SEIZURES Flashcards

1
Q

Causes of nonepileptic seizures

A

Extreme metabolic disruption from systemic disease
A deficiency state
Local effects of a brain tumor
Withdrawal from sedative/hypnotic drugs including ethanol
Infection
Renal failure
Hypoxic encephalopathy
Febrile convulsions

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2
Q

How do epileptic seizures happen?

A

A group of abnormal neurons in the epileptogenic foci spontaneously depolarize and the foci will recruit normal neurons –> seizure

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3
Q

Details about seizure activity patterns

A

Consists of a set of sensory, mental, and/or motor activities that are fairly consistent for a given individual

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4
Q

Partial seizures begin at…

A

…discrete and relatively limited focus

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5
Q

The pattern of partial seizures depends on what?

A

The area stimulated

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6
Q

Focal motor without march definition

A

Twitching limited in one area and doesn’t spread

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7
Q

Focal motor with march definition

A

Twitching starts in one area and spreads

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8
Q

Characteristics of a simple partial seizure

A

Has limited spread. Uncomplicated, affects only limited aspects of neural function, has motor or sensory symptoms

(The example Gengo gave in lecture where the patient said the room smelled weird but Gengo said it was fine, the patient realized they had a simple partial seizure)

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9
Q

Are consciousness and memory disturbed in a simple partial seizure?

A

No

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10
Q

Characteristics of complex partial seizures

A

Alteration of consciousness follows initial simple seizure. May appear alert and aware but consciousness impaired
Typically appears confused or preoccupied
May exhibit automatisims: purposeless and automatic behaviors (lip smacking, sucking, fumbling with clothing, etc.)

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11
Q

Where do complex partial seizures usually arise?

A

Temporal lobe

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12
Q

Feature of a generalized seizure (in regard to how much of the brain is involved)

A

Can’t be linked to a single foci, involves entire cerebrum. Includes seizures that vary immensely in terms of severity and amount of brain tissue recruited

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13
Q

Absence seizure features

A

Minor impairment of neural function because of short duration
Blank stare or other facial expression indicates impaired consciousness
2-10 seconds later- resumes pre-seizure activity
Disruption in intentional behavior, consciousness, and memory but not posture, muscle tone, or ongoing automatic behavior (walking)
May include lip smacking, pouting, eye blinking
Can occur 100s of times/day

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14
Q

When do simple absence seizures occur?

A

Childhood and adolescence, begins in childhood and peaks at 6-7 y/o

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15
Q

Do simple absence seizures resolve?

A

Yes, they usually go away when the CNS matures but may progress to generalized tonic-clonic seizures

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16
Q

Feature of a tonic-clonic seizure (in regard to how much of the brain is involved)

A

All brain systems can be recruited into paroxysmal discharge

17
Q

3 phases of a tonic-clonic seizure

A

Tonic phase
Clonic phase
Terminal phase

18
Q

Tonic phase features

A

Brief period of muscle flexing followed by 10-15 seconds of pronounced extension, bladder may empty, breathing stops, pupils unresponsive to light
End indicated by short period of muscle tremor

19
Q

Clonic phase features

A

Onset indicated by initial muscle relaxation
Violent spasms of contraction and relaxation
Strongest muscles dominate- elbow flexion, leg extension, torso hyperextension
Respiration resumes but ineffective- cyanosis
Heavy saliva secretion and blood from bitten tongue → froth of blood in mouth

20
Q

Terminal phase

A

Limp and quiet with normal breathing
May be followed by several hours of deep sleep or may become conscious with no recollection of seizure

21
Q

Seizure definition

A

uncontrolled electrical activity in the brain, that can produce a physical convulsion, minor physical signs, thought disturbances, or a combination of these symptoms

22
Q

Epilepsy definition

A

condition characterized by a relatively long-term disturbance of brain structures and/or function that produces an increased susceptibility to seizures

23
Q

Difference between a person who has epilepsy vs. seizures

A

Everyone who has epilepsy has seizures, but not everyone who has a seizure has epilepsy

24
Q

Common causes of seizures in adults 20-50 y/o

A

Possible it could be from underlying causes like metabolic imbalances, toxicity, hemodynamic instability, psychogenic (patient thinks they’re having a seizure but they’re really not)

25
Q

Common causes of seizures in adults >50 y/o

A

Usually from a tumor, bleeding, infection, fibrosis secondary to a stroke that occurred 6-12 months earlier…usually don’t have a good prognosis

26
Q

Seizure history

A

When was your first seizure?
How often do you have seizures?
When was your most recent seizure?
What did you do, or eat, or take the day of your most recent seizure?
What anticonvulsant medications have you used in the past?
What medications are you currently taking in addition to the anticonvulsant?
Medication-specific questions regarding toxicity
Determine relevant counseling points for this patient and their specific medications
Be sure patient understands the goal of therapy

27
Q

Management of epilepsy

A

Control with one drug, only go to polytherapy only after several drugs have failed

28
Q

Goal of epilepsy therapy

A

Reduce the number of seizures (NOT GET RID OF THEM ENTIRELY) and have the patient experience the least amount of side effects

29
Q

Favorable outcomes of seizure therapy

A

Seizure free >3 years
Monotherapy
Background EEG normal
No psychomotor retardation
No juvenile myoclonic epilepsy

30
Q

Who should diagnose epilepsy?

A

A NEUROLOGIST

31
Q

What to do if a pregnant patient has seizures and needs therapy

A

Use AED monotherapy if necessary at the lowest dose

32
Q

AEDs to avoid in pregnancy

A

Lamotrigine
VPA+CBZ+PB polytherapy
Avoid VPA and CBZ but if not, use lower divided doses

33
Q

Patients taking OCs but also have seizures

A

Divalproex has no effect on OC efficacy

34
Q

What medications decrease OC effectiveness and why?

A

phenobarbital, phenytoin, primidone, carbamazepine all decrease it because they increase the CL of estrogen

35
Q

AEDs that are CI’ed in breastfeeding

A

Ethosuximide, zonisamide, clonazepam, diazepam