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IM4 > Seizures > Flashcards

Seizures Flashcards

1
Q

What is a seizure?

A
  • Sudden abnormal, excessive electrical discharge or neurons in the brain (neurons fire at faster than normal rate)
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2
Q

What do seizures cause?

A
  • Involuntary movements
  • Sensory phenomenon
  • Emotional expression
  • Unusual behavior
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3
Q

What causes a seizure?

A
  • Cause of most is unknown
  • Stroke, brain tumors, TBI, cerebral infection
  • Hypoxic birth injury, neurodevelopmental disorders, neurodegenerative disease
  • Low and very high glucose levels!
  • Abnormal serum electrolytes
  • Withdrawal
  • Dehydration or water intoxication
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4
Q

Extracranial disorders associated with seizures

A
  • HTN
  • Heart, lung, liver, kidney disease
  • Lupus
  • Diabetes
  • Septicemia
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5
Q

How are seizures/epilepsy detected?

A

EEG
- only way to know its a seizure

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6
Q

What is critical for successful surgical intervention?

A

Locating where the seizure originates/where it is happening in the brain

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7
Q

Two classes of seizures

A
  • Generalized
  • Focal
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8
Q

Focal seizures

A
  • Simple
  • Complex
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9
Q

Generalized seizures

A
  • Tonic-Clonic
  • Absence
  • Myoclonic
  • Atonic
  • Tonic
  • Clonic
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10
Q

Seizures may progress through several phases. These phases include:

A
  • Prodromal phase
  • Aural phase
  • Ictal phase
  • Postictal phase
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11
Q

Tonic-Clonic seizures

A
  • Loss of consciousness and falling
  • Body stiffens (tonic) with jerking of extremities (Clonic)
  • Cyanosis, excess salivation, tongue/cheek biting, incontinence
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12
Q

Postictal phase for tonic-Clonic seizures

A
  • Muscle soreness, fatigue
  • May sleep for hours
  • No memory of seizure!
  • May not feel normal for hours to days
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13
Q

Typical absence seizures

A
  • Usually in children
  • Caused by flashing lights and hyperventilation
  • Symptom: staring spell “daydreaming”
  • Unresponsive when spoken to during seizure
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14
Q

Atypical absence seizures

A
  • Staring spell with eye blinking, jerking lips, repetitive finger movements
  • Lasts 30 seconds
  • Usually continue into adulthood
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15
Q

Atonic seizure

A
  • Begins suddenly, person falls
  • Loss of muscle tone
  • Last less than 15 seconds
  • Person usually remains conscious
  • Risk for head injury!!!
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16
Q

Tonic seizures

A
  • Sudden onset of increased tone in extensor muscles
  • Often occur in sleep!
  • Affects both sides of body
  • Lasts less than 20 seconds
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17
Q

Clonic seizures

A
  • Begin with loss of consciousness and sudden loss of muscle tone
  • Followed by rhythmic limb jerking that may or may not be symmetric
  • Rare
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18
Q

Focal seizures

A
  • AKA partial or partial focal seizures
  • Begin in specific region of cortex in one hemisphere of brain
  • Produce manifestations based on function of area of brain involved
  • Simple or complex
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19
Q

Simple focal seizures

A
  • Person remains conscious and alert
  • Sudden and unexplainable feeling of joy, anger, sadness, or nausea
  • May hear, smell, taste, see, or feel things that are not real
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20
Q

Complex focal seizures

A
  • Loss of consciousness or decreased awareness
  • Eyes remain open but can’t interact
  • Repetitive purposeless actions
  • Dont remember activity started before seizure
  • Lasts 30 seconds to 20 mins
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21
Q

Psychogenic nonepileptic seizures

A
  • Triggered by emotional events
  • EEG doesn’t show seizure
  • No vital sign changes
  • History of emotional or physical abuse or traumatic event often emerges
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22
Q

Status epilepticus

A
  • Any seizure lasting longer than 5 mins
  • Neurologic emergency
  • Can occur with any type of seizure
  • May result in permanent brain damage or death
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23
Q

What is the most common complication of seizure disorder

A
  • Depression
  • Social stigma
  • Discrimination
  • Driving sanctions
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24
Q

What diagnostic test is used to confirm a seizure?

A

EEG

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25
Q

Primary drugs for treatment of tonic-clonic and focal onset seizures

A
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Valproic acid (Depakote)
26
Q

How do antiepileptic drugs work?

A
  • Suppression of sodium influx
  • Suppression of calcium influx
  • Promotion of potassium efflux
  • Blockade of receptors for glutamate
    -Potentiation of GABA
27
Q

Phenytoin

A
  • Most widely used traditional AED
  • Active against partial and generalized tonic-clonic seizures
  • Suppresses seizures without depressing entire CNS
28
Q

Phenytoin MOA

A

Causes selective inhibition of sodium channels

29
Q

Phenytoin A/E

A
  • Effects on CNS (Nystagmus, sedation, ataxia, diplopia, cog. Impairment)
  • Gingivial Hyperplasia
  • Dermatologic effects (morbilliform measles like rash)
  • Effects in pregnancy (teratogen)
  • CV effects ( dysrhythmias and hypotension)
30
Q

What decreases the effects of Phenytoin?

A
  • Oral contraceptives
  • Warfarin
  • Glucocorticoids
31
Q

What increases levels of phenytoin?

A
  • Diazepam
  • Isoniazid
  • Cimetidine
  • Alcohol
  • Valproic acid
32
Q

What decreases levels of phenytoin?

A
  • Carbamazepine
  • Phenobarbital
  • Alcohol
33
Q

Phenytoin administration

A

With food

34
Q

Old AEDs

A
  • Carbamazepine
  • Valproic acid
  • Phenobarbital
35
Q

Carbamazepine MOA

A
  • Same as phenytoin but minimal effects on cognitive function
  • Used for bipolar disorder and trigeminal neuralgia
36
Q

Carbamazepine A/E

A

Bone marrow suppression

37
Q

Valproic acid

A
  • 1st line drug for all partial & generalized seizures
  • Used for bipolar disorder & migraine prevention
38
Q

Valproic acid A/E

A
  • Hepatotoxicity
    -Pancreatitis
39
Q

Phenobarbital

A
  • One of the oldest AED, effective and inexpensive
  • Can cause physical dependence
  • Decreases effects of warfarin and birth control
40
Q

Phenobarbital A/E

A

Drowsiness, interferes with metabolism of vitamin D & K

41
Q

Phenobarbital toxicity

A
  • Nystagmus
  • Ataxia
42
Q

Newer AEDs

A
  • Oxcarbazepine
  • Lamotrigine
  • Gabapentin
  • Pregabalin
  • Levetiracetam
  • Topiramate
43
Q

Oxcarbazepine mode of action

A
  • Blockade of voltage-sensitive sodium channels
  • For management of partial seizures
44
Q

Oxcarbazepine A/E

A
  • Dizziness
  • Drowsiness
  • Avoid driving & other hazardous activities
45
Q

Lamotigine

A
  • Broad spectrum of antiseizure activity
  • Bipolar disorder
46
Q

Lamotrigine MOA

A

Blocks sodium and calcium channels

47
Q

Lamotrigine A/E

A
  • Life threatening rash
  • Risk for suicide
48
Q

Gabapentin

A
  • Very well tolerated
  • Adjunct therapy for partial seizures
  • Common side effects: somnolence, dizzy, ataxia, fatigue, nystagmus, peripheral edema
49
Q

Pregabalin

A
  • Useful for neuropathic pain, postherpetic neuralgia
  • Adjunct therapy for patial seizures
  • Can cause life threatening angiodema
50
Q

Levetiracetam

A
  • Does not interact with other AEDs
  • MOA unknown
51
Q

Topiramate

A

Broad spectrum antiseizure agent

52
Q

Lorazepam

A
  • First line management
  • Effects last up to 72 hours
  • Usual dose 4mg IV at rate of 2 mg/min
53
Q

Diazepam

A
  • Short duration
  • Must be administered repeatedly
  • 5-10 mg IV every 5 to 10 mins @ 5 mg/min (don’t exceed 30 mg)
54
Q

Fosphenytoin

A

Less irritating

55
Q

Should you discontinue antiseizure drugs abruptly? Why or why not?

A

No, this may cause seizures

56
Q

Epilepsy surgical treatment

A
  • Neurosurgery (best success rate)
  • Vagal nerve stimulation
  • Laser ablation
  • Radiosurgery
  • Hemispherectomy for severe cases
57
Q

How long should patient stay on antiseizure meds after surgery?

A

2 years or longer

58
Q

Nursing management

A

“SEIZURE”
- S : turn patient to SIDE
- E : Ensure safety (rails/pads)
- I : Initiate oxygen therapy
- Z : Zero restraints
- U : Undo tight clothing
- R : Record the seizure
- E : Evaluate post seizure

59
Q

Prodromal phase

A

Different for each patient
Intuition/gut feeling

60
Q

Aural phase

A

When you actually experience s/s

61
Q

Ictal phase

A

Seizure is actively happening

62
Q

Ictal phase

A

Seizure is actively happening

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