Neuro Seizures Flashcards
define epilepsy
at least two unprovoked seizures more than 24HRs apart
define seizure
paroxysmal event due to abnormal synchronous charge of CNS neruons
how does a seizure present?
sudden, involuntary movement OR sudden loss of consciousness OR BOTH!
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
impaired awareness usually assoc with which general class of seiures?
generalized
- tonic-clonic
- tonic
- clonic
NON-Motor:
-absence
abnormal discharge from ONE discrete section of one hemisphere?
focal or partial seizures
simultaneous discharge of both hemispheres
generalized
can focal seizures be just motor?
no, can be motor or non-motor
*dep which lobe is affected
non-motor: sensory things
can a focal seizure evolve to become a generalized seizure?
yes
what is the MC ype of seizure in adults with epilepsy?
focal seizures with impaired awareness—complex partial
What clinical characteristics defines seizures as generalized or partial?
Generalized seizures are assoc with COMPLETE loss of consciousness
Partial is preserve wakefulness
MC lobe focal seizure arise from
temporal
muscular rigidity
tonic
rhythmic jerking
clonic
MC type of seizure in elderly?
partial (focal) seizures
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
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
Jacksonian march
motor aspect of partial seizure.. starts in one area (focal) and then spread to other parts of affected limb or body
Automatisms
- what is it
- seen with what seizure
seen with partial/focal seizures (MC complex partial)
-repetitive behaviors.. ex lip smacking
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
how to differentiate b/w absence and complex partial seizure?
with complex partial—pt can have postictal state where that doesnt happen with absence!
is there an aura preceeding a focal/partial seizure?
YES!!!
*aura can be similar to actual seizure itself
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
MCC for 2/3 of new onset seizure
idiopathic
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?
- 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 >
no
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
5
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?
NO
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?
- surgery—MC is temporal lobectomy
- Vagus nerve stim–refractory
- 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
