seizures Flashcards
What is a seizure?
A seizure is a sudden, transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic, or psychic phenomena, alone or in combination, often accompanied by alteration or loss of consciousness.
Seizures may occur after a ____, ____, ____ or ___ insult to the brain (symptomatic seizures) occurs or spontaneously without prior known CNS insult.
metabolic, traumatic, anoxic, infectious
Epilepsy is defined as
Epilepsy is defined as two seizures that are separated by at least 24 hours, a single seizure associated with a greater than 60% risk of recurrence or the diagnosis of an epilepsy syndrome
During childhood, the incidence of epilepsy is highest in what age period?
newborn
The chance of having a second seizure after an initial unprovoked episode in a child is about ___%.
50
Etiology of epilepsy and seizures
genetic (usually due to multiple genes)
idiopathic (accounts for >60%)
acquired (injury, brain, tumors, strokes, previous infections, electrolyte imbalance, autoimmune disordes)
classification of seizures (3)
- focal
- generalized
- unknown
There are several types of generalized seizures that are recognized with the new classification: (7):
- generalized tonic- clonic,
- absence (typical, atypical, and with special features),
- myoclonic,
- myoclonic atonic,
- tonic,
- clonic, and
- atonic seizures.
What are 2 types of focal seizures
Focal seizure with retained awareness
Focal seizure with altered awareness
Describe focal seizure with retained awareness
(simple partial seizures)
- arise from a specific anatomical focus.
- Clinical symptoms include motor (tonic, clonic, myoclonic), sensory, psychic, or autonomic abnormalities, but consciousness is preserved.
- The location and extent of spread of the seizure focus determine the clinical symptoms.
Describe focal seizure with altered awareness
(complex partial seizures)
- similar sensorimotor signs + alteration of consciousness.
- dyscognitive features may occur
- patients may have automatisms or stare during these seizures
Describe generalized seizures
Tonic, clonic, and biphasic tonic-clonic seizures may occur alone or in association with other seizure types.
seizure begins abruptly but occasionally is preceded by a series of myoclonic jerks
consciousness and control of posture are lost, followed by tonic stiffening and upward deviation of the eyes.
Pooling of secretions, pupillary dilation, diaphoresis, and hypertension are common.
What can help define the location of seizure onset?
specific symptoms, eg deja vu suggests temporal lobe onset
Questions that help clarify the type of seizure (5)
Was any warning noted before the onset?
What did the patient do during the event?
Was there urinary or fecal incontinence?
How long did it last?
How was the child behaving after the seizure? (Any postictal events?)
what can cause febrile seizures?
(meningitis, encephalitis, brain abscess)
types of febrile seizures and their description (2)
- Simple febrile seizures
last < 15 minutes, and occur only once in a 24-hour period in a neurologically and developmentally normal child.
- Complex febrile seizures
lasts >15 minutes, recurs within 24 hours, or the child has preexisting neurological challenges
Treatment of febrile seizures
most children require no treatment
Rectal diazepam can be administered during a seizure
Do paracetamol or ibuprofen decrease the chance of having febrile seizure?
NO
What is epilepsy syndrome?
Epilepsy syndromes have
distinctive EEG and clinical features (age of seizure onset, specific seizure types)
At least two unprovoked (or reflex) seizures occurring >24h apart
One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
What is benign epilepsy of childhood with centrotemporal spikes
self limited epilepsy with spontaneous remission, usually by age 15-17;
age of onsent 4-10 y
unknwon etiology, but family history of epilepsy is common
pharmacoresponssive but preventive medication could not be required
normal cognition, although learning ad behavioral disorders can occur
What is childhood absence epilepsy
blank stare, daydreaming, mimics attentional disorder
mostly self-limited epilepsy, age of onsent 3-10 years, peaks at 6-7 years
first choice of medication: ethosuximide
generalized tonic clonic: valproic acid
comorbid learning disabilites and ADHD
What is juvenile myoclonic epilepsy
Juvenile myoclonic epilepsy (JME) begins in adolescence (12 – 18 years old) and, notably, involves myoclonic seizures.
photosensitive epilepsy: seizures can be triggered by flashing or flickering lights.
what are myoclonic seizures
Myoclonic seizures manifest with symmetric, irregular, shock-like, jerks of the shoulders and arms, most notably, which can cause the person to drop items, but can also affect the legs, which can cause falls.
What is west syndrome
West syndrome is the triad of infantile spasms, developmental regression, and a dramatically abnormal EEG pattern (hypsarrhythmia—a pattern of chaotic high-voltage slow waves, spikes, and polyspikes).
What are infantile spasms
Infantile spasms are brief contractions of the neck, trunk, and arm muscles, followed by a phase of sustained muscle contraction lasting less than 2 seconds
What is Lennox-Gastaut Syndrome
is a severe epilepsy syndrome with variable age of onset.
Most children present before age 5 years
multiple seizure types are present
Many children have underlying brain injury, malformations, or genetic etiologies.
The seizures are typically difficult to control, and most patients have significant intellectual disability.
What is status epilepticus
Status epilepticus is a neurological emergency and is defined as
ongoing seizure activity or
repetitive seizures without recovery of consciousness for greater than 30 minutes.
Possible triggers of Status Epilepticus
epilepsy syndromes
cerebral damage
brain tumor
electrolyte abnormalities
drug/alcohol overdose or withdrawal
encephalits
Status epilepticus management
Stabilization:
ABC
Cardiac monitoring
Oxygen
IV access
LAB
Pharma:
Benzodiazepine
Standard anticonvulsant med
Continuous infusion
General anesthesia
Laboratory evaluation for an otherwise healthy child with a self-resolved, unprovoked seizure and a normal physical and neurological examination
no laboratory evaluation is required
Laboratory evaluation for Children with simple febrile seizures who have recovered completely
require little or no laboratory evaluation other than studies necessary to evaluate the source of the fever.
Children with clinical signs and symptoms of meningitis (neck stiffness, Kernig sign, Brudzinski sign), or history or physical examination suggestive of intracranial infection, should undergo what diagnostic procedure?
lumbar puncture
What does complete LAB for evaluation of seizure consist of? (4)
complete blood count and
measurement of glucose, and
electrolytes,
also blood or urine toxicology screening.
