Seizures Flashcards
chronic neuro disorders
- seizures/ epilepsy
- MS
- parkinsons
- amyotrophic lateral sclerosis
what is happening to the brain during a seizure
multiple neurons firing at a faster rate
metabolic disturbances associated w seizures
-acidosis
-electrolyte imbalance
-hypoglycemia
-hypoxia
-alcohol withdrawal
-dehydration, water intoxication
extracranial disorders associated w seizures
-HTN
-heart, lung, liver, kidney dz
-systemic lupus
-DM
-septicemia (sepsis)
T or F : seizures resulting from systemic or metabolic disturbances (underlying causes that can be treated) are not considered epilepsy
True
T or F : cause of most seizures are unknown
true
known causes of seizures
-stroke, brain tumor, cerebral infection, TBI
-hypoxic birth injury, neurodevelopment disorders, neurodegenerative dz
other causes of seizures
-low or high glucose levels
-abnormal electrolytes
-lack of sleep
-alcohol withdrawal
epilepsy
dz with continuing predisposition to seizures w consequences
what detects epilepsy?
EEG - electroencephalography
what is critical for successful surgical intervention for epilepsy?
locating seizure focus
classes of seizures
generalized
focal
where is a focal seizure
one area of brain - focused (every time)
Where is a generalized seizure?
any part of brain, different every time
two types of focal seizures
-simple
-complex
generalized seizures
-tonic-clonic
-absence
-myoclonic
-atonic
-tonic
-clonic
phases of seizures
-prodromal
-aural
-ictal
-postictal phase
prodromal phase
sensations/behavioral changes the pt will experience
aural phase
sensory warning - similar each time / hear, see, taste something
ictal phase
first symptoms of seizure - firing of neurons
post ictal phase
recovery after seizure
triggers for seizure
EXTREME things
-lights
-stress
-sleep
-sounds
-stopping anti seizure meds
-exercise
tonic clonic seizure is characterized by
loss of consciousness and falling
what happens to body in tonic clonic seizure
body stiffens (tonic - 10-20 sec) with subsequent jerking of extremities (clonic - 30-40 sec)
symptoms that may occur during tonic clonic seizure
cyanosis , salivation, tongue / cheek biting , incontinence
does a pt with a tonic clonic seizure remember ?
NO - no memory of seizure
postictal phase of tonic clonic seizure
-muscle soreness
-fatigue
-pt may sleep for hours
-may not feel normal for hours-days
-no memory
T or F ; every time pt has a seizure can lead to tissue brain death
TRUE
typical absence seizures symptoms
no symptoms in BODY
-‘daydreaming’
-unresponsive
how long do absence seizures last
abt 10 seconds
atypical absence seizures symptoms
‘daydreaming’ with :
-eye blinking
-jerking movements of lips
-repetitive finger movements
how long do atypical absence seizures last
abt 30 seconds
atonic seizure involves
tonic episode or paroxysmal muscle loss of muscle tone - sudden fall
how long do atonic seizures last
15 seconds
what are pts with atonic seizures at risk for?
fall risk - head injury
myoclonic seizure symptoms
-sudden excessive jerking
-pt can fall
-twitching of extremities
-loss of consciousness,
-multiple times a day , multiple clusters
tonic seizures involves
sudden onset of maintained increased muscle tone in extensor muscles
when do tonic seizures often occur
sleep
what side(s) of body do tonic seizures affect
both
how long do tonic seizures last
about 20 seconds
is consciousness preserved in a tonic seizure
usually
clonic seizure begins with
loss of consciousness and sudden loss of muscle tone
what happens after loss of consciousness and loss of muscle tone in a clonic seizure
rhythmic limb jerking , may/may not be symmetric
are clonic seizures rare
yes
simple focal seizures - pt remains
conscious and alert
what does the pt experience during a simple focal seizure
unusual feelings or sensations
-sudden unexplainable feelings of joy, anger, sadness, nausea (aural phase)
-may hear, smell, taste, see or feel things that are not real
complex focal pts have a
loss of consciousness or alteration in awareness
what do the eyes do in complex focal seizures
may remain open, cannot interact
-may display strange behaviors
-automatisms
-don’t remember activity started before / during seizure
psychogenic nonepileptic seizure
-imitate seizures but triggered by emotional events - experience same symptoms
-diagnosed by EEG
-hx of emotional, physical abuse or traumatic event
status epilepticus is what ?
continuous seizure activity when seizures recur in rapid succession without return to consciousness between seizures
status epilepticus is a seizure lasting longer than
5 min
2 + seizure in close succession without return to consciousness (no postictal phase)
is status epilepticus an emergency?
yes
what can status epilepticus result in?
brain damage, death
complications of seizures
-depression
-social
-discrimination
-driving
primary drugs for treatment of tonic-clonic and focal onset seizures
-phenytoin
-carbamazepine
-valproic acid
who is more at risk for SE?
comorbidities
how to AED work?
-supress Na, Ca influx
-promote K efflux
-block receptors for glutamate
-potentiation of GABA
what do plasma drug levels help us do?
-determine dosage
-pt adherence
-determine cause of lost seizure control
-identify cause of toxicity
what is seizure disorder mainly treated with ?
anti epileptic drugs (AED)
is a cure possible for seizures?
no - just reduce seizures and symptoms
what can happen if you abruptly stop AED?
status epilepticus
most widely / first used AED is what?
phenytoin
MOA of phenytoin
causes selective inhibition of Na channels (slows recovery from inactive to active state)
adverse effects of phenytoin
-CNS: nystagmus, sedation, ataxia, diplopia, cognitive impairment
-gingival hyperplasia (oral care!!) !!!!!!!!!!!
-morbilliform (measles like) rash
-teratogen
-cardiac dysthymias and hypotension
phenytoin decreases the effects of
oral contraceptives, warfarin, glucocorticoids
what does pt need to take if taking phenytoin levels
2+ forms of BC
phenytoin increases dilantin levels
diazepam, isoniazid, cimetidine, alcohol, valproic acid
how do we administer phenytoin
with food
old AED - carbamazepine
MOA
same as phenytoin but minimal effects on cognitive function
old AED - carbamazepine
adverse effects
bone marrow suppression - anemia, leukopenia, leukcytopenia
old AED - valproic acid is the 1st line for
all partial and generalized seizures
old AED - valproic acid MOA
same as phenytoin and carbamazepine - suppress Na influx
old AED - valproic acid adverse effects
hepatotoxicity, pancreatitis
old AED - phenobarbital can cause
physical dependence
old AED - phenobarbital decreases the effects of
warfarin and BC
old AED - phenobarbital adverse effects
drowsiness, interferes with metabolism of Vit D and K
old AED - phenobarbital toxicity
nystagmus and ataxia
newer AED - oxcarbazepine MOA
block voltage sensitive Na channels
newer AED - oxcarbazepine management of what seizures?
partial
newer AED - oxcarbazepine can be given with
other meds
newer AED - lamotrigine MOA
blocks Na and Ca channels
newer AED - lamotrigine can cause
-life-threatening rash
-risk for suicide
newer AED - gabapentin adjunct therapy for
partial seizures
newer AED - gabapentin can also be given for
neuropathic pain
newer AED - pregabalin useful for
neuropathic pain , neuralgia
newer AED - pregabalin adjunct therapy for
partial seizures
newer AED - pregabalin can cause
life threatening angioedema
newer AED levetiracetam does not interact with
other AEDs
newer AED - topiramate broad spectrum
antiseizure agent
management of status epilepticus 1st line
lorazepam , effect lasts up to 72 hrs , NEED IV SITE - check every shift
management of status epilepticus 2nd line
diazepam - short duration, 5-10mg IV every 5-10 min (not exceed 30mg)
management of status epilepticus 3rd
phenytoin
management of status epilepticus 4th
fosphenytoin - less irritating
pts with what types of seizures are candidates for surgery?
focal / defined site
how long should pt stay on AED after surgery?
2+ years
SEIZURE acronym
S- suction or turn pt to side
E- ensure safety
I- initiate O2 therapy
Z- zero restraints
U- undo tight clothing
R- record sezire or look at what is happening to pt
E- evaluate seizure
