export_seizures Flashcards
Seizure
-‘abnormal excessive or synchronous neuronal activity in the brain’ –involuntary changes in awarness or behavior
Epilepsy
recurrent, unprovoked seizures due to inherent brain dysfunction - different from seizures provoked by transient, reversible abnormalities (metabolic:hyponatremia, drug withdrawal, drug intox)
Focal epilepsy most commonly from
-most from mescal temporal/hippocampus
Epilepsy epedimiology
- High in early childhood. (genetic, congenital malforms, trauma, neoplasm) - Decreases till 60-> vasc disease, neoplasm*, trauma, infections, neurogenerative. vasc more likely?
Simple Partial Seizures
-Begins in definitive area of brain, does not effect consciousness. -autonomic/psychiatric symptoms–> often overwhelming fear/depersonilization
Complex partial Seizures
A seizure that begins in definitive area in brain and DOEs affect consciousness. Aura is ALWAYS sign of focal seizure
Primary generalized seizure
Affects whole brain at same time– consciousness is lost. -Ie. absence, atonic, tonic and tonic-clonic
Secondarily generalized seizure
affects single part of brain then spread to rest of the brain
Todd’s Paralysis
focal neurological deficit, usually weakness that persists up to 24 hours after a seizure
Epilepsy Syndrome
seizure classification scheme which includes type of seizure, their localization, frequency, sequence of events, circadian distribution, precipitating factors, age of onset, mode of inheritance, physical or mental symptoms and signs, prognosis, and response to treatment
Absence Seizure
-Staring -Primary generalized -EEG-spike and wave activity at 3 cycles per second -no post ictal
Juvenile myoclonic syndrome
- Myoclonic jerks, typically upon waking -triggers: sleep deprivation, classic- teenager after all nighter -EEG:generalized polyspike and wave discharge diffusely throughout at 4-6 Hz -TX: Depakote; or keppra
Lennox-Gasaut Syndrome
Typically occurs in children ages 2-6. Seizures are very difficult to control. • Multiple seizure types, which vary among patients, include tonic (stiffening of the body, upward deviation of the eyes), atonic (brief loss of muscle tone and consciousness), atypical absence, and myoclonic (sudden muscle jerks).
West Syndrome/tuber sclerosis
A syndrome of infants that consists of the triad of infantile spasms, a pathognomonic EEG pattern (high amplitude waves and a background of irregular spikes) called hypsarrhythmia and mental retardation. • The best treatment is with adrenocorticotropic hormone.
Benign rolandic epilepsy
-The most common epilepsy syndrome in children. Characterized by nocturnal seizures. • Has characteristic centrotemporal spikes. • Rarely needs treatment, children only have a few seizures and it always remits by age 16.
Landau-Kleffner Syndrome
-Progressive aphasia in children affecting both Broca’s and Wernicke’s areas. Onset is typically seen b/w 3-5 y/o. -80-85% will demonstrate epileptiform activity during non-REM sleep
Jacksonian March
Pattern of seizure progressing up someone’s body before generalizing.
Tuberous Sclerosis
-cortical tubers, ash-leaf macules, GERD - tx: ACTH can prevent infantile spasms associated with TS by reducing CRH made ( excess excitability) -INFANTILE SPASMS
Gelastic Seizure
-laughing fits -Hypothalamus neoplasm
Syncopal Event
-Vasovagal -Can have convulsive movements -Absence of emotional cue (cardiac etiology)
Non-Epileptic Seizures
-Pseudoseizures -different movements, lasting different amounts of time - VS> epileptic seizures are stereotypic ( identical for certain patient in duration/presentation) -R/O epilepsy -EEG can help differentiate -
Mimics of seizure
The differential of a possible epileptic attack is quite large and includes anything that can cause a sudden, paroxsymal change in consciousness or neurological symptom. Common mimics of seizures include: syncope, transient ischemic attacks, migraines, movement disorders, narcolepsy/cataplexy, psychiatric pathology/non-epileptic seizures (NES), and malingering. It is important to note that in many patients NES and epileptic seizures may coexist.
Electrolyte abnormalities in Seizure
- hypomagnesia, hyper/hypo-glycemia, natremia, HYPO-calcemia
Depakote
-Valproic acid -Anti-epileptic -WEIGHT GAIN -Class D in pregnancy–> neural tube defects
Topimarate
-Topamax -Anti-epileptic - KIDNEY STONES
Oxcarbazepine,carbamazepine
-HYPONATREMIA
Phenytoin
-CEREBELLAR ATROPHY
Lamictal
-Stevens-Johnson syndrome
Simple Febrile Seizure
A GTC that lasts less than 1 min and doesn’t occur again within 24hrs…associated with a febrile state
RF for epilepsy
-seizures >15 min, not generalized but with focal fetters, and structural abnormalities on imaging
Complex Febrile Seizure
-focal features >15 min, or recurs in 24 hours -3% will develop epilepsy -should be treated if complex,
Status Epilepticus
-life threatening ->5-10 min or seizures without regaining consciousness in between >30 min Benzos first line; IV phenytoin not given too quickly bc risk of cardiac arythmias
Epilepsia Partialis Continua
-persistant focal motor seizure, typically involving hand and foot
AED-principles
-Try to get dosage so one type will treat epilepsy -if no response, add more; but chance that 2nd will treat is only 10% -Make sure non-compliance is not the issue
Epilepsy interventions
-Most common-remove temporal lobe -determination of the focus is very important as to make sure no deficits occur in the patient ( other lobes as well) -Corpus collostomy in its with partial seizures to stop spread - Sometimes ( ie. Sturge Weber syndrome) –> need dramatic surgical procedures -Vegas stimulation
Carbamazepine (Tegretol)
-partial seizures -SE: can worsen absence, myotonic, atonic. Hyponatremia, vertigo, HA, ataxia, blood dyscriasis
