MDT Seizures =[ Flashcards
of the population will have at least one seizure
5-10%
Highest incidence for seizures occurs in _______ and _____
early childhood and late adulthood
____________is characterized by recurrent unprovoked seizures
Epilepsy
An abnormal, excessive, hypersynchronous discharge from an aggregate of CNS
neurons
Seizure
Etiology of Seizure Young adults (18-35 years)
(a) Trauma
(b) Metabolic disorders (Alcohol withdrawal, uremia, hyper/hypoglycemia)
(c) CNS Infection
Etiology of Seizure Older adults (>35 years)
(a) Cerebrovascular disease
(b) Brain tumor
(c) Metabolic disorders
(d) Degenerative disorders (Alzheimer)
(e) CNS Infection
Classification of what?
(a) Depends on how much cortical involvement occurs with seizure
(b) Preictal phase can have auras that are associated to onset of seizure
(c) Focal seizure with retained awareness
2) Only one part of the brain is affected
3) Presentation depends on focal area involved
Classification of what?
(a) Depends on how much cortical involvement occurs with seizure
(b) Preictal phase can have auras that are associated to onset of seizure
(c) Focal seizure with retained awareness
(d) Focal seizure with impaired awareness
Partial Seizures
What type of partial seizure?
1) Formerly known as simple partial seizure
2) Only one part of the brain is affected
3) Presentation depends on focal area involved
For example: Seizure that begins in occipital cortex can lead to flashing lights sensation
Focal seizure with retained awareness
What type of partial seizure?
1) Formerly known as complex partial seizure
2) Only one part of the brain is affected
3) During seizure patient appears to be awake but not in contact with others in
environment and do not respond normally to instruction or questions
4) Patients often have no memory of what occurred during the seizure
5) May exhibit automatisms
a) Facial grimacing
b) Gesturing
c) Lip smacking
d) Chewing
e) Repeating words or phrases
Focal seizure with impaired awareness
What type of seizure?
1) Involves the entire brain
2) May or may not lead to alteration of consciousness
3) Most common type is the tonic-clonic seizure (AKA grand mal)
a) Tonic phase characterized by sudden muscle stiffening
b) Clonic phase characterized by rhythmic jerking
(1 Tongue biting is common in this phase
c) Episodes usually last 1-2 minutes
4) Other types
a) Absence seizure
b) Clonic seizure
c) Atonic seizure
Generalized seizures
What phase?
1) Somnolence, confusion or headache that may occur for several hours
2) Patient often have no recollection of event
3) Weakness of limbs may occur (“Todd paralysis”)
Postictal
what would you use in diagnosis of Seizure
Video EEG Monitoring
Definition:
Single seizure lasting more than or equal to 5 minutes or 2 or more seizure between which there is an incomplete recovery of consciousness
Status eplilepticus (EMERGENCY)
Treatment: Status eplilepticus (EMERGENCY)
(1 Diazepam 5mg IV/IM Q5-10 minutes; do not exceed 30mg
(2 Valproic acid 30mg/kg
(3 Correct any underlying problem that may be contributing to seizure
(4 Intubation
First Aid for seizure
a) Clear the room, maintain the airway if needed
b) For partial seizures, redirect gently
c) Started IV catheters (postictal phase)
d) Blood work
(1 Electrolytes, LFT, CBC
(2 Finger stick glucose
Treatment for active seizure
a) Diazepam 5 mg IV/IM Q5-10 minutes; do not exceed 30 mg
(1 MOA: Modulates postsynaptic effects of GABA transmission leading to increase in presynaptic inhibition
(2 Side effects: Ataxia, hypotension, respiratory depression
b) MEDEVAC immediately
What type of seizure
1) Not associated with abnormally excessive neuronal activity
2) Differences between epileptic seizure
a) PNES episodes usually last longer than 2 minutes
b) Patients eyes are closed during PNES events
c) Incontinence is less common in PNES
d) Usually there is no postictal phase in PNES
Psychogenic nonepileptic seizure
Psychogenic nonepileptic seizure
Diagnosis
video EEG (no changes in electrical activity
Treatment
Psychogenic nonepileptic seizure
Psychotherapy with cognitive behavioral therapy or interpersonal therapy
