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Setha: Neuro > Reisert: Seizures > Flashcards

Reisert: Seizures Flashcards

1
Q

Paroxysmal event due to abnormal CNS discharge with resultant manifestations depending on area involved

A

seizure

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2
Q

5-10% of population in lifetime

More prevalent in early childhood and later in adulthood

A

Seizure

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3
Q

Patient with reccurent seizures

0.3-0.5% of population

A

Epilepsy

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4
Q

Two types of seizures?

A

Partial and Generalized

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5
Q

Deranged area of cerebral cortex often due to a structural anomaly

Consciousness is preserved

A

Simple partial seizure

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6
Q

Third type of partial seizure?

A

Partial seizure secondarily generalized

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7
Q

partial seizure where consciousness is impaired

A

complex partial seizure

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8
Q

Diffuse region of brain firing simultaneously

Often a widespread problem:

Cellular disorder (mental retardation)

Biochemical disruption (low sodium)

Structural issue (brain tumor)

A

Generalized seizure

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9
Q

Motor, sensory, autonomic psychic but without loss of consciousness. Often clonic with repetitive flexion/extension

Example: hand tremor on opposite side of abnormal brain activity

______ partial seizure

A

Simple

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10
Q

EEG shows abnormal impulses in focial area of brain

A

Simple partial seizure

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11
Q

Jacksonian March

Todd’s paralysis

Epilepsia partialis continua

A

Variations of simple partial seizures

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12
Q

Motor activity begins distally, like fingers, and spreads to whole extremity

EEG: spike waves

Which variation of simple partial seizure?

A

Jacksonian March

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13
Q

Local paresis lasting minutes to hours

What variation of simple partial seizure?

A

Todd’s paralysis

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14
Q

Continues hours to days

What variation of simple partial seizure?

A

Epilepsia partialis continua

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15
Q

Changes in somatic sensations (paresthesias)

Change in vision (flashing lights, hallucinations)

Changes in equilibrium (falling, vertigo)

Autonomic changes (flushing, sweating)

Odd feelings (déjà vu)

Sx of what type of seizures?

A

Simple partial seizures

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16
Q
  • Focal activity progresses to loss of contact with environment (ictal stage)
    • Stare and amnesia
  • Often begins with aura stereotypical for patient –> feel funny
  • Followed by ictal stage
    • involuntary behaviors
    • chewing, picking
  • Post inctal confusion
  • Lasts seconds to hours

Signs/Sx of _______ partial seizures?

A

Complex

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17
Q

EEG between spells (inter ictal) usually normal or brief discarhge of spikes

A

Complex partial seizures

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18
Q

electrical discharge spread and both hemispheres become involved

Results in tonic-clonic seizure

Common when partial seizures in frontal lobe –> look like generalized seizures

A

Partial seizures with secondary generalization

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19
Q

Arise in both cerebral hemispheres simultaneously

Look like focal seizure that secondarily generalized though not associated with specific focal onset event

A

generalized seizures

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20
Q

Absence seizures and tonic-clinic seizures

These are included in ______ seizures?

A

generalized

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21
Q

Brief loss of consciousness without postural control that lasts a few seconds

No post ictal confusion

Other subtle findings include: eye blinking, chewing, clonic movements of hands

A

Absence seizures (petit mal)

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22
Q

Onset: typically childhood - 4-8 y/o or early adolescence

15-20% of childhood seizures

May occur all day long –> daydreaming appearance

A

Absence seizures

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23
Q

EEG shows symmetrical discharge

Spike and wave

Start stop with inter-ictal normal EEG

Worsens with hyperventilation manuever

A

Absence seizures

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24
Q

_________ seizures may be associated with T-C seizures

A

Absence

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25
Q

What % of cases of absence seizures remiss in childhood?

A

60-70%

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26
Q

Similar to absence but symptoms last longer and have more motor features

May have brain abnormality such a mental retardation/developmental delay

Harder to tx than absence seizures

A

Atypical absence seizures

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27
Q

Which seizures are considered grand mal?

A

Generalized tonic-clonic seizures

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28
Q

10% of patients with epilepsy

Most common type when seizures are due to metabolic derangement

A

Generalized tonic-clonic seizures

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29
Q

Episodes often of sudden onset

May have prodrome but less so than aura in focal seizures that secondarily generalize

A

Generalized tonic-clonic seizures

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30
Q

Tonic phase: increased muscle tone

Often moan or cry

Change in respiration: secretions pool, cyanosis, jaw clenches, bite tongue

Sympathetic sx: increased BP & HR, pupil dilation

Characteristics of what type of seizure?

A

T-C seizures

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31
Q

Clonic activity: muscles relax and contract, usually lasts about a minute

Post-ictal state: unresponsive, flaccid, salvation or airway obstruction, bowel/bladder incontinence

May last min - hours before awakening

Post seziure: HA, fatigue, muscle aches

Characteristics of what type of seizures?

A

T-C seizures

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32
Q

Tonic phase: Increased low voltage fast activity with high amplitude polyspike discharges

Clonic phase: spike and wave activity develops

Post-ictal: slowing then recovery

EEG for what type of seizures?

A

T-C seizures

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33
Q

_________ and ________ are variations of T-C seizures

A

Atonic and Myoclonic seizures

34
Q

1-2 sec lose motor tone

brief loss of consciousness

no post-ictal confusion

associated with other epileptic syndromes

A

Atonic seizures

35
Q

When are you at risk of atonic seizures?

A

After head injury

36
Q

Brief contraction or jerk similar to when you fall asleeo and you twitch

A

Myoclonic seizures

37
Q

Myoclonic seizures are seen in _______ injury

A

brain

38
Q

Bilateral jerk with maintained consciousness

Worse with awakening, sleep deprivation

Seen in adolescence

A

Juvenile myoclonic epilepsy

39
Q

benign

good response to meds

may spontaneously remit

A

Juvenile myoclonic epilespy

40
Q

Seen in children

Usually impaired cognitive function

Associated with CNS disease: developmental delay, trauma, infection, neural injuries

EEG: slowing and spike waves

Often difficult to control

A

Lennox Gastaut syndrome

41
Q

Difficult to control

partial epilepsy with characteristic features

MRI shows hippocampal sclerosis

A

Mesial temoral lobe epilepsy

42
Q

Shift in balance of excitation and inhibition in CNS

A

Etiology of seizures

43
Q

Change in seizure threshold (fevers in children)

Genetic role

Traumatic brain injury

Other events including strokes, infection

Mechanisms of _________

A

seizures

44
Q

Stress

Sleep deprivation

Menses

Medications

A

precipitating factors of seizures

45
Q
  • A burst of electrical activity
  • Influx of extracellular calcium
    • Excitatory molecules such as NMDA (N-methyl-D-aspartate) may further calcium influx
  • Influx of sodium
    • Under influence of GABA (Gamma-aminobutyric acid) or potassium channels
  • Spike discharge
  • Inhibitory neurons overwhelmed by calcium and potassium
  • Propagation of action potentials
  • Channel problems may be source of genetic epilepsy
A

seizure

46
Q

Birth injury

Hypoxemia

Congenital abnormalities

Drugs (maternal)

Cause seizures in what age range?

A

Neonates

47
Q

Febrile seizures

seen in which age range?

A

Early childhood

48
Q

What % of children have febrile seizures?

A

3-5%

49
Q

3mo-5 years

Most commonly 18-24 mo

A

Febrile seizures

50
Q

Otitis media

Respiratory infection

Gastroenteritis

Infections seen with which type of seizure?

A

Febrile seizures

51
Q

Early on in febrile illness T-C activity

Can be simple (one event) or complex (repeated activity)

NOT epilepsy

Recurrence about 1/3 of patients

A

Febrile seizures

52
Q

Age where epilepsy becomes apparent

A

Childhood

53
Q

Think trauma

Worse the trauma, worse the seizures

A

Seizures in adolescence

54
Q

Cerebrovascular disease (50% new onset seizures)

Trauma

CNS tumor

Degernative disease

Medical (Hypo/hyperglycemia, renal failure, liver dx, drugs)

A

Seizures in adulthood

55
Q

______ is key (observe/bystander) when diagnosing a seizure disorder

A

History!

56
Q

ASAP to measure brain activity: awakeness/activity

Burst of action potentials

Baseline alpha wave (8-13 Hz) with eyes closed

Faster beta activity (>13 Hz) increase with activity /eye opening

Slower theta activity (4-7 Hz) and delta (<4 Hz)

A

EEG to diagnosis seizure disorder

57
Q

Awake/sleep

Eyes open/closed or with photo stimulation

Hyperventilation

Sleep deprivation

_____ situations assessed for seizure disorder

A

EEG

58
Q

Abnormal activity that starts/stops abruptly or abnormal acitivty during T-C seizure

A

EEG key findings with seizure disorder

59
Q

Inter-ictal may see spikes or sharp waves in ____% of cases (worse prognosis)

A

40%

60
Q
  • EEG
  • Imaging
    • Most get
    • MRI best
  • Blood tests
    • Usually normal
    • May see elevated prolactin level in first 30 mins.
A

Work up for seizures

61
Q

Diff dx with seizures

Tired, sweaty, tunnel vision

May have 10 sec of convulsive activity

A

Syncope

62
Q

Diff diagnosis with seizures

Non-epileptiform behvaiors that resembles seizures

Seen with stress/conversion reaction

Head turning, shaking, twitching, no LOC, pelvic thrust that waxes and wanes

A

Psychogenic seizures

63
Q
  • Basic life support
    • Vital signs, CPR
  • Treat cause if identified
    • Infection, tumor, drugs
    • Cerebrospinal fluid tap?
    • Imaging (MRI preferred)
  • Meds if more than one episode or high risk
    • 31-71% risk of second seizure in one year
  • Assess for likelihood of recurrence
    • Are meds needed long term?
    • 2 year trial on meds?
  • Safety
    • Work
    • Driving
A

Seizure treatment

64
Q

______ meds are first line seizure meds

______ meds are second line

A

Older

Newer

65
Q

If the patient is low risk

One seizure and then seizure free

Normal exam (no developmental delay, head injury, etc)

Normal EEG

DO SLOWLY

A

When you can consider stopping seizure drugs

66
Q

Some say if more than 15-30 mins

Others if > 15 seconds

May range from T-C seizure to more subtle

May need EEG to verify

A

Contiuous seizure

67
Q

Cardiovascular implications

Hyperthermia

Metabolic derangements

CNS injury

These are conconsidered a _________ in status epilepticus

A

Medical emergency!

68
Q

Metabolic problems

Drug toxicity

CNS infection or tumor

Head injury

Refractory epilepsy

Causes of ______

A

Status epilepticus

69
Q
  • Metabolic work up
  • Benzodiazepine (Lorazepam (Ativan®), diazepam (Valium®), midazolam (Versed®) [More water soluble than diazepam] others
  • Phenytoin (Dilantin®)
  • Phenobarbital
  • Anesthesia
    • Phenobarbital coma?
A

Treatment of status epilepticus

70
Q

Which type of seizure do you primarily use surgical treatment?

A

Refactory epilepsy

71
Q

Temporal lobectomy

Focal lesion removal

Corpus callosotomy

A

Surgical procedures for seizures

72
Q

Place bipolar electrode in left vagus nerve

Generator delivers a pulse

May take a while to work

MOA: may simply increase seizure threshold

A

vagal nerve stimulator

73
Q
  • Developmental delay/mental retardation
  • Parenting
  • Stigma
  • 2-3x greater death rate
  • Work? Driving?
  • Menstrual cycles may increase risk
  • Pregnancy
    • Seizures may worsen or improve in half of pts
    • May alter drug levels
    • Tx may cause birth defects
    • May affect contraception
A

Other issues seen with seizures

74
Q

What % of people with seizure like sx get CT?

A

100%!

75
Q

Seizure tx

Blocks voltage dependent calcium channels, modulating excitatory neurotransmitter release

Safe

Sedation and dizziness MC S/E

A

Gagapentin

76
Q

Tx for seizures

Binds alpha2-delta subunit of calcium channels reducing neurotransmitter release producing anti-nociceptive and antiseizure effects

Safe

Sedation and dizziness MC S/E

A

Pregabalin

77
Q

Treatment for partial seizures, post herpetic neuralgia, neuropathic pain in diabetes and spinal cord, and fibromyalgia

A

Pregabalin

78
Q

Carbamazepine

Phenytoin

Lamotrigine

Valproic acid

Tx for ______ seizures?

A

Partial

79
Q

Valproic acid

Iamotrigine

Carbamazepine

Phenytoin

Tx for ____ seizures?

A

Generalized

80
Q

Treatment for partial seizures, post herpectic neuralgia and neuropathic pain

A

Gabapentin

81
Q

EEG, Video EEG

Neuroimaging

SPRCT or PET scans (functional)

Electrical mapping

A

Requirements for surgical treatment of seizures

82
Q

What is it important to monitor with seizure medications?

A

Adverse drug reactions

Effectiveness

Levels

LFT

Blood counts

Setha: Neuro (9 decks)

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