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Clin Med 3 Final Exam > Lecture 1-seizures > Flashcards

Lecture 1-seizures Flashcards

1
Q

seizure definition

A

A sudden, excessive electrical discharge in the brain characterized by a variety of
symptoms, including uncontrolled
movements of the body, disorientation,
confusion, or loss of consciousness.

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2
Q

epilepsy definition

A

condition in which a person has recurrent
seizures due to a chronic, underlying process.
– At least 2-3 seizures w/o clear precipitatingfactors.
– Epilepsy may be considered a “syndrome”
consisting of several events (seizures).
• A person with a single seizure, or a recurrent seizure due to a correctable circumstance
does not necessarily have “epilepsy.”

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3
Q

Seizure etiologies

A

Trauma: birth trauma (hypoxia), head injury
• Congenital defects
• Metabolic: hypoglycemia, hyponatremia, hypo- or hypercalcemia, uremia, Reye’s syndrome.
• Infection: meningitis, encephalitis, abscess
• Drugs: theophylline, lidocaine, cocaine, etc.
• Drug w/drawal: EtOH, narcotics, anxiolytics, anticonvulsants, steroids.
• Other toxins: lead, organic phosphates, etc.
Neoplasia: primary and metastatic lesions.
• Vascular: CVA (ischemia vs. hemorrhage),
arteritis, sickle cell disease, hypertension, A-V malformation.
• Degenerative neurologic disease
• Childhood febrile seizures
– 3-5% of normal children.

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4
Q

ictal

A

during the seizure

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5
Q

interictal

A

between seizures

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6
Q

postictal

A

after the seizure

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7
Q

repetitive flexion/extension movements

A

clonic

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8
Q

rigid posturing/continuous muscle tension

A

tonic

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9
Q

tonic/clonic

A

combo of tonic and clonic movements

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10
Q

factors that lower the seizure threshold making seizures more likely

A

epileptogenic

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11
Q

having characteristic seizure activity (spiking) on EEG

A

epileptiform

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12
Q

types of partial seizures

A

simple partial
complex partial
partial with secondarily generalized

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13
Q

types of generalized seizures

A 
generalized tonic-clonic
absence
tonic
atonic
myoclonic
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14
Q

arise from a focal area of the brain and progress in a manner consistent with the area of irritation (what type of seizure is this)

A

partial seizure

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15
Q

do simple partial seizures have alteration of consciousness?

A

no; patient is able to interact with others and remember the event

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16
Q

do complex partial seizures have alterations in consciousness?

A

yes; impaired consciousness; unable to respond to visual or verbal commands; reduced awareness in postictal period

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17
Q

what type of seizure can become secondarily generalized

A

complex parial

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18
Q

SPS (simple partial seizure) motor symptoms

A

start in motor cortex, can be a twitch or include jacksonian march or todds paralysis

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19
Q

clonic movements starting in hand or foot and progressing to involve whole limb (seizure type?)

A

jacksonian march (SPS)

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20
Q

paralysis that lasts minutes to hours (cant move arm/leg; may be mistaken for stroke) seizure type?

A

todds paralysis (SPS)

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21
Q

SPS sensory cortex symptoms

A

parathesias, numbness, tingling of arm, face etc.

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22
Q

SPS temporal lobe symptoms

A

deja vu, epigastric discomfort

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23
Q

SPS occipital lobe symptoms

A

flashing lights, visual changes

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24
Q

CPS (complex partial seizure) clinical picture

A

Combination of focal motor and focal sensoryactivity, with alteration of consciousness.
(also called “psychomotor seizures”)
• May exhibit bizarre behavior.
• Exaggerated emotions.
• Episodic fluctuations in attitude, attention, behavior, and memory.
• Epigastric and abdominal sensations.

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25
Q

CPS seizure progression

A

Seizure may begin with an aura.

• Ictal phase
– Sudden behavioral arrest or motionless stare.
– Automatisms: involuntary, automatic behaviors, eg. chewing, lip smacking, swallowing, hand movements, emotionaloutburst, running, etc.

• Postictal: confusion, amnesia

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26
Q

Bilateral generalized electrical discharge arising from both cerebral hemispheres simultaneously (seizure type?)

A

Generalized

27
Q

Absence or petit mal seizure clinical picture

A

Characterized by sudden brief loss of consciousness without loss of postural control.
– Lasts only a few seconds.
– Consciousness returns promptly.
– No postictal confusion.
– automatisms
– May be confused with “daydreaming.”
Almost always begin in childhood or early adolescence.
• Person is “absent” to higher cortical function during the attack.
• May occur hundreds of times per day!

28
Q

Characteristic EEG pattern for absence seizures

A

generalized spike and wave pattern

29
Q

main seizure type in 10% of people with epilepsy

A

Generalized Tonic-Clonic

30
Q

most common seizure type due to metabolic problems

A

generalized tonic-clonic

31
Q

GTC (generalized tonic clonic) typical presentation

A

Usually begins abruptly, w/o warning.
• Occasional promonitory signs beforehand.
-sudden LOC, falls to ground, has tonic then clonic, then postictal phase

32
Q

Tonic Phase of GTC

A

– Tonic phase (lasts 10-40 sec):
• generalized tonic contractions - body rigid; jaw clenched; loud moan or cry; eyes roll back.
• Increased BP, HR, pupil size; cyanosis.

33
Q

Clonic phase of GTC

A

– Clonic phase (30 sec to 3 min):
• Muscle groups relax & contract; jerky movements.
• May froth at the mouth; lose bowel/bladder control.

34
Q

Postictal phase of GTC

A 
Postictal phase (minutes to hours):
• confused, sleepy; c/o HA, body ache; amnesia.
35
Q

Continuous seizures, or recurrence without regaining consciousness is called (seizure type?)

A

status epilepticus

36
Q

automatisms

A

Accompanied by subtle, bilateral motor

signs such as rapid eye-blinking, chewing, slight rapid movements of hands (automatisms).

37
Q

status epilepticus is a medical emergency bc it can lead to:

A

cardiorespiratory dysfunction
• metabolic derangements
• hyperthermia
• irreversible brain damage after 2 hours.

38
Q

what do status epilepticus seizures look like as they continue?

A

Seizures can be more subtle as they last longer. Beware continued
unresponsiveness.

39
Q

Sudden, brief generalized muscular contraction, of limbs and trunk. (seizure type)

A

generalized myoclonic

40
Q

causes of generalized myoclonic seizures

A
  • metabolic disorders
  • degenerative CNS diseases
  • anoxic brain injury
41
Q

benign form of myoclonus (localized or generalized)

A

sudden jerking movements experienced by some normal people as they are falling asleep.

42
Q

atonic seizure clinical picture

A

Sudden loss of postural tone lasting 1-2 seconds.
– Consciousness briefly impaired.
– No postictal confusion.
– May cause brief drop of head or nodding mvmt.

43
Q

longer atonic seizures will result in

A

falls to the ground

44
Q

what seizure type is usually associated with other forms of epilepsy?

A

atonic seizures

45
Q

where do you look for injuries that may have occured during a seizure?

A

Scalp, tongue, neck, back, extremities.

46
Q

while obtaining a history from a pt that had a seizure what is really important?

A

talking to someone that witnessed an event

47
Q

labs to order for a seizure patient?

A
  • CBC, U/A
    • Comprehensive metabolic panel (CMP): glucose, electrolytes, Ca++, renal & liver tests.
  • Serum magnesium
  • Toxicology screen
    – prescription & illicit drugs
    – drug levels (eg. theophylline, anticonvulsants)
  • Serology - syphilis screen
48
Q

all new onset seizure patients need

A

imaging studies: cranial CT, MRI, CXR

49
Q

Key diagnostic test for seizures

A

EEG

50
Q

specialized test that may be needed in patients with refractory seizures

A

PET or SPECT

51
Q

acute seizure treatment

A

ABC’s: Airway, Breathing, Circulation

– Do not try to put anything in patient’s mouth.– Turn patient on side; protect head from injury.

52
Q

Status epilepticus treatment

A 
- I.V. access--anticonvulsant I.V.
– 50% Glucose (50cc).  
- Narcotic antagonist?  
- Thiamine 100mg i.v.
– Review STAT lab work.   
- Cardiac monitoring
53
Q

IV anticonvulsant used for status epileticus

A

IV lorazepam/diazepam or iv phosphenytoin or phenytoin: loading dose followed by continuous infusion

if seizure persists: phenobarbital IV/ midazolam infusion

54
Q

Chronic epilepsy treatment

A

Treat underlying condition.

  • Avoid precipitating factors (video games, stress, sleep deprivation)
  • Antiepileptic Drug Therapy (AED Tx).
  • Neurologist consultation (suggested for most cases of epilepsy)
  • Counseling re: driving, vocational issues, and depression.
55
Q

anti-epileptic drug therapy general considerations

A
  • Antiepileptic drugs of choice for each type of seizure disorder
  • AED Therapy is almost ALWAYS started with a SINGLE DRUG, titrated upwards.
  • Follow blood levels to keep in therapeutic
    range.
    • Patient education is CRUCIAL - to promote compliance with regular use of AED’s.
    • Be alert to potential drug interactions.
56
Q

myoclonic/atonic seizure first line drug

A

valproic acid

57
Q

focal onset seizures first line drugs

A
  • carbamazepine
  • phenytoin
  • valproic acid
58
Q

GTC first line drugs

A
  • valproic acid
  • carbamazepine
  • phenytoin
59
Q

absence seizure first line drugs

A
  • ethosuximab

- valproic acid

60
Q

% of epileptic patients resistant to medical tx

A

20%

61
Q

refractory epilepsy tx options

A
  • surgery: temporal lobectomy, lesionectomy, corpus callosotomy
  • Vagal nerve stimulation
62
Q

temporal lobectomy outcomes

A

70% seizure-free and 15-25% have 90% reduction in

seizures.

63
Q

Vagal nerve stimulation

A

pacemaker like device for partial seizures

Clin Med 3 Final Exam (6 decks)

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