Seizures Flashcards
what is a seizure?
Transient occurrence of s/s d/t abnormal hyper-synchronization of neurons
def epilepsy
brain disorder characterized by repeated epileptic unprovoked seizures
def status epilepticus
MEDICAL EMERGENCY
seizure that lasts >5min OR more than one seizure that occurs without a return to a normal level of consciousness for >5min between episodes
what are some triggers that can cause provoked seizures?
- toxins/drugs: intoxication or withdrawal, medications, poor antiepileptic compliance
- neuro: STROKE, injury/trauma, tumour, inflammatory, hypoxic brain injury
- infectious: CNS infection (meningitis/encephalitis), febrile seizure (peds), sepsis
- metabolics: hypoglycemia, lytes, liver/renal failure
- sleep deprivation
- flashing lights
- genetics
what are the 4 phases of a seizure?
prodromal ➔ aural ➔ ictal ➔ postictal
what are some general s/s that may occur during a seizure?
- clonic movements: jerking
- tonic: stiffening
- spacing out
- brief muscle jerks
- spacing out
- unusual sensations
- Todd’s paralysis: paralysis in one side of the body ➔ usually temporary (~15h)
common s/s during the postictal phase?
- confusion
- drowsiness
- total amnesia
def focal (partial) seizure
seizure where only one hemisphere is affected ➔ can progress into a generalized seizure
def generalized seizure
seizure where both hemispheres are affected
types of focal seizures
Focal w/ intact awareness (simple partial) and focal w/impaired awareness (complex partial)
s/s of focal w/ intact awareness
usually last <2min
Motor: dystonic posturing, clonic movements, jerking/rigidity, jacksonian march (abnormal movements start in one muscle group and progress to adjacent)
Sensory: hearing, smelling, seeing, tasting things that aren’t there
Autonomic: sweating, epigastric discomfort, pallor, flushing, scratching, dilated pupils
s/s of focal w/impaired awareness
appears awake but impaired awareness
automatism: chewing, lip-smacking, scratching, disrobing
structured hallucinations, deja vu, dysphasic, disorientation of time
types of generalized seizures
- absence - petit mal
- tonic
- clonic
- tonic-clonic
- myoclonic
- atonic
how to work up a seizure?
- collateral hx – figure out the type of seizure
- hx of seizure
- medication use
- pmhx - immunosuppression or maliganncy, recent illness
- social - drugs or alcohol
- attempt to identify the trigger
- consider brain imaging (MRI > CT)
- EEG ➔ can be used for risk stratifcation for repeat seizure
- consider labwork to w/u etiology
- consider neurology outpt referral ?epilepsy
one s/s of each type of generalized seizure
- absence - petit mal: children, unresponsive - blank staring
- tonic: whole body stiffening
- clonic: whole body rhythmic jerking
- tonic-clonic: MC, may have prodrome, muscle rigidity (biting of tongue/cheek) ➔ repetitive violent jerking (cyanosis or frothing, urinary/fecal incontinence)
- myoclonic: sporadic contraction of muscles in 1 or more muscle groups
- atonic: loss of muscle tone ➔ drop attack
what are some stroke mimics?
- Syncope (DDx atonic)
- Stroke (DDx atonic)
- Movement disorders
- Sleep-related movements
- ADHD (DDx absence seizures)
- Eti of altered LOC (DDx for non-convulsive seizures)
- Panic disorders/hyperventilation
how to tx seizure?
if an unprovoked seizure in an adult and they returned to normal baseline ➔ most likely does not need initiation of antiepileptic med
if in active seizure ➔ protect their airway and tx underlying cause
- if needed acutely ➔ benzodiazapine
- refer to neurology afterwards
how to tx epilepsy?
refer to neurology for initiation of medications
- some classes: sodium channel blockers, GABA receptor agonists (benzos and barbiturates), glutamate antagonists
ex. phenobarbital, carbamazepine, phenytoin, valproic acid, topiramate
consider surgical tx if meds not working (refractory – not responsive after trying > 3 drugs_
keto diet ➔ ketones cross BBB ➔ increase GABA (inhibitory) and decrease glutamate (exitatory)
what pt education you give for ppl who had a seizure?
- avoid triggers
- swimming safety and bathing alone precautions
children
- manage seizures at school
- counselling on future fears
- establishing health habits ➔ no drugs/alcohol
adults
- counselling on vocational concerns
- report to ministry of transport ➔ revoke license
- counselling on reproductive health, family planning, etc re: teratogenic meds (valproic acid)
- drug-alcohol interactions
- independent living concerns
seniors
- polypharmacy
- importance of compliance
- independant living
- safety and injury risks
how to tx status epilepticus?
- ABCDE + remove trigger
- thiamine ➔ glucose ➔ naloxone
- benzodiazepine
- phenytoin
- other supportive care
if seizures continue >20min ➔ intubate + phenobarbital ➔ can consider inducing coma
