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z S15 HEHI 4 > seizure disorders > Flashcards

seizure disorders Flashcards

1
Q

antiepileptic drug black box warning

A

monitor for notable changes in behavior indicating emergence/worsening of suicidal thoughts, behavior

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2
Q

convulsion

A

seizure that results in physical movements/motor actiity

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3
Q

epilepsy

A

two or more seizures experienced by a person; chronic disorder in which repeated unprovoked seizure activity occurs
- may be caused by an abnormality in electrical neuronal activity; imbalance of neurotransmitters (especially GABA), or combo of BOTH!

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4
Q

focus

A

localized area of neurons within brain where seizures can start

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5
Q

seizure

A

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness, motor or sensory ability, and/or behavior

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6
Q

seizure threshold

A

point at which cells become unstable, allowing for possibility of seizure

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7
Q

idiopathic seizures

A

no identified cause

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8
Q

idiopathic seizures incidence

A

70-75%

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9
Q

epilepsy etiology

A

any condition or process that disrupts neuron cell membrane stability can result in seizures

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10
Q

only place where t-currents are large enough to cause action potential firing

A

certain hypothalamus neurons

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11
Q

cell damage: significance regarding seizures

A

damaged cells increase the risk for seizure

  • subsequent seizures result in more damaged cells
  • also consider head injury destroying CNS cells
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12
Q

seizure initiation*

A

two CONCURRENT events*

1) influx of extracellular Ca
2) hypersynchronization

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13
Q

hypersynchronization

A

of action potentials.

  • associated with Ca, K
  • surrounding cells enticed to join in
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14
Q

diseases increasing risk of epilepsy

A

children: mental retardation, cerebral palsy, cpmr

alzheimer, stroke, hx of one unprovoked

some linked to mom or dad with epilepsy

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15
Q

most frequent known causes of epilepsy

A
  • head trauma
  • brain tumor, stroke
  • poisoning
  • infections
  • maternal injury
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16
Q

preventable epilepsy risk factors

A
  • decreased sleep
  • emotional distress
  • EtOH withdrawal
  • excess caffeine
  • fever
  • hypoxia
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17
Q

preictal phase

A

right before seizure

- identifiable by some patients

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18
Q

ictal phase

A

seizure occurs

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19
Q

postictal phase

A

immediately after seizure; because brain has had increased activity, recovery necessary (lethargy, somnolence, confusion)

  • not all patients have one, depends on seizure effect on level of consciousness during seizure. if no substantial LOC, no postictal phase.
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20
Q

interictal

A

time between seizures; can be hours to days

  • can involve changes in personality, behaviors
  • key assessment period!
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21
Q

preictal auras: autonomic

A
  • stomach “fullness”
  • blushing
  • respiration changes
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22
Q

preictal auras: cognitive

A
  • deja vu
  • jamais vu
  • dreamy states
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23
Q

common preictal symptoms (3 types)

A

affective: fear, panic, depression, elation
sensory: “tastes like a penny”
automatisms

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24
Q

jamais vu

A

opposite of deja vu, person in familiar situation but it feels unfamiliar

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25
Q

common preictal symptoms (3 types)

A

affective: fear, panic, depression, elation
sensory: “tastes like a penny”
automatism/involuntary: lip smacking, chewing, rubbing, odd behaviors

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26
Q

common postictal states

A

slurred speech, confusion, inability to follow commands, lethargy

27
Q

unprovoked seizure

A

primary, idiopathic

28
Q

provoked seizure

A

secondary or acute symptomatic
- precipitated by fever (febrile seizures), metabolic conditions (hypoglycemia), or primary insult to CNS

NOT EPILEPSY: treat cause = treat seizures

29
Q

simple partial seizure

A

aura before: deja vu, offensive smell, sudden pain

  • focal twitching; one-sided movement of extremity
  • visual sensations
  • feelings of doom
  • arrest of speech (can’t speak but CAN write)
  • autonomic symptoms: hr, skin flush, epigastric discomfort
  • conscious throughout therefore NO POSTICTAL STATE
30
Q

complex partial seizure

A

1 to 3 minutes

  • syncope/black out
  • automatisms
  • patient unaware of environment; may wander at start
  • patient typically unaware of seizure, amnesia
  • may progress to this from simple partial
  • impaired consciousness, awake
  • temporal lobe most often; aka “psychomotor” or “temporal lobe” seizures
  • most common among older adults, difficult to diagnose
  • POSTICTAL STATE (no complete LOC but level of activity enough to cause)
31
Q

generalized: absence seizure

A

seconds; brief loss of consciousness, blank staring/unresponsive, “daydreaming”

  • automatisms
  • NO POSTICTAL: immediate return to baseline

fomerly petit mal
if untreated, may occur frequently throughout day
common in kids, tends to run in families

32
Q

generalized: tonic-clonic seizure

A
  • 2-5 minutes
    tonic phase: rigidity of all muscles (esp arms/legs) + LOC
    clonic phase: rhythmic jerking of all extremities
    – possible incontinence, tongue biting
  • POSTICTAL PHASE: fatigue, acute confusion, lethargy, up to an hour

formerly grand mal

33
Q

generalized: atonic seizure

A

few seconds
impaired consciousness + sudden loss of muscle tone; “drop attacks”/falls

most resistant to drug therapy

NO POSTICTAL PHASE; however - postictal CONFUSION

34
Q

generalized: myoclonic seizure

A
  • few seconds
    brief jerking/stiffening of extremities (singly or in groups, symmetric or asymmetric)
    no impaired consciousness

NO POSTICTAL PHASE

35
Q

status epilepticus

A

MEDICAL EMERGENCY
UNRELENTING tonic-clonic lasting > 5 min
OR
consecutive seizures w/o recovery (some defn 30”)

can result in permanent neurologic injury or death
- generalized convulsive!

36
Q

partial seizures: 2 types

A

simple

complex

37
Q

generalized seizures: 6 types

A 
absence (petit-mal)
atonic
myoclonic
tonic-clonic (grand mal)
tonic
clonic
38
Q

status epilepticus: therapeutic management

A
  1. airway, oxygen (turn on side to prevent aspiration)
  2. IV access
  3. labs: electrolytes, ABG, toxicology
    • IV BENZOS * until seizure has stopped
      - dilantin drip, Mg
  5. concurrent IV anticonvulsants
  6. search for cause (to treat!)
39
Q

sudden unexpected death in epilepsy

A

sudep; rare; cause unknown; syndrome, not illness

  • person with epilepsy suddenly dies NOT as a result of drowning or injury following a seizure NOR status epilepticus

preventing seizures, awareness of night time seizures MAY reduce risk

40
Q

seizures: diagnostic tests

A

CT, MRI, EEG

SMA-6, Cr, BUN, toxicology, ABG

41
Q

SMA-6

A

serum concentrations of sodium, potassium, chloride, glucose, blood urea nitrogen, and carbon dioxide

42
Q

glutamate

A

?

43
Q

seizure: therapeutic management to protect from injury during seizure

A
  • turn on side
  • do NOT restrain
  • protect from hitting body parts
  • nothing in mouth
  • observation, reassurance
44
Q

seizure: therapeutic management post-seizure

A
  • airway clearance, maintenance, oxygen
  • assess for injury
  • monitor LOC
45
Q

generalized seizure

A

involves both cerebral hemispheres

46
Q

tonic seizure

A

30 sec - several minutes

abrupt increase in loss of muscle tone, LOC, autonomic changes

47
Q

clonic seizure

A

several minutes

muscle contraction and relaxation

48
Q

automatism

A

behavior of which the patient is not aware and is not under patient’s control
- lip smacking, picking at clothes

49
Q

partial seizures

A

aka focal or local seizures

begin in part of ONE cerebral hemisphere

  • can become generalized tonic-clonic, tonic, or clonic
  • most often seen in adults
  • generally less responsive to medical treatment
50
Q

primary or idiopathic epilepsy + tx

A

not associated with any identifiable brain lesion or other specific cause; genetic factors most likely play a role in development

management typically successfully through pharm

51
Q

secondary seizures + causes + triggers + tx

A

result from underlying brain lesion, most commonly tumor or trauma

also may be caused by: metabolic disorder, acute alcohol withdrawal, electrolyte disturbances (hyperkalemia, water intox, hypoglycemia), high fever, stroke, head injury, substance abuse, heart disease

triggers: increased physical activity, emotional stress, excessive fatigue, alcohol/caffeine consumption, certain foods or chemicals

tx underlying condition, tx seizure
NOT CONSIDERED EPILEPSY

52
Q

assessment questions

A 
how many seizures?
how long they last?
pattern of occurence?
describe manifestations?
aura?
taking prescribed drugs, herbs?
head trauma?
high fever?
alcohol, illicit drug hx?
other medical conditions? (stroke, htn)
53
Q

breakthrough seizure

A

occurs despite the use of anticonvulsants that have otherwise successfully prevented seizures in the patient

54
Q

cyanosis during generalized tonic-clonic seizure

A

typically self-limiting with no treatment necessary

55
Q

acute seizures

A

occur in greater intensity, number, or length than the usual seizures, may also appear in clusters different from typical seizure pattern

  • lorazepam or diazepam may be given to stop clusters to prevent development of status epilepticus
56
Q

status epilepticus: common causes

A
  • sudden withdrawal from anti-epileptic drugs
  • infection
  • acute alcohol, drug withdrawal
  • head trauma, cerebral edema
  • metabolic disturbances
57
Q

status epilepticus: ABG

A

drawn to determine arterial blood gas levels and to identify metabolic, toxic, and other causes of uncontrolled seizure

58
Q

status epilepticus: metabolic changes if left untreated

A

hypoxia, hypotension, hypoglycemia, dysrhythmias, lactic/metabolic acidosis

muscle breaks down -> myoglobin accumulates in kidneys -> renal failure, electrolyte imbalance

59
Q

*notable seizure cause: neonates

A

perinatal hypoxia, ischemia

+ metabolic disturbances, drug withdrawal

60
Q

*notable seizure cause: kids >1 mo

A

febrile seizures

61
Q

*notable seizure cause: adolescents 12-18y

A

trauma

+ infection, still!

62
Q

*notable seizure cause: young adults 18-35y

A

trauma

63
Q

*notable seizure cause: older adults > 35y

A

cerebrovascular disease

+ metabolic disorders (uremia, hepatic failure, electrolyte abnormalities, hypoglycemia)

z S15 HEHI 4 (7 decks)

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