Seizures Flashcards
What is a seizure
Electrical storm in the brain
What is epilepsy
recurrent unprovoked seizures associated with abnormal electrical activity in the brain
What is the criteria for being diagnosed with epilepsy
2 or more unprovoked seizures separated by AT LEAST 24 hours
When will you start someone on anti-seizure medication
after second unprovoked seizure
What are examples of a provoked seizure
infections
alcohol withdrawal
low blood sugar
surgery
What are the 3 main classifications of seizures
Focal onset
generalized onset
unknown onset
What are focal onset seizures
seizures that start in and affect one part of the brain
generally originates paroxysmal discharge in the temporal lobe
What is a primary generalized seizure
abnormal electrical discharge that originates from the diencephalic activating system and spread simultaneously through the brain
What are the stages of a seizure
prodrome
aura
ictal phase
post-ictal phase
What type of seizures do auras occur in
focal epilepsy
What is the ictal phase
Time from the first symptom (including aura) until the end of the seizure activity
What is an example of automatisms
lip smacking
What progression may you see in seizures as the activity spreads to other parts of the brain
Aura->focal aware-> focal unaware-> bilateral tonic clonic
What is the post-ictal phase
Time between the end of a seizure and return to baseline
What is a focal seizure with impaired awareness
Starts in one area of the brain
duration 1-3 minutes
What are signs someone is having a focal seizure with impaired awareness
picking at clothes
bicycling of legs
utilization behavior
Smacking lips
What is a bilateral tonic clonic seizure
may see head or eye deviation (pt. looking away from seizure)
will show figure 4 or fencing posture
If a patient demonstrates fencing posture, where is their seizure located
frontal lobe
If a patients hand goes up to their face, what does it tell you about the seizure
Tells you which side of the brain the seizure is happening in
hand=side of seizure
What are generalized seizures
absence
myoclonic
clonic
tonic
tonic-clonic
atonic
What is an absence seizure
sudden behavioral arrest
What is a clonic seizure
rhythmic contraction of arms and legs
What is an atonic seizure
loss of muscle tone “drop attack”
What type of seizures do children typically have
absence seizures
*generally happen in clusters
If a myoclonic seizure disorder starts with childhood, what will happen as they grow
They should grow out of it
If myoclonic seizures starts in juvenile ages, will they grow out of it
no
When are myoclonic seizures most common
morning time upon waking up
What happens if a seizure lasts longer than 5 minutes
They probably won’t stop on own-> call 911
What side is best to turn a person on to and why
left
better venous return
What is the difference between provocation and triggers
Provoked= things out of the ordinary that cause seizures
Trigger= known causes for seizure
What is an example of provocation
severe hypoglycemia
Which patients will have febrile seizures
children under age 5
-should be primary/general in onset…No prodrome
What are medication side effects for anti seizure medications
Balance issues
double vision
prolonged nystagmus
If someone has a “wine stain” on their face, what is it indicative of
brain was effected with seizure and the patient probably needs surgery
What is a storage weber sign
a wine stain on the face
How would you differentiate between confusion and aphasia
when a patient is aphasic, they can act out a word but cannot think of what it is
What is PNES
psychogenic non-epileptic seizures
can someone with epilepsy have non-epileptic seizures
Yes
What is the most common correlation for PNES
sexual abuse
If someone has a prolonged seizure that breaks on its own and they go into status, is this a sign of epilepsy or PNES
PNES
What test do you need to truly confirm whether a seizure is epileptic or not
EEG
What is the standard of care for seizures if a patient has only had one
avoid typical precipitants if unprovoked
Correct imbalance if provoked
When should anti-convulsants be used for patients
if they have had 2+ unprovoked seizures
What do broad spectrum ASMs treat
generalized and focused epilepsies
What do narrow spectrum ASMs treat
only focal epilepsy
*may make generalized worse
What is the drug of choice for idiopathic generalized epilepsy
Valproic acid
*avoid in women of child bearing age
When can/should you consider stopping seizure medication
when a patient is seizure free for 2 years
What type of birth control should a female be on while taking AEDs
IUD
If the risk of seizures outweighs the risk of fetotoxicity, what drug should the mother be put on
Keppra
folic acid supplement
What are acute repetitive seizures
closely group seizures over minutes to 2 days that increase in frequency
What are the 3 types of status epilepticus
tonic clonic
focal with impaired consciousness
absence
What is status epilepticus
continuous seizure activity for at least 5 minutes
OR
2+ seizure attacks without recovery of consciousness in between
What makes status epilepticus complex
usually a combo of seizure types
The longer it goes, the less noticeable it is
What is the first like agent for status
4mg IV lorazepam x 2
