Seizure Disorders Flashcards
What is a seizure and what is epilepsy
Seizures are a sudden uncontrolled electrical discharge of neurons in the brain that interrupts normal function.
•May be symptom of an underlying illness
•Any seizure resulting from a systemic or metabolic disturbance that is resolved when the underlying problem is corrected is not epilepsy.
• Epilepsy is a condition in which a person has spontaneously recurring seizures (even if a long interval separates each attack).
State ten causes of seizures
State three specifically in these age groups 2-20,20-30,after 50
V: vascular-Vascular, eg. cerebral infarction,AVM, Subarachnoid hemorrhage
Stroke
Hypertensive crisis
Increased ICP secondary to clogged shunt
I: infection-Encephalitis,sepsis,meningitis and inflammatory conditions, eg. herpes simplex, MS
T: trauma,temperature,toxins-Pyrexia ,Alcohol withdrawal, Drugs.eg. ciclosporin, lidocaine, quinolones, SSRIs, interferons, cocaine lithium withdrawal of amphetamines, anti seizure drugs ingestion,barbiturates, Brain trauma and surgery, Epidural hematoma
Subdural hematoma
Intracranial hematoma
Cerebral contusion
Traumatic birth injury
A: AV malformation.
D(diseases;Neural degenerative disorders. eg. Alzheimer’s, Developmental eg.neuronal migration abnormalities,harmatomas
•Hippocampal sclerosis, Heart, liver, lung, or kidney disease
Systemic lupus erythematosus
M: metabolic-Metabolic abnormalities, eg. porphyria, hypocalcaemia,hypoglycemia, Seizures can be induced by electrolyte disturbances such as hyponatremia, hypernatremia, hypocalcemia, and hypomagnesemia.(hyponatremia causes seizures by-too much water that dilutes the Na+ value. As a result, water moves into body cells, causing them to swell. This swelling causes a major problem in brain cells, which is a change in mental status that can progress to seizures or coma)
I: idiopathic-Genetic predisposition, Provoked seizures, eg.photosensitivity, sleep deprivation
N: neoplasm-Intracranial mass lesions, eg. tumour, neurocysticercosis
OTIS CAMPBELL(for drugs that cause seizures)
Organophosphates
Tricyclic antidepressants
Isoniazid, Insulin
Sympathomimetics Cocaine, Clozapine Amphetamines, Antiepileptics
Methylxanthines (theophylline, caffeine)
Phencyclidine (PCP)
Benzodiazepine/Barbiturate withdrawal
Ethanol withdrawal
Lidocaine
Lithium
First 6 months of life – severe birth injury, congenital defects involving the central nervous system, infections, and inborn errors of metabolism.
2 – 20 years of age – birth injury, infection, trauma, and genetic factors.
20 – 30 years of age – structural lesions, such as trauma, brain tumors, or vascular disease.
After 50 years of age – cerebrovascular lesions and metastatic brain tumors.
Seizures occur due to problems in a part of the brain. State the two main types of seizures and define them(part of brain affected and presence of aura or not)
What is Todd’s paralysis
Which type of airway adjunct is best in seizures?
Generalized
Partial
GENERALIZED SEIZURES: Involves both sides of the brain.
Bilateral synchronous discharges in the brain from the onset of a seizure.
Entire brain is affected.
Usually no warning or “aura”.
PARTIAL SEIZURES: Begins in a specific region of the cortex.
Caused by focal irritations.
Unilateral manifestation arising from a localized area of the brain.
Exception:
Partial seizures may spread to involve the whole brain leading to a generalized tonic-clonic seizure.
A tonic-clonic seizure that is preceded by an aura or warning is a partial seizure that generalizes secondarily.
Many tonic-clonic seizures sometimes appear to be primarily generalized, but the partial component can be missed.
Postictally, secondary generalized seizures can result in a temporary neurological deficit called Todd”s paralysis.
Nasopharyngeal airway adjunct
State the subtypes of generalized seizures
Subtypes
-Tonic-Clonic ( Grand Mal)
-Typical Absence(Petit Mal)
- Atypical absence
-Myoclonic
-Tonic
-Akinetic
What are the clinical manifestations of tonic clonic seizures
Clinical Manifestations:
Loss of consciousness.
Stiffening of the body for 10-20 sec. (Tonic. Tonic Latin means tone, tension. If muscles are tensed, they become stiff. So tonic seizures, stiffening of body)
Jerking movements of the extremities. (Clonic,clonic means muscle spasms or rapid relaxation and contraction of muscles. Spasms lead to jerking movements or shaking. So Clonic seizures cause shaking or jerking)
May appear cyanotic, have excess salivation, bite their tongue or cheek, and may experience incontinence.
During postictal phase(phase after the seizure. Ictal phase is during the seizure phase) , usually sore, tired, and confused; may sleep for several hours.
What are the clinical manifestations of absence seizures (typical and atypical)
-Abscence
Typical Absence (Petit Mal)
Usually occurs in children; rarely goes beyond adolescence.
May develop into another type of seizure.
3 Hz spike-and-wave discharge
Clinical Manifestations:
Brief staring spell lasting a few seconds.
Brief loss of consciousness.
May occur up to 100 times a day if untreated. (these children usually don’t do well in school)
Atypical Absence Clinical Manifestations: Staring spells. Brief warnings. Peculiar behavior during the seizure. Confusion after the seizure. Has other EEG changes
What are myoclonic seizures
What are tonic seizures?
What are akinetic seizures?
-Myoclonic seizures
Isolated muscle jerking
-Tonic Seizures
Intense stiffening of the body, not followed by jerking
-Akinetic or atonic Seizures
Cessation of movement,
falling
loss of consciousness
What are the subtypes of partial seizures
State their clinical features
(So in generalized seizures they lose consciousness but in partial seizures they don’t lose consciousness. Generalized seizure there’s no aura but in partial seizures they have an aura. Remember this by specialized aura. It’s not general. It’s specialized so partial)
-Simple or focal Partial seizures
Clinical Manifestations:
No loss of consciousness. Patient is Alert
Usually last < 1 minute.
May involve an alteration in motor, sensory, or autonomic system(Sensory nerve damage often results in tingling, numbness, pain, and extreme sensitivity to touch. Autonomic nerves control involuntary or semi-voluntary functions, such as heart rate, blood pressure, digestion, and sweating. Motor involves movement)
Eg. of focal motor seizure- Jacksonian.(Jacksonian seizure is a type of simple partial seizure characterized by abnormal movements that begin in one group of muscles and progress to adjacent groups of muscles.)
-Complex Partial Clinical Manifestations: Usually in the temporal lobe. Lasts > 1 minute. Assoc. with loss of awareness or altered consciousness Psychomotor sx: Lip-smacking, continuing an activity before seizure began, or fumbling with objects. Psychosensory sx: vertigo, déjà vu, visual or auditory sensations, altered thought processes (Visual and auditory disturbances cause the temporal lobe is affected)
What are the phases of seizures and define each.
Prodromal Phase:
Sign or activity which precedes a seizure.
Aural Phase:
Sensory warning.
Ictal Phase:
Full seizure.
Postictal Phase:
Period of recovery after the seizure.
How do you diagnose seizures?
When should EEG be done when there’s a suspected seizure
How do you describe a seizure?(pofd)
State five diagnostic tests for seizures
Accurate and comprehensive description of the seizures
Patient’s health history.
Recent illness, trauma,
Medication (new and old and whether patient is compliant. If defaulted, ask how long patient has defaulted), and
Recent social activity such and change in consumption of drugs or alcohol.
EEG is a useful adjuvant to the history if it shows abnormalities.
EEG should be done within 24 hours of a suspected seizure
Correct classification of the seizure type - The choice of treatment depends on the classification of the type of seizure.
Physical Examination
Birth and developmental history, Significant illness and injuries, Family history, Febrile seizures, Comprehensive neurologic assessment.
Seizure History
Precipitating factors, Antecedent events, Seizure description (including onset, duration, frequency, postictal state. (POFD) )
Diagnostic Studies
CBC, electrolytes, LFP’s(local field potentials), fasting glucose, BUN, creatinine
Lumbar puncture for CSF analysis(do CT scan before LP in a seizure, meningitis,encephalitis)
Electroencephalography (EEG)
CT, MRI, MRA, MRS, PET (positron emission tomography) scan
We don’t do contrast CT in seizures. We only do contrast CT if we suspect there’s a tumor causing it.
You ought to do a BUEandCr before giving contrast dye cuz it can cause renal impairment
Do a Ct to rule out a tumor before doing Lumbar puncture cuz LP can cause Herniation of brain stem if there’s a tumor.
You can also do LP for a subarachnoid haemorrhage.
How do you asses seizures in the emergency (signs of seizures)
What health information is important to obtain during assessment ?
Tonic- Clonic seizures
In an emergent situation it is critical for the nurse to assess for the signs of an oncoming seizure, or symptoms that the patient is in the midst of a seizure episode in order to apply appropriate life saving interventions. Some of these symptoms include:
Presence of an aura
Loss of consciousness
Signs of bowel/bladder incontinence
Tachycardia, diaphoresis
Pallor, flushing or cyanosis
Confusion and headache
Signs associated with tonic, hypertonic, clonic and postictal phases of a seizure
Presence of repeated clonic tonic seizures for several minutes in a row
Health information that is important to obtain during an assessment would include:
the last episode of a seizure and any co morbidities related to it.
compliance with their drug regimen
How do you intervene in emergency for a seizure patient and after the seizure
Emergent interventions for our patient center around the ABC’s and prevention of injury which include:
Maintaining the patients airway - Position the patients head and body to one side to lessen the risk of aspiration. Assist with suctioning, oxygen therapy, and assisted ventilation as needed after the seizure episode ends.
Maintaining patient safety - If sitting or standing, clear the area around the patient and ease them down to the floor supporting their neck and head in your lap, and loosen any constrictive clothing.
Never restrain or force objects into the mouth of a person during a seizure. This can lead to further injury of the patient and possibly to the care giver.
Stay with the patient through the entire seizure episode and carefully observe the exact onset, and events that preceded it. Assessment of the course and nature of the seizure is critical in order to help diagnose the type of seizure, and identify subsequent treatment to follow.
Continued assessment of vitals and LOC after the episode has completed is important as well as providing explanation of events, reassurance, and a period of rest for the patient.
post seizure:
Regular meals and snacks in between if feeling shaky, faint, or hungry
When giving drugs for seizures what is the goal?
Therapy is aimed toward preventing seizure occurrence.
Anti-seizure drugs act by stabilizing nerve cell membranes and preventing spread of the epileptic discharge.
The principle for drug therapy is to begin with a single drug based on patient age, weight, type, frequency, and cause of the seizures and to increase the dosage until the seizures are controlled or until toxic side effects occur.
Name four drugs for tonic clonic and partial seizures and three for absence, myoclonic and akinetic seizures
What are the side effects of Valproic acid and carbamazepine
Carbamazepine
Phenobarbital
Phenytoin
Levetiracetam (keppra)
Valproic acid
The other types of seizures:
Valproic acid
Phenobarbital
Carbamazepine:
Ataxia, aplastic anemia, thrombocytopenia,
Valproic:
Hepatotoxicity, pancreatitis, hyperammonemia
A significant number of patients whose epilepsy cannot be controlled with drug therapy are candidates for surgical intervention
Some examples of surgeries are: limbic resection, multilobar resections, anterior temporal lobe resections, and amygdalohippocampectomy
True or false
OTHER THERAPIES:
Vagal nerve stimulation
Biofeedback
True
