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Clin Med Fall 2015 > Seizure Disorder Test 2 > Flashcards

Seizure Disorder Test 2 Flashcards

1
Q

Seizure

A

finite event cause by excessive discharge of cerebral neurons
(significant depolarization& resting membrane potential)

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2
Q

Epilepsy

A

chronic disorder of recurrent seizures

  • sometimes called seizure disorder
  • chronic medical condition produced by temporary changes in the electrical function of the brain, causing seizures which affect awareness, movement or sensation (cognition & level of consciousness)
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3
Q

Incidence and Prevalence of Seizures

A

-estimated to affect 1.65 million americans
(does not include seizures related to fever or cerebral trauma)
-1% of americans are classified with seizure disorder by age 20
-2/3 seizures begin in childhood-most in 1st yr of life
-most common disorder in ped. neurology

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4
Q

Pathophysiology

A
  • sudden excessive discharge of aggregates of neurons (rapid or sudden depolarization of nerve cells)
  • disruption of the normal physiochemical mechanism of nerve cells
  • when idiopathic-usually related to decreased inhibition
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5
Q

Pathophysiology when accompanied by a focal lesion (PVL/tumor/MS plague) or CNS immaturity

A
  • hyperexcitable neurons in a partially discharged state near lesion ( doesn’t take as much to depolarize cells)
  • susceptible to activation by hyperthermia (febrile seizures), hypoxia, hypoglycemia, hypercalcemia
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6
Q

Types if Seizures

A 
Partial Seizures
-simple partial seizure (focal seizure)
-complex partial seizure
-complex partial progressing to generalized
Generalized Seizures
- Absence seizure (petit mal)
-myoclonic seizure
-tonic-clonic seizure (grand mal)
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7
Q

Simple Partial Seizure(focal seizure)

A
  • limited to one area of the brain (stay in region of affected brain)
  • consciousness maintained
  • cortical origin
  • can affect motor & sensory( in one area of brain ~motor area:tic, eyes and sensory area: sensation)
  • focal EEG abnormality
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8
Q

Complex Partial Seizure

A
  • stay in region of brain affected
  • involves greater area of the brain
  • repetitive behaviors present
  • consciousness is altered or lost
  • cortical origin
  • syn. psychomotor temporal lobe epilepsy
  • focal EEG abnormality
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9
Q

Complex partial progressing to generalized

A
  • effects surrounding areas as well
  • cortical origin that goes to subcortical regions
  • progressing to generalized tonic/clonic (grand mal ) epilepsy
  • focal -> generalized EEG abnormality
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10
Q

Generalized seizures

A 
subcortical origin
Generalized EEG abnormality 
-absence (petit mal)
-tonic seizures
-tonic/clonic seizure( grand mal)
-akinetic seizures
-infantile seizures
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11
Q

Absence Seizure (petit mal)

A

minor convulsive mm activity with sudden cessation of conscious activity
- eye flutter->become unconscious

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12
Q

Myoclonic Seizure

A

-sudden, brief, single or repetitive mm contraction
-consciousness is generally maintained
(differs from simple partial bc of level ( amount of brain affected)

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13
Q

Tonic-Clonic Seizure (grand mal)

A
  • sudden loss of consciousness
  • falls are common (off chair/to floor)
  • generalized rigidity (tonic) phase followed by rapid generalized jerking (clonic) phase
  • if occurs when driving or swimming-> death
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14
Q

Tonic- Clonic phases

A
  • likely do not breathe in either phase
  • teeth clenching
  • tongue may occlude airway
  • vomiting or food (object) in mouth could lead to aspiration
  • best position is ion ground lying on side
  • lose consciousness
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15
Q

Tonic Phase

A

10 sec

  • eyes opne
  • elbows flexed
  • arms pronated
  • legs extended
  • teeth clenched
  • pupils dilated
  • breath held-cynosis
  • bowel /bladder control lost at end of phase
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16
Q

Clonic Phase

A

1-2 min
-tremor gives way to violent generlaized shaking
-eyes roll back and forwards
- tongue may be bitten
-tachycardia develops
-breathinf recommences at end of phase
( repeated seizures-> lack of oxygen to brain: status epilepticus)

17
Q

Convulsive Status Epilepticus

A
  • generalized tonic-clonic seizures are prolonged and repeated w/ no recovery in between
  • medical emergency
  • often associated w/ tumor/CNS infection or drug abuse
  • little to no breathing b/w episodes of seizures-> brain damage
  • seizure meds as rectal suppository to stop or prevent seizures
  • life threatening
18
Q

Questions to ask w/ pt w/ hx of seizures

A
  • type or symptoms of seizure?
  • triggers?
  • frequency?- when was the last one
  • repeated seizures or status epilepticus?
19
Q

Epilepsies of Childhood

A

-severe myoclonic epilepsy of childhood
-Lennox-Gastaut
-Landau-Kleffer
(severely affect development & musculoskeletal control)
-frequently occur in childhood- may grow out of it
-many different seizure related symptoms of childhood

20
Q

Aura

A

-specific feeling/experience an individual experiences as the onset of a seizure
-most common aura:smell of brunt rubber
-could have variety of sensory experiences as an aura (see bright light or auditory)
(keys individual in that they are having a seizure- not the trigger)

21
Q

Medical Mgmt-Dx

A

-EEG
-Metabolic studies
-X-ray
-MRI or CT
( see if other disorder is causing; tumor/infection, txt that to cure seizure)

22
Q

Immediate Mgmt

A

Protect from harm

  • may lower pt to floor
  • soft object under head
  • turn head to side if vomiting to prevent aspiration
  • do NOT try and stop the mvmts NOR force anything into the mouth
23
Q

Medical Mgmt- Control of Seizures

A
  • support and education
  • medication (80% controlled by meds)
  • diet:
  • Surgery
24
Q

types of seizure meds

A

-Depakene
- Tegretol
-Mysoline
-Valium
-Zarontin
-Klonopin
-Dilantin
-Neurontin
*refer to chuck ciccone for discussion of seizure meds
(common side effect~sedation)

25
Q

Diet

A

ketogenic diet (high in fats, low in sugar- high levels of ketones break down fatty acids-helps control seizures)

26
Q

Sugery

A

intense pre-surgical work-up to determine if candidate

-only successful in

27
Q

Prognosis

A
  • in idiopathic epilepsy, dx before the age of 10, a 75% remission rate (seizure free for 5 years) is seen
  • Generally not life-threatening (except in status epilepticus)
    • death by asphyxia (airway compromised~vomit/food)
    • death by drowning
28
Q

Impacts of seizure disorder beyond the seizures

A
  • dont know when it will occur again
  • unable to drive
  • usually unable to become prego (unless cleared by MD to be seizure free for a certain period of time and can go off meds)

Clin Med Fall 2015 (10 decks)

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