Seizures Flashcards by Ashlyn Landrum

chronic neuro disorders

seizures/ epilepsy
MS
parkinsons
amyotrophic lateral sclerosis

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what is happening to the brain during a seizure

multiple neurons firing at a faster rate

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metabolic disturbances associated w seizures

-acidosis
-electrolyte imbalance
-hypoglycemia
-hypoxia
-alcohol withdrawal
-dehydration, water intoxication

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extracranial disorders associated w seizures

-HTN
-heart, lung, liver, kidney dz
-systemic lupus
-DM
-septicemia (sepsis)

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T or F : seizures resulting from systemic or metabolic disturbances (underlying causes that can be treated) are not considered epilepsy

True

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T or F : cause of most seizures are unknown

true

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known causes of seizures

-stroke, brain tumor, cerebral infection, TBI
-hypoxic birth injury, neurodevelopment disorders, neurodegenerative dz

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other causes of seizures

-low or high glucose levels
-abnormal electrolytes
-lack of sleep
-alcohol withdrawal

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epilepsy

dz with continuing predisposition to seizures w consequences

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what detects epilepsy?

EEG - electroencephalography

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what is critical for successful surgical intervention for epilepsy?

locating seizure focus

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classes of seizures

generalized
focal

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where is a focal seizure

one area of brain - focused (every time)

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Where is a generalized seizure?

any part of brain, different every time

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two types of focal seizures

-simple
-complex

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generalized seizures

-tonic-clonic
-absence
-myoclonic
-atonic
-tonic
-clonic

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phases of seizures

-prodromal
-aural
-ictal
-postictal phase

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prodromal phase

sensations/behavioral changes the pt will experience

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aural phase

sensory warning - similar each time / hear, see, taste something

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ictal phase

first symptoms of seizure - firing of neurons

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post ictal phase

recovery after seizure

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triggers for seizure

EXTREME things
-lights
-stress
-sleep
-sounds
-stopping anti seizure meds
-exercise

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tonic clonic seizure is characterized by

loss of consciousness and falling

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what happens to body in tonic clonic seizure

body stiffens (tonic - 10-20 sec) with subsequent jerking of extremities (clonic - 30-40 sec)

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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