Neuro Seizures Flashcards by Caroline Bouillon

define epilepsy

at least two unprovoked seizures more than 24HRs apart

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define seizure

paroxysmal event due to abnormal synchronous charge of CNS neruons

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how does a seizure present?

sudden, involuntary movement
OR
sudden loss of consciousness 
OR
BOTH!

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two types of focal/partial seizures

*what differentiates them

simple partial
complex partial
*whether PT has impaired consciousness or not
NOT total LOC—bc that is generalized seizure

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impaired awareness usually assoc with which general class of seiures?

generalized

tonic-clonic
tonic
clonic

NON-Motor:
-absence

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abnormal discharge from ONE discrete section of one hemisphere?

focal or partial seizures

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simultaneous discharge of both hemispheres

generalized

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can focal seizures be just motor?

no, can be motor or non-motor
*dep which lobe is affected

non-motor: sensory things

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can a focal seizure evolve to become a generalized seizure?

yes

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what is the MC ype of seizure in adults with epilepsy?

focal seizures with impaired awareness—complex partial

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What clinical characteristics defines seizures as generalized or partial?

Generalized seizures are assoc with COMPLETE loss of consciousness

Partial is preserve wakefulness

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MC lobe focal seizure arise from

temporal

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muscular rigidity

tonic

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rhythmic jerking

clonic

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MC type of seizure in elderly?

partial (focal) seizures

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Todd’s paralysis

after having a simple partial/focal seizure.. the post-itctal phase PT may develop neurologic deficits that are focal…. such as hemiparalysis lasting minutes—hours

*resolves in 24 hours

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some typical CM for focal seizure in general

focal sensory, motor OR autonomic s/s: dep on lobe affected

Motor: clonic movements or tonic movements, Jacksonion march

Sensory: paraesthesias, numbness, pain, heat, cold, sensation of movement, olfactory, flashing lights (photopsia)

Autonomic: abdominal (pain, N/V/, hunger), cardiovasc (ST), BP changes, bronchoconstriction

Psycologic: fear, dejavu, hallucinations,

Automatisms: lip smacking, facial grimacing, chewing, manual picking, patting, coordinated movements, or repeating words/phrases—–may then accompany complex partial seizure

*aruas can precede seizure

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Jacksonian march

motor aspect of partial seizure.. starts in one area (focal) and then spread to other parts of affected limb or body

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Automatisms

what is it
seen with what seizure

seen with partial/focal seizures (MC complex partial)

-repetitive behaviors.. ex lip smacking

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What seizure is similar in nature to absence seizure in terms of s/s?

complex partial

esp with the blank stare or loss of awareness

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how to differentiate b/w absence and complex partial seizure?

with complex partial—pt can have postictal state where that doesnt happen with absence!

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is there an aura preceeding a focal/partial seizure?

YES!!!

*aura can be similar to actual seizure itself

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V
I
T
A
M
I
N
S
\+
G

tell us causes of seizures

Vascular–stroke, bleed, AVM
Infection–meningitis, encephlaitis, abscess
Trauma–esp penetrating
Autoimmune–CNS vasculitis
Metabolic–hypoglycemia***, hypoNA/CL/MG, hypoxia, drugs OD/withdrawl
Idiopathic–2/3 of new onset seizures!!!
Neoplasms—
Pyschiatric—-
+
G—geneic and developmental

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MCC for 2/3 of new onset seizure

idiopathic

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common drug that can decrease seizure threshold?

antihistamines

for any seizure, what lab studies do we want to order

- oxygen sat - glucose, cbc, metabolic panel - pregnancy - Lactate level---elevated w.in 2 hours of tonic-clonic seizure - toxins in blood and urine - genetic testing (more so outpatient)

what diagnostic tests do we order for any seizure?

EKG--arrhythmias - neuroimaging---MRI IS SUPERIOR TO CT-NC - LP is suspecting men/enceph - EEG

what must we do prior to LP?

head CT!!!!

when would an EEG be normal?

1. if PT not actively seizing (normal or abnm b/w events) | 2. some focal/partial seizures

EEG always abnormal with?

tonic-clonic

can an EEG localize a seizure focus?

yes

do we place things in PTs mouth when they are seizing >

define status ep

single, continuous epileptic seizure lasting 5 mins or greater OR more than 1 seizure within a 5 min pd w/o recovery in b/w episodes

treat seizures over ____ minutes

TX of absence: 1st line 2nd line

1st---Ethosuximide (anti-epileptic) | 2nd---Valporic acid or lamotrigine

Tx with Ethosuximide for....

absence seizure | kids

MC age group for absence seizure

childhood------4-10 yrs | *usually ceases by puberty

drop attacks? | at risk for?

atonic (generalized) seizure | high risk for head injuries---PT need to wear helmets

loss of consciousness followed by rigidity

tonic seizure ---generalized

sudden brief sporadic invol twitching. may be one mucle or a group of muscles NO loss of consciousness

myoclonic---

repetitive jerking movements usually lasting <2-3 mins oft assoc with postitacl state

clonic seizure---generalized

what is increased in the blood after a generalized seizure?

prolactin and lactic acid!!! | *good to get these values to see if PT has a real seizure or pseudoseizure

Tx for SE: 1st line 2nd line 3rd line

1st--IV BEnzos------ **Lorazepam (ativan) ( ***midazolam IM if IV cant be established 2nd----phenytoin or Fosphenytoin if no resp to benzos 3rd line---phenobarbital is no resp to phenytin (NOW IT IS REFRACTORY)

MC type of seizure due to metabolic disturbance?

tonic-clonic

what does EEG look like for tonic phase of seizure

Low voltage.. fast acitivity..

What does EEG look like for clonic phase of seizure

high amplitude interrupted by spike and slow wave pattern

EEG looks like for postictal phase

diffuse slowing of cerebral activity

consciousness impaired with atonic seizure? postictal phase? usually associated with_____

yes.. about 1-2 seconds NO postictal confusion state Normally assoc with epilepsy syndrome

sudden, brief loss of consciousness WITHOUT loss of postural tone

absence seizure | "daydreamer"

is there postictal phase with absence?

what is the main seizure type in children with epilepsy?

absence

EGG shows-generalized, symmetric, 3-Hz spike-and-slow-wave discharges that begins and ends suddenly, superimposed on a normal EEG background

absence seizure

what seizure is assoc with structural CNS abnormalities?

atypical absence | *same as absence but with longer pd of LOC and +postical confusion

EEG: shows hypsarrhythmia...

Epileptic spasms | *seen with infants

EEG: diffuse, giant slow waves with a chaotic background or irregular multifocal spikes and sharp waves

Hypsarrhythmia---seen in infants with epileptic spasms

seizure in a child who is age 3-6MO in the setting of a fever w/o CNS infection

febrile seizure

MC illness febrile seizures are seen wiht?

acute respiratory illnes

what is prognosis for febrile seizure? what is likelihod of develop into epilepsy"?

good prognosis | very rarely evolve

recurrence of febrile seizure?

common...30-50% of cases

Risk factors that increase likelihood of a febrile seizure to result in epilepsy

- Family history of epilepsy - abnormal neurologic or developmental status - focal seizure > 15 min

age range for febrile seizures

6MO-5 years

good way to differentiate b/w syncope and seizure?

*brief sweating PD before syncope

which AED is contra in pregnancy and for PT <2YO

Valporic acid

What AED is good for febrile seizures and kids in general

Phenobarbitol

Non-pharmacologic tx for epilepsy?

1. surgery---MC is temporal lobectomy 2. Vagus nerve stim--refractory 3. ketogenic diet for peds

what is a complication from AEDs?

osteoporosis

Do PTs with epilepsy have incr/decr mortality?

2-3x higher than general public