Seizure Disorder Test 2 Flashcards
Seizure
finite event cause by excessive discharge of cerebral neurons
(significant depolarization& resting membrane potential)
Epilepsy
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)
Incidence and Prevalence of Seizures
-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
Pathophysiology
- 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
Pathophysiology when accompanied by a focal lesion (PVL/tumor/MS plague) or CNS immaturity
- 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
Types if Seizures
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)
Simple Partial Seizure(focal seizure)
- 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
Complex Partial Seizure
- 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
Complex partial progressing to generalized
- effects surrounding areas as well
- cortical origin that goes to subcortical regions
- progressing to generalized tonic/clonic (grand mal ) epilepsy
- focal -> generalized EEG abnormality
Generalized seizures
subcortical origin Generalized EEG abnormality -absence (petit mal) -tonic seizures -tonic/clonic seizure( grand mal) -akinetic seizures -infantile seizures
Absence Seizure (petit mal)
minor convulsive mm activity with sudden cessation of conscious activity
- eye flutter->become unconscious
Myoclonic Seizure
-sudden, brief, single or repetitive mm contraction
-consciousness is generally maintained
(differs from simple partial bc of level ( amount of brain affected)
Tonic-Clonic Seizure (grand mal)
- 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
Tonic- Clonic phases
- 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
Tonic Phase
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
Clonic Phase
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)
Convulsive Status Epilepticus
- 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
Questions to ask w/ pt w/ hx of seizures
- type or symptoms of seizure?
- triggers?
- frequency?- when was the last one
- repeated seizures or status epilepticus?
Epilepsies of Childhood
-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
Aura
-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)
Medical Mgmt-Dx
-EEG
-Metabolic studies
-X-ray
-MRI or CT
( see if other disorder is causing; tumor/infection, txt that to cure seizure)
Immediate Mgmt
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
Medical Mgmt- Control of Seizures
- support and education
- medication (80% controlled by meds)
- diet:
- Surgery
types of seizure meds
-Depakene
- Tegretol
-Mysoline
-Valium
-Zarontin
-Klonopin
-Dilantin
-Neurontin
*refer to chuck ciccone for discussion of seizure meds
(common side effect~sedation)
Diet
ketogenic diet (high in fats, low in sugar- high levels of ketones break down fatty acids-helps control seizures)
Sugery
intense pre-surgical work-up to determine if candidate
-only successful in
Prognosis
- 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
Impacts of seizure disorder beyond the seizures
- 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)
