skin rash
congenital defects
sudden cardiac death
- heart block
- v-tach or v-fib

69
Q

who is phenytoin often prescribed to

A

prophylactically for people w TBIs and CVAs

70
Q

what is carbamazepine effective for

A

partial and generalized sz
very effective for wide range of sz

71
Q

what is a pro of carbamazepine

A

better tolerated than phenytoin

72
Q

what are 3 ways that carbamazepine is better tolerated than phenytoin

A
  • less side effects
  • dose less stringent
  • not same risk of toxicity
73
Q

what are potential adverse effects of carbamazepine and how is this mitigated

A

leukopenia
anemia
thrombocytopenia

CBC checked often

74
Q

what is valproic acid effective for

A

partial, generalized, absence, and myoclonic sz

75
Q

what are potential adverse effects of valproic acid (2)

A

fatal pancreatitis
liver damage
- esp in <2yo

76
Q

what is the primary reason benzodiazepines is administered

A

dec activity in CNS

77
Q

what pharm treatment is given for acute sz

A

IV lorazepam, benzodiazepines, or diazepam
- CNS depressants to chill out

then IV phenytoin
- monitor closely w regular blood draws bc small therapeutic range

78
Q

what do we monitor for in long term use of drugs (3)

A

toxicity
adjustment of dosage
compliance

79
Q

what is a consideration in dc a medication

A

wean slowly over weeks to months to avoid adverse effects
- withdrawal can have severe effects

80
Q

what are 7 non-pharm med interventions

A

transcranial magnetic stim
transcranial DC stim (tDCS)
surgery
deep brain stim
vagus nerve stim
medidal marijuana
diet (ketogenic)

81
Q

how can transcranial magnetic stim aid in dx

A

localize foci or origin point of sz activity

81
Q

how can transcranial magnetic stim aid in dx

A

localize foci or origin point of sz activity

81
Q

how can transcranial magnetic stim aid in dx

A

localize foci or origin point of sz activity

82
Q

what are 3 uses for TMS

A

dx
info on effectiveness of meds
treat sz activity

83
Q

how can TMS provide info on effectiveness of meds

A

detect changes in excitability before and after AEDs

84
Q

how does TMS treat sz activity

A

repetitive electrical brain stim leads to lasting changes in neuron to neuron signaling

low frequency TMS reliably dec regional cortical excitability

85
Q

what does support is there for TMS

A

not FDA approved yet for sz control
- can treat migraines and MDD

clinical trials conducted
low level evidence but no main adverse effects noted

86
Q

what is tDCS

A

neuro stim or neuromodulation applied at low levels on scalp over brain
- can inc or dec activity in underlying region

87
Q

how is tDCS different from TMS

A

tDCS - use electrical impulses
TMS - magnetic

88
Q

what support is there for tDCS

A

not FDSA approved yet for sz
- studies promising

89
Q

who are candidates for surgical management of sz (2)

A

lack of response to meds
disability resulting from chronic sz

90
Q

what is the most common part of the brain that sz originate from

A

temporal lobe

91
Q

what cases has there been the highest success rate in surgical management (3)

A

focal sz
sz that begin as focal
unilateral, multifocal

92
Q

what are surgical options (3)

A

lobectomy
hemispherectomy
corpus callostomy

92
Q

what are surgical options (3)

A

lobectomy
hemispherectomy
corpus callostomy

92
Q

what are surgical options (3)

A

lobectomy
hemispherectomy
corpus callostomy

92
Q

what are surgical options (3)

A

lobectomy
hemispherectomy
corpus callostomy

92
Q

what are surgical options (3)

A

lobectomy
hemispherectomy
corpus callosotomy

93
Q

what is the most common surgical procedure and why

A

temporal lobectomy

most common location for sz origination
successful outcomes

94
Q

effectiveness of lobectomies

A

70-90% reduction or complete relief from sz

95
Q

what is a corpus callosotomy and what does this do and what doesn’t this do

A

sever neural connections b/w R and L hemispheres

prevents spread of sz from one side to other
- limits reach of abnormal electrical activity
- doesn’t cure focal sz

96
Q

what is a deep brain stimulator and what does it do

A

stimulator implanted under scalp

detects abnormal signals and transmits a corrective electrical signal
- adding more electrical activity can jam signals and stop it

97
Q

what is the effectiveness of deep brain stimulator and what is a good way to implement this

A

dec sz activity by 50% in those resistant to AEDs

good adjunct treatment

98
Q

what is a risk of deep brain stimulator

A

high risk of infection bc invasive

99
Q

what support is there for deep brain stimulators

A

FDA approved

100
Q

what is a vagus nerve stimulator

A

delivers small electrical current to brain via vagus nerve reducing electrical bursts

101
Q

who is the vagus nerve stimulator appropriate/effective for

A

FDA approved for 12+yo w refractory partial epilepsy

dec frequency of partial or focal sz

102
Q

what support is there for the use of medical cannabis

A

wide range of outcomes
- isolated case of SE

becoming more common w legalization
- legal issues with access in 3 states
- compassion access in other states where not legal

103
Q

what dietary intervention can be used and who is this seen to be most effective for

A

ketogenic diet

pedi population w poor response to AEDs

104
Q

how is it thought that a ketogenic diet can dec sz activity

A

diet rich in fat and low in protein, carbs

ketosis = break down fats instead of carbs for energy

by-produce of ketosis is betahydroxybutyrate (BHB) which inhibits sz in animals

105
Q

what are potential side effects of a ketogenic dietary intervention

A

nutritional deficiency
kidney stones

106
Q

what is a consideration with using a ketogenic dietary intervention

A

very rigid
have to measure food portions carefully

107
Q

what are alternative management options (6)

A

yoga and meditation
biofeedback
aerobic exercise
music therapy
acupuncture
herbal remedies

108
Q

what support is there for alternative management

A

no evidence to support
- no studies, nothing in literature

anecdotal evidence, and is healthy for you anyway

109
Q

what are 5 common co-morbidities of epilepsy

A

memory deficits
hemiplegia
learning disability
visual field deficits
activity

110
Q

why are memory deficits a common co-morbidity of epilepsy

A

if unconscious for parts of day, then limits ability to form memories

111
Q

what risk of mortality is there for epilepsy

A

higher than sudden death in general population

sudden unexpected death in epilepsy (SUDEP)
- cardiac or respiratory failure
- may occur in period following sz

112
Q

why may death occur with status epilepticus

A

brain physiology changes resulting in cardiac arrhythmia and/or respiratory failure, hypoxia

113
Q

what are 5 main activity precautions for someone w epilepsy

A

driving motorized vehicles
drowning / water activity
ascending heights / falls
working w fire/cooking
working w power tools

114
Q

what is a consideration of drowning precautions

A

can drown in an inch of water in a minute
- avoid water or make sure monitored by someone

115
Q

what is Todd’s paresis

A

weakness seen in post-ictal state tends to last for long period of time

116
Q

what are PT considerations for sz management (6)

A
  1. adhere to sz precautions
  2. awareness of triggers and prodromal signs
  3. post-ictal sx
  4. clinical reasoning of when to call 911
  5. empower self management
  6. consider setting specific
117
Q

what are some post-ictal sx (5)

A

weakness
lethargy
confusion
HA
todd’s paresis

Neuro Rehab 2 (48 decks)

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