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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
common preictal symptoms (3 types)
affective: fear, panic, depression, elation sensory: "tastes like a penny" automatism/involuntary: lip smacking, chewing, rubbing, odd behaviors
26
common postictal states
slurred speech, confusion, inability to follow commands, lethargy
27
unprovoked seizure
primary, idiopathic
28
provoked seizure
secondary or acute symptomatic - precipitated by fever (febrile seizures), metabolic conditions (hypoglycemia), or primary insult to CNS NOT EPILEPSY: treat cause = treat seizures
29
simple partial seizure
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
complex partial seizure
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
generalized: absence seizure
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
generalized: tonic-clonic seizure
- 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
generalized: atonic seizure
few seconds impaired consciousness + sudden loss of muscle tone; "drop attacks"/falls most resistant to drug therapy NO POSTICTAL PHASE; however - postictal CONFUSION
34
generalized: myoclonic seizure
- few seconds brief jerking/stiffening of extremities (singly or in groups, symmetric or asymmetric) no impaired consciousness NO POSTICTAL PHASE
35
status epilepticus
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
partial seizures: 2 types
simple | complex
37
generalized seizures: 6 types
``` absence (petit-mal) atonic myoclonic tonic-clonic (grand mal) tonic clonic ```
38
status epilepticus: therapeutic management
1. airway, oxygen (turn on side to prevent aspiration) 2. IV access 3. labs: electrolytes, ABG, toxicology 4. * IV BENZOS * until seizure has stopped - dilantin drip, Mg 5. concurrent IV anticonvulsants 6. search for cause (to treat!)
39
sudden unexpected death in epilepsy
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
seizures: diagnostic tests
CT, MRI, EEG | SMA-6, Cr, BUN, toxicology, ABG
41
SMA-6
serum concentrations of sodium, potassium, chloride, glucose, blood urea nitrogen, and carbon dioxide
42
glutamate
?
43
seizure: therapeutic management to protect from injury during seizure
- turn on side - do NOT restrain - protect from hitting body parts - nothing in mouth - observation, reassurance
44
seizure: therapeutic management post-seizure
- airway clearance, maintenance, oxygen - assess for injury - monitor LOC
45
generalized seizure
involves both cerebral hemispheres
46
tonic seizure
30 sec - several minutes | abrupt increase in loss of muscle tone, LOC, autonomic changes
47
clonic seizure
several minutes | muscle contraction and relaxation
48
automatism
behavior of which the patient is not aware and is not under patient's control - lip smacking, picking at clothes
49
partial seizures
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
primary or idiopathic epilepsy + tx
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
secondary seizures + causes + triggers + tx
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
assessment questions
``` 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
breakthrough seizure
occurs despite the use of anticonvulsants that have otherwise successfully prevented seizures in the patient
54
cyanosis during generalized tonic-clonic seizure
typically self-limiting with no treatment necessary
55
acute seizures
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
status epilepticus: common causes
- sudden withdrawal from anti-epileptic drugs - infection - acute alcohol, drug withdrawal - head trauma, cerebral edema - metabolic disturbances
57
status epilepticus: ABG
drawn to determine arterial blood gas levels and to identify metabolic, toxic, and other causes of uncontrolled seizure
58
status epilepticus: metabolic changes if left untreated
hypoxia, hypotension, hypoglycemia, dysrhythmias, lactic/metabolic acidosis muscle breaks down -> myoglobin accumulates in kidneys -> renal failure, electrolyte imbalance
59
*notable seizure cause: neonates
perinatal hypoxia, ischemia + metabolic disturbances, drug withdrawal
60
*notable seizure cause: kids >1 mo
febrile seizures
61
*notable seizure cause: adolescents 12-18y
trauma + infection, still!
62
*notable seizure cause: young adults 18-35y
trauma
63
*notable seizure cause: older adults > 35y
cerebrovascular disease + metabolic disorders (uremia, hepatic failure, electrolyte abnormalities, hypoglycemia)

z S15 HEHI 4 (7 decks)

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