Seizure Types and Treatment Flashcards
What are the two definitions of a seizure?
- Occasional, sudden, excessive, rapid and local discharges or gray matter;
- Alteration of behavior that results from abnormal and excessive activity of a group of cerebral neurons
Abnormal spikes are seen on ____ associated with cellular networks during a seizure
EEG
What are some possible triggers for a seizure?
- Genetic predisposition
- Trauma, ischemia, stroke, malformation of cortical development
- Febrile illness, sleep deprivation
What neuron channels are associated with seizure pathophysiology?
AMPA and NMDA
What are the two types of seizure?
Partial and Generalized
What are the two types of partial seizures?
Simple and Complex
What are the types of generalized seizure?
- Absence
- Tonic
- Atonic
- GTC
- Myoclonic
What is the most important component of a diagnosis of epilepsy?
HISTORY (then EEG, MRI, and labs)
What is epilepsy?
The tendency to have recurrent unprovoked seizures
Abnormalities in which levels of brain function can lead to epilepsy?
- Neuronal networks
- Neuronal structures
- Neurotransmitters
- Synthesis, inhibition, excitation
- Synaptic development
- Ion channels
What is the term for epilepsies of undetermined type?
Lennox-Gastaut syndrome
What is a key distinguishing feature of simple partial seizures?
What are some signs and symptoms?
Consciousness is not impaired
- Clonic movements of face, arm leg
- Somatosensory and autonomic symptoms
- Psychic symptoms: Deja vu; hallucinations; illusions
Are simple partial seizures long or brief?
What are the post-ictal symptoms?
Brief
No post-ictal symptoms (usually)
What is Todd paralysis (associated with simple partial seizures)?
Focal weakness in a part of the body after a seizure
What are other names for complex partial seizures?
What feature is often used to distinguish these from simple partial seizures?
“Temporal lobe” or “Psychomotor” seizures
Consciousness is impaired
What are some manifestations of compex partial seizures?
- Staring
- Automatisms: Facial grimacing; gestures; chewing; lip smacking; repetitive speech
- Fragmented but coordinated motor tasks
How long do complex partial seizures last?
What are the post-ictal symptoms?
Lasts 30 seconds to a minute
- Post-ictal impairment
- Lethargy
- Confusion
- Lasts minutes to hours
What two parts of the brain are associated with complex partial seizures?
Temporal lobe and Frontal lobe
What are the features of an aura?
What brain region associated with complex parital seizures is responsible for auras?
- Aura (associated with temporal lobe origin)
- Fear
- Stomach pain
- Light headedness
- Rising sensation in head or chest
- Distortion of memory or time
- De’ja vu
What post ictal symptoms are associated with a complex partial seizure of temporal lobe origin?
- May have automatism
- Fatigue or deep sleep (not well for hours afterwards)
- Headache
- Emesis
What symptoms are associated with complex partial seizures of frontal lobe origin?
- Arrest of activity
- Versive head and or neck movements
- Blank stare (loss of contact)
- Few automatisms
- Abrupt on and off
What is a tonic-clonic seizure?
Loss of consciousness with stiffening of limbs (tonic phase) that has evolution to generalized jerking of muscles (clonic phase)
What are the post ictal symptom of a tonic-clonic seizure?
What age group is more likely to have these?
Deep sleep post-ictal
Majority in childhood
What are the typical features of an absence seizure?
How long does it last?
Abrupt cessation of activity and change in facial expression (blank stare)
Motor, behavioral and autonomic changes
Less than 30 seconds
Describe absence seizures in terms of…
Eye movement:
Head movement:
Autonomic phenomena:
- Eye movement:
- Clonic eye movements: Nystagmus; blinking
- Head movement:
- Head nodding
- Autonomic phenomena:
- Pupil dilation
- Pallor
- Flushing/sweating
- Salivation
Which type of clonic seizure is associated with EEG changes?
What does a migrating clonus indicate?
Focal clonic seizures are associated with EEG changes
Migrating clonus indicates metabolic or anoxic damage
How long do tonic seizures last?
What are features of a tonic seizure?
Brief, 60 seconds
Sudden onset of increased extensor tone
Imparied consciousness
What are the features of an atonic seizure?
- “Drop attacks” - sudden loss of tone
- Usually only brief loss of consciousness
How long are myoclonic seizures?
To which locations are they generalized?
- Sudden, brief (<350 mS)
- Generalized or confined to face, trunk
Myoclonic Seizures may be seen prior to what other types of seizures?
Myoclonic seizures can also serve as a sign of ______ ____ _______
- Can be seen prior to absence, tonic or tonic-clonic seizures
- Myoclonic seizures can also serve as a sign of diffuse brain injury
Define Status Epilepticus
30 minutes of sustained seizure activity or two or more seizures without full recovery of consciousness between seizures
What are the two most important components of an evaluation of seizures?
History and Physical
What evaluations should be used for the following disorders…
- Focal seizure:
- Primary generalized epilepsy:
- Developmental regression:
- Focal seizure: MRI
- Primary generalized epilepsy: EEG only
- Developmental regression: Extensive evaluation
What initial lab studies should be done in the evaluation of seizures?
- Glucose, electrolytes, BUN
- ABG
- Antiepileptic drug levels
- CBC
- Urinalysis
What second phase studies should be done in the evaluation of a seizure?
- Lumbar puncture
- Liver function tests
- Toxicology screen
- Metabolic testing
- EEG
- Brain imaging (CT or MRI)
What risks of therapy exist in treatment of seizures?
- Idiosyncratic reaction
- Systemic toxicity
- Stigma
- Expense
What are some side effects of antiepileptic medication?
- Direct toxicity
- Dermatologic
- Bone marrow effects
- Hepatic effects
