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Neurology > Seizure Disorders > Flashcards

Seizure Disorders Flashcards

1
Q

What are the three seizure disorders on the NCCPA blue print for Neurology? (3)

A
  1. Generalized convulsive disorder
  2. Generalized non-convulsive disorder
  3. Status Epilepticus
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2
Q

What is the definition of a seizure?

A

Transient disturbance of cerebral function d/t an abnormal paroxysmal neuronal discharge in the brain (hyperactivity in a certain area)

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3
Q

How do you define Epilepsy?

A

Any disorder characterized by recurrent unprovoked seizures. Two or more unprovoked seizures. Affects about .5% of the US population

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4
Q

What are the three causes of seizures?

A
  1. Genetic epilepsy
  2. Structural/metabolic
  3. Unknown
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5
Q

What are the different causes of Structural/Metabolic group? (7)

A
  • Congenital abnormalities or perinatal injuries
  • Withdrawal from alcohol or drugs
  • Trauma
  • Tumors
  • Vascular dz
  • Degenerative disorders
  • Infectious disease (bacterial meningitis, HSV encephalitis, brain abscess, etc.)
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6
Q

What are the classifications of focal seizures? (2)

A
  1. Without impairment of awareness, consciousness, or memory (simple partial seizures)
  2. With impairment of consciousness, awareness, or memory (complex partial seizures)
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7
Q

What are the classifications of generalized seizures? (4)

A
  • Absence
  • Myoclonic
  • Tonic-clonis
  • Tonic, Clonic, or atonic (separately)
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8
Q

General Characteristics of Focal Seizures (3)

A
  • Focal motor or somatosensory symptoms
  • Can spread to different parts of the limb or body
  • Can progress to become a generalized tonic-clonic seizure
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9
Q

What is the sequence of a tonic-clonic seizure? (4)

A
  • period of tonicity (stiffness)
  • period of clonic movements (spasming)
  • +/- vocalizations, loss of bowel/bladder control
  • postictal state (pt is very sleepy)
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10
Q

Absence Seizure Characteristics (5)

A
  • impairment of consciousness, NOT unconscious
  • sometimes can have tonic, clonic or atonic components
  • Usually begin at childhood and end at 20
  • Pt is often not aware they have missed something (very short seizure)
  • Used to be called petit mal seizures
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11
Q

Tonic-Clonic Characteristics (5)

A
  • sudden loss of consciousness
  • Tonic phase: pt becomes rigid, falls to the ground and stops breathing, <1 minute
  • Clonic phase: pt has jerking of the body that lasts 2-3 minutes
  • Injury can occur
  • May have urinary or fecal incontinence
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12
Q

What happens in the postictal period of a tonic-clonic seizure? (5)

A
  • Often sleepy
  • Disoriented
  • Confused
  • Sore (production of lactic acid)
  • Headache
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13
Q

What is status epilepticus?

A

Pt regains consciousness after the seizure then falls back asleep and has further convulsions (continued electrical activity)

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14
Q

What are 4 things used to diagnose epilepsy?

A
  • History
  • Careful PE
  • EEG
  • MRI of the brain
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15
Q

What are the risk factors for having a second seizure? (5)

A
  • Previous provoked seizure
  • Focal seizure
  • Abnormal neurological exam
  • FmHx of epilepsy
  • Abnormal EEG findings
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16
Q

What are the secondary injuries following a seizure?

A
  • Pneumonia
  • Vertebral compression fracture
  • Burns
  • Shoulder or mandible dislocation
  • head trauma
17
Q

How is an EEG used in the diagnosis of epilepsy?

A

Supports the diagnosis of epilepsy and can help identify a focus in some cases but it cannot tell you what the cause of it is

18
Q

How is MRI used in the diagnosis of epilepsy?

A

Used to pinpoint an epileptic focus if one exists and can classify the lesion in some cases

19
Q

How is the WADA test used in the diagnosis of epilepsy?

A

Used to localize and epileptic focus if MRI and EEG cannot

20
Q

How is the WADA test performed?

A
  • Catheter inserted into central circulation
  • Sodium amobarbital given to have the brain
  • memory test performed
  • Do the same thing to the other side of brain
  • The side with impairment is the side with the epileptic focus
21
Q

Name three other components used to evaluate an epilepsy diagnosis. (4)

A
  • PET scan during the seizure and when they are not having a seizure
  • Neuropsychological exam
  • Magnetoencephalography (MRI+PET)
  • If medication does not work, the case is presented to epilepsy surgery conference
22
Q

Tx Options (3)

A
  • No medical tx (ketogenic diet, biofeedback)
  • Medication
  • Surgery
23
Q

Tx with Medication Considerations (5)

A
  • Do they need to be treated?
  • Choose the best med for the pt
  • Choose the best dosing schedule for the pt
  • Consider side effects (mono vs. poly therapy)
  • Consider tapering if seizure free for 2 years and clear on EEG
24
Q

What are the different types of Epileptic Surgeries? (9)

A
  • Resection
  • Temporal lobectomy
  • Multiple subpial transection
  • Hemispherotomy/hemispherectomy
  • Callosotomy
  • Vagus nerve stimulation
  • Anterior thalamic stimulation
  • Cerebral responsive stimulation
  • Investigational
25
Q

When should you do surgery over medication? (3)

A
  • Temporal lobe epilepsy (focal seizures, focal seizures that generalize, unilateral/multifocal epilepsy with infantile hemiplegia-> Rasmussen’s encephalitis)
  • Tried and failed meds 3x
  • Identifiable lesion
26
Q

Resection/Lobectomy

A
  • 70-90% reduction or cessation of seizures

- Most successful when the lesion is small

27
Q

Corpus Callosotomy

A
  • Used for focal seizures which generalize to the opposite side
  • Seizures may continue on one side
28
Q

Multiple Subpial Transection

A
  • Cutting nerve fibers in the gray matter of brain
  • Used when seizures originate in a part of the brain that cannot be removed
  • 70% improvement
29
Q

Hemispherectomy

A
  • Used in children <13 with damage of half the brain
  • Cerebral cortex is removed on one side
  • Younger children recover better, so do it as early as you can
30
Q

What should seizure its avoid? (6)

A
  • Missing medications
  • Sleep deprivation
  • Alcohol
  • Stress
  • Strobe lights (if photosensitive)
  • If you have side effects from meds tell your provider!
31
Q

Seizure Restrictions for Patients (5)

A
  • Driving
  • Operating heavy machinery
  • Swim or bathe alone
  • Navigate heights
  • Anything that would put you or someone else at risk

Neurology (12 decks)

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