Seizure Disorders Flashcards
What are the three seizure disorders on the NCCPA blue print for Neurology? (3)
- Generalized convulsive disorder
- Generalized non-convulsive disorder
- Status Epilepticus
What is the definition of a seizure?
Transient disturbance of cerebral function d/t an abnormal paroxysmal neuronal discharge in the brain (hyperactivity in a certain area)
How do you define Epilepsy?
Any disorder characterized by recurrent unprovoked seizures. Two or more unprovoked seizures. Affects about .5% of the US population
What are the three causes of seizures?
- Genetic epilepsy
- Structural/metabolic
- Unknown
What are the different causes of Structural/Metabolic group? (7)
- 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.)
What are the classifications of focal seizures? (2)
- Without impairment of awareness, consciousness, or memory (simple partial seizures)
- With impairment of consciousness, awareness, or memory (complex partial seizures)
What are the classifications of generalized seizures? (4)
- Absence
- Myoclonic
- Tonic-clonis
- Tonic, Clonic, or atonic (separately)
General Characteristics of Focal Seizures (3)
- Focal motor or somatosensory symptoms
- Can spread to different parts of the limb or body
- Can progress to become a generalized tonic-clonic seizure
What is the sequence of a tonic-clonic seizure? (4)
- period of tonicity (stiffness)
- period of clonic movements (spasming)
- +/- vocalizations, loss of bowel/bladder control
- postictal state (pt is very sleepy)
Absence Seizure Characteristics (5)
- 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
Tonic-Clonic Characteristics (5)
- 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
What happens in the postictal period of a tonic-clonic seizure? (5)
- Often sleepy
- Disoriented
- Confused
- Sore (production of lactic acid)
- Headache
What is status epilepticus?
Pt regains consciousness after the seizure then falls back asleep and has further convulsions (continued electrical activity)
What are 4 things used to diagnose epilepsy?
- History
- Careful PE
- EEG
- MRI of the brain
What are the risk factors for having a second seizure? (5)
- Previous provoked seizure
- Focal seizure
- Abnormal neurological exam
- FmHx of epilepsy
- Abnormal EEG findings
What are the secondary injuries following a seizure?
- Pneumonia
- Vertebral compression fracture
- Burns
- Shoulder or mandible dislocation
- head trauma
How is an EEG used in the diagnosis of epilepsy?
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
How is MRI used in the diagnosis of epilepsy?
Used to pinpoint an epileptic focus if one exists and can classify the lesion in some cases
How is the WADA test used in the diagnosis of epilepsy?
Used to localize and epileptic focus if MRI and EEG cannot
How is the WADA test performed?
- 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
Name three other components used to evaluate an epilepsy diagnosis. (4)
- 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
Tx Options (3)
- No medical tx (ketogenic diet, biofeedback)
- Medication
- Surgery
Tx with Medication Considerations (5)
- 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
What are the different types of Epileptic Surgeries? (9)
- Resection
- Temporal lobectomy
- Multiple subpial transection
- Hemispherotomy/hemispherectomy
- Callosotomy
- Vagus nerve stimulation
- Anterior thalamic stimulation
- Cerebral responsive stimulation
- Investigational
When should you do surgery over medication? (3)
- 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
Resection/Lobectomy
- 70-90% reduction or cessation of seizures
- Most successful when the lesion is small
Corpus Callosotomy
- Used for focal seizures which generalize to the opposite side
- Seizures may continue on one side
Multiple Subpial Transection
- 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
Hemispherectomy
- 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
What should seizure its avoid? (6)
- Missing medications
- Sleep deprivation
- Alcohol
- Stress
- Strobe lights (if photosensitive)
- If you have side effects from meds tell your provider!
Seizure Restrictions for Patients (5)
- Driving
- Operating heavy machinery
- Swim or bathe alone
- Navigate heights
- Anything that would put you or someone else at risk
