seizures Flashcards by Kelsey Cook

Epilepsy is a chronic condition that can be diagnosed after a patient has _____ unprovoked seizures more than 24 hours apart.

two

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Epilepsy states that epilepsy is best charcterized as a group of syndromes that are concerned with ________, _____, & ______ consequences of the conditions that promote seizure recurrence.

neurobiological, cognitive, and psychological

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Status epilepticus refers to a neurological emergency in which a single seizure last for more than ____ minutes or repeated seizures are present without a recovery of consciousness in between.

5 minutes

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seizure resistant to pharmacotherapy and death have been associated with ______ seizure duration.

increased.

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Epilepsy is the ______ most common neurological disorder in the United States.

third

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The incidence is highest in what two age groups?

individuals over 65 years of age and those under two years of age.

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Epilepsy is observed to be more prevalent in what ethnicity? and what other group of people?

african Americans and the socially disadvantaged populations.

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it is estimated what percentage of the american population will experience a seziure in their lifetime?

10%

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Epilepsy has a strong association with what psychological disorder?

depression

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Epilepsy is noted to generate an imbalance between _____ and _____ neuro transmitters, resulting in seizures

Inhibitory GABA signaling

Excitatory glutamatergic signaling

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People with epilepsy have a mortality rate that is ____ to _____ times higher than that of the general population.

2 to 3

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Individuals with epilepsy have risk of sudden death that is ____ times greater than the general population

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Epiliepsy is found in 13-25% of what four disorders?

autism

cerebral palsy

Down Syndrome

Intellectual Disability

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Several types of seizures begin within or spread to the _______ ______.

cerebral cortex

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Too much _____ can cause a seizure and too little ___ can cause a seizure

too much Glutamate (Eccess–matE)

too little GABA (insufficient)

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describe what the cerebral cortex is?

the outer layer of the neuronal tissue that surrounds the hemisphere of the human brain.

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name the two major classes of seizures?

focal and generalized

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what type of seizures typically start in one hemisphere of the brain

focal

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What are the 2 types of symptom classes that focal seizures can produce

motor or non-motor symptoms

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Focal seizures are unilateral or bilateral? meaning what?

unilateral

meaning they do not spread beyond the local network of neurons in a single hemisphere of the brain.

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what are the 3 types of awareness that take place during focal seizures

still aware (awake/concious)
unaware
awareness unknown

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Generalized seizures are unilateral or bilateral? Meaning what?

Bilateral and symmetrical

meaning they cause electrophysical disturbances across the entire brain.

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the cerebral cortex can be subdivided into regions called?

lobes

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name the lobes of the cerebral cortex.

frontal

parietal

temporal

occipital

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even though focal seizures occur in ___ hemisphere, these seizures can also transition into _____ seizures

- one hemisphere - bilateral tonic clonic seizures

What are the motor symptoms associated with focal seizures

* Tonic: constant stiffness * Atonic: limp or loss of muscle tone * myoclonic: brief jerking movements * clonic: rhythmic jerking * hyper-motor: thrashing, kicking, clapping * Epileptic spasms: sudden flexion, extension, grimacing head noding

what can dictate the symptoms or clinical presentation of the seizure?

the regions of the brain that are affected by the abnormal electrophysiological activity.

what are the non motor symptoms associated with focal seizures

* Sensory (olfactory, visual, auditory\_ * Cognitive (issues thinking, focusing, memory problems) * Emotional (laughing, crying, fear) * Autonomic: (cardiovascular or gastrointestinal)

Abnormal network activity that spreads to the frontal lobe is most commonly associated with seizure types that result in?

loss of consciousness

seizures that in motor dyfunction (AKA jerking) movements or muscle rigidity typically involve the portions of the?

lower brain and brainstem that are responsible for controlling movement.

describe atonic

limp or loss os muscle tone

describe myoclonic

brief jerking movements

describe clonic

rhythmic jerking

neuronal activity normally occurs in a _____ manner, resulting int he ordered transfer of information across synapses from one region of the brain to another

sequential

describe epileptic spasms

sudden flexion, extension, grimacing head nodding

how long do focal seizures last

1-2 minutes

if a focal seizure changes into a bilateral tonic clonic seizure, these seizures are also classified as

generalized seizures

what hemispheres do generalized seizures affect

both hemispheres (which can cause bilateral motor symptoms)

what are the two types of generalized seizures

motor or absence seizures

what physically surround the neuronal networks to regulate the duration and extent to which the wave of activity can spread

specialized neurons called interneurons and glial cells.

in comparison to focal seizures, generalized seizures always cause

impaired awareness

what type of motor symptoms can be produced as a result of generalized motor seizures

tonic, atonic, myoclonic, clonic, epileptic spasms, or combination of these

for generalized absence seizures can differentiated into ___ or \_\_\_\_\_

Typical or atypical

can inhibitory neurons be overcome?causing what?

yes initiation of a seizure

In generalized absence seizures, what type of symptoms are present when classified as typical

suddent onset of a blank stare, upward deviation of the eyes, and an inability to respond

the early phase of ictogenesis is often referred to as ?

initation

ictogenesis results from what?

rapid succession of synchronized action potentials in a subset of neighboring neurons.

in generalized absence seizures, what type of symptoms are produced from the atypical category

when the seizures presents with a change in muscle tone and the onset and end of the seizure is not quick like typical absence seizures

the burst of excitatory activity that causes ictogenesis is caused by?

long lasting depolarization of neuronal membranes due to calcium influx and opening of voltage dependent sodium channels

Generalized absence seizures typically lasts _____ and have a ____ recovery

1-2 minutes quick recovery

With generalized absence seizures, what are the two different types of motor movements that can be present

myoclonic (jerking movements) or eyelid Myoclonia

repetitive action potentials can lead to an accumulation of ______ in presynaptic terminals.

calcium

the accumulation of calcium in presynaptic terminals, leads to enhanced release of ______ and propagation of seizure activity to?

neurotransmitters adjacent groups of neurons

What is eyelid myoclonia defined as

jerking movement of the eyelids with the eyes moving upward

the combination of membrane depolarization and the presence of excitatory neurotransmitters such as _____ stimulate the NMDA receptor which further enhances neuronal activation via the _____ influx

glutamate calcium

since some patients have seizures that are unwitnessed by a third party, these types of seizures are classified as

unknown onset

what is epileptogensis?

the transformation of a normal neuronal network into one that is chronically hyper excitable

what are the two characteristics that need to be described by the patient or a witness to diagnose the type of seizure in addition to an EEG

1. the types of motor symptoms witnessed 2. how aware the patient was

local neurotransmitter imbalances may be a potential mechanism for ?

focal epileptogenesis

in suceptible patients temporary imbalances between ____ and \_\_\_\_\_, as well as the influence of neuromodulators such as ______ and ________ neurotransmitters might trigger the initation of a seizure

glutamate and GABA acetylcholine and monamine neurotransmitters

what is Lennox Gastaut syndrome

childhood epileptic encephalopathy that is categorized by the clinical triad of multiple types of generalized seizures, mental retardation or regression and diffuse slope of spikes and and waves on an EEG

seizures resulting from brain injury usually exhibit a delay of ____ to ____ between an initial CNS injury and the first seizure

months to years

name a few examples of CNS injury that can lead to seizures

trauma stroke fever or infection

when does Lennox Gastaur syndrome (LGS) typically occur

in children within the first 7 years of life

LGS typically causes ____ seizures and often include \_\_\_\_\_\_

multiple daily seizures along with drop attacks

what are the three steps taken in order to classify a type of seizure

1. determine if the seizure is focal, generalized, or unknown 2. verify that the patient had impaired awareness during the seizure (lack of responsiveness, LOC, does not recall the events that occur during the seizure) 3. determine if motor, non-motor, or absense symptoms were present

Many patients with different types of temporal lobe epilepsy (related to structural changes in neuronal networks) have highly selective loss of ? that do what?

inhibitory neurons that may regulate the excitatory neurons within the dentate gyrus

what is the dentate gyrus

a group of neurons in the hippocampus

when verifying that the patient had impaired awareness during the seizure, if any of these markers are true (LOC..etc) then the patient is classified as having \_\_\_\_\_\_\_awareness. However, if no one can verify the level of the patients awareness, it is considered that the patient had _____ awareness

impaired awareness unknown awareness

an initial injury such as a head injury, may lead to very focal confined region of structural change that causes local \_\_\_\_\_\_\_\_, which lead to further structural changes that evolve over time until the focal lesion produces clinically evident \_\_\_\_\_.

hyperexcitability seizures

motor and non motor symptoms can initially present like a focal seizure and progress into \_\_\_\_\_

a bilateral tonic clonic seizure

Diagnosis of seizure disorder consists of?

physical examination patient history EEG recordings

An MRI or CT can be performed to rule out _____ for seizures

CNS disorders

\_\_\_\_% of seizures have no known cause

50%

Physical examination can evaluate seizure disorders that can be associated with?

epilepsy

what are the three types of etiologies that seizures can be classified as

idiopathic, symptomatic, or unknown

Common etiologies related to epilepsy include (try to name a few, there is 8 altogether)?

TBI infections alcohol or drug abuse stroke brain tumor Alzheimer's disease electrolyte distrubances genetic factors

for idiopathic causes of a seizure, this is attributed to ______ etiology, but related to ______ cause

unknown underlying etiology genetic or family history cause

for symptomatic etiology, this is classsified as _______ etiology, or _____ as an underlying cause

underlying cause or evidence of brain injury cryptogenic is considered symptomatic but with no documented underlying cause

for an unknown or undetermines etiology, this refers to

no identifiable cause

Though there is no laboratory test for epilepsy, _____ levels may be transiently elevated for up to 20 minutes after a seizure has occurred.

serum prolactin

when is an EEG typically obtained after a patient has a seizure

48 hrs or more after a seizure episode

\_\_\_% of patient with true seizures will have multiple ____ EEG's

10% and normal EEG's

\_\_\_\_\_ can also be performed to rule out an metabolic causes of a seizure

drug toxicity or alcohol screen

EEG can provide what information about seizures?

the type and location of the seizure focus

epilepsy can impact a person's quality of life through associated pain, anxiety, and \_\_\_\_\_.

insomnia