Module 4 Flashcards
term “seizure” refers to a
sudden change in behavior caused by abnormal, synonymous electrical activity within the brain. Seizures can be provoked by an underlying medical condition or unprovoked.
Causes of provoked seizures include
febrile-related seizure in infancy, trauma, hypoglycemia, hyponatremia, hypocalcemia, drug abuse, and alcohol withdrawal. Provoked seizures are most often generalized tonic-clonic seizures
Epilepsy, by definition, is
a condition in which an individual is predisposed to seizures and has had two or more unprovoked seizures during their lifetime
Status epilepticus is defined as a
seizure lasting longer than 30 minutes or multiple seizures without return to baseline in a 30-minute period. This is a medical emergency
seizure body changes
Motor activity—jerking or stiffening of a limb
*Autonomic function—tachycardia or sweating
*Vision—seeing colored shapes
*Olfaction—smelling strange odors
*Language—aphasia
*Psychological feeling—déjà vu
*Sensation—paresthesias in one area of the body
*Consciousness
focal seizure definition
affects only one part of brain
generalized seizure
affects entire brain
Focal onset seizures are typically caused by
an underlying focal lesion or abnormality in the brain that acts as an epileptogenic seizure focus. A seizure focus can lie in any area of the cerebral cortex and thus, different patients’ seizures can vary quite dramatically from one another, depending on the area of brain affected
focal onset seizure is further classified on the basis of whether
consciousness is impaired during the attack
most common seizure in adults with epilepsy
focal seizure with impaired awareness (previously called partial seizures)
focal seizure, impaired awareness
pts appear awake, not aware of their surroundings
automatisms examples
, such as chewing, lip smacking, repeating words, or gestures
generalized onset seizures
associated with childhood onset generalized epilepsy syndromes
both hemispheres involved
consciousness briefly impaired
motor manifestations bilateral
EEG shows bilat hemisphere activity
absence seizure is a
nonmotor seizure that causes a sudden interruption of ongoing activities, typically with a blank stare. If the patient is speaking, speech will be slowed or interrupted; if the patient is walking, he or she will stand transfixed; if eating, the food will be stopped on the way to the mouth. The attack typically lasts a few seconds
most frequently encountered generalized seizures
tonic-clonic (Previously called grand mal)
tonic-clonic seizures
sudden, tonic stiffening of muscles, often associated with stridor or an ictal cry, and the patient falls to the ground in the tonic state. The patient lies rigid; during this state, tonic contraction inhibits respiration and cyanosis may occur. The tongue may be bitten, and urine may be voided involuntarily. The tonic stage then leads to clonic convulsive movements lasting a variable period of time. At the end of this stage, deep respiration will occur and all muscles will relax.
in the postictal period (the stage following a tonic-clonic seizure), the patient will have
a depressed level of conscious. The individual frequently goes into a deep sleep and may have a significant headache when awakened
Myoclonic jerks are
sudden, brief, shock-like contractions, which may be generalized or confined to the face and trunk or to one or more extremities. They may occur predominantly during sleep and are associated with certain generalized epilepsy syndromes.
Atonic seizures cause
a sudden loss of muscle control
Tonic seizures cause
sudden muscle stiffening.
drop attacks
associated with atonic and tonic seizure, causes sudden falls without warning
PNES
paroxysmal seizure-like events that arise from psychological disturbances rather than abnormal electrical brain activity.
Up to 80% of PNES are associated with
early sexual abuse, especially in females.
PNES are often comorbid with
epilepsy and can be considered to be a type of conversion disorder. It can cause significant morbidity including repeated hospitalizations and intensive care unit admissions
highest frequency seizures
young children, persons older than 65
disorders that initiate seizures
drug OD
drug withdrawal
head trauma
stroke
infection
tumor
systemic problems that cause hyperexcitable neurons
hypocalcemia
hypoglycemia
hyponatremia
hypoxia
antiepileptic drugs reduce
hyperexcitability of neuro cell membranes by slowing activation of sodium channels
GABA agonist MOA
counteract person’s tendency to have seizures
benzos
during seizure, brain metabolism
accelerates in affected area
increase in o2 use, glucose, lactate levels
Todd’s paralysis,
which is a transient hemiparesis following some seizures
seizure dx labs
ecg, cbc, cmp, UA, drug screen
seizure imaging
1st time- CT or MRI to eval for lesion
EEG
In adults presenting with a first-time unprovoked seizure, the risk of recurrent seizure is greatest in
the first 2 years after the seizure (21%–45%)
1st seizure tx
workup performed, antiepileptic therapy not required unless pt experiences recurrent activity
structural lesions associated with recurrent seizures
brain tumor
AVM
if a patient has uncontrolled epilepsy requiring multiple antiepileptic drugs,
consultation with a neurologist should be considered.
antiepileptic drugs have possible increased risk of
suicidality
seizure precaution
take showers, not baths
swim only with partner
cook with microwave or back burners
avoid climbing ladders
Alzheimer’s disease (AD) is
a progressive, neurodegenerative condition and the most common form of dementia
sixth leading cause of death overall, fifth leading cause of death for individuals older than 65 yrs
AD is characterized by an
insidious onset; slow, progressive cognitive decline; and an array of emotional and behavioral problems that result from cognitive decline
The cognitive decline in AD manifests as an
impaired ability to learn new information or recall previously learned information and one or more additional cognitive disturbances in language (aphasia), function (apraxia), perception (agnosia), or executive function
The incidence of the sporadic form of AD in the general population increases rapidly with
age
additional alzheimer’s risk factors
lower educational and occupational levels, family history, head injury, Down syndrome, and vascular disease
For 60- to 70-year-old individuals with AD, the average life expectancy is
7 to 10 years after diagnosis.
The rare familial form of AD typically has
an earlier onset. Inheritance is autosomal dominant
Neurons that use the neurotransmitter ________ are especially susceptible to the alzheimers
acetylcholine
Pathologic changes seen in brains of patients with AD include
neuritic plaques and neurofibrillary tangles
Each plaque has a core of
beta-amyloid, an insoluble peptide
One major protein in these tangles is an aberrant form of
tau protein (which, in its normal form, stabilizes microtubules), and patients with AD have elevated concentrations of tau proteins in their cerebrospinal fluid.
often AD symptoms initially presented by
family members before pt
80% of AD pts in nursing homes have
behavioral problems
An easily administered bedside test for cognition is
the Montreal Cognitive Assessment
refer to memory disorder center
if atypical presentation, severe impairment, complex comorbidities
AD diagnostic tests
CBC, CMP, TSH, B12
MRI, CT, PET
two categories of serum biomarkers being studied to determine relevance to diagnostic criteria
beta-amyloid accumulation
biomarkers indicating level of injury
may be the most effective way to prevent the development of excess disability
Maintaining as much normalcy as possible in relationships and everyday activities
Treatment with this med for AD should be considered at the time of diagnosis
cholinesterase inhibitors (donepezil, reminyl, exelon)
doesn’t prevent progression, seems to slow rate of decline
