Seizures Flashcards
____% of first time seizures occur before age 20
75%
Patho
Increased cell membrane excitability due to failure of normal inhibitory mechanisms - GABA
Leads to intense, prolonged neuronal discharges
May remain localized or may spread to involve entire cortex
Etiology
Idiopathic
EtOH withdrawal (very common)
Metabolic (hypoglycemia, hepatic failure, hyper/hyponatremia)
Infectious (meningitis, abscess, neurosyphilis)
Degenerative (i.e. MS, senile dementia)
Neoplastic (esp. in elderly with new onset seizures)
Toxic (theophylline)
Head trauma (epidural/subdural hematomas)
Vascular (stroke, AVM, subarachnoid hemorrhage)
Perinatal (infx, metabolic disorders)
Eclampsia
Classification of Seizures
Generalized szs
- Grand mal
- Petit Mal (Absence)
- Myoclonic
Partial/Focal szs
- Simple partial
- Complex partial
Generalized Seizures
(general)
Cause abrupt LOC because entire cerebral cortex is activated
Grand Mal Seizure
AKA tonic-clonic seizures
Begin with LOC, usually without warning
Tonic phase: pt falls to ground with trunk/extremities extended
Clonic phase: rhythmic jerking of trunk and extremities
- Often, apnea, cyanosis, tongue-biting, urinary incontinence
- Typically last 60-90 seconds
Post-ictal phase: after attack, pt remains unconscious, flaccid, confused, usually for many minutes before slowly regaining consciousness (20-60min)
Todd’s Paralysis: occassionally may have transient postictal focal paresis
Petit Mal (Absence) Seizures
Typically very brief - only a few seconds
Abrupt LOC, no response to voice
Blanke stare, eyelids may twitch
No falls, involuntary movement, no incontinence
No post-ictal phase; attacks cease abruptly; pt unaware that anything has happened
May be frequent (>100/day)
Typically seen in school-aged kids, resolving as they grow up; very rare to see in a
Myoclonic Seizures
LOC associated with extremity jerking
Usually has post-ictal phase
Partial (Focal) Seizures
general
Due to electrical discharged beginning in localized region of brain
May remain localized or may spread, becoming more generalized
Often due to focal structural brain lesion - tumor, AVM, scar tissue, CVA, head injury
Simple Partial Seizures
No alteration of consciousness
Manifestations may be:
- Motor: tonic or clonic movements, often unilateral, often limited to one extremity
- Sensory: paresthesias/numbness, flashing lights, olfactory/gustatory hallucinations
Complex Partial Seizures
AKA psychomotor sz or temporal lobe sz
Involves changes in LOC or mentation - pt not thinking clearly, but are conscious
Usually bizarre sx with psychic features
- visceral sxs (nausea, butteflies in stomach)
- hallucinations (visual, olfactory, auditory, olfactory)
- memory disturbances (deja vu, jamais vu)
- dream-like states
- automatisms: repetitive, purposeless movements (lip smacking/playing with clothes)
- affective disorders (paranoia, depression, elation)
Consequences of being diagnosed with seizure disorder
Employment
Insurability
Driving
Long-term meds
Psychogenic Seizure
aka pseudoseizure
Often occur in repsonse to emotional upset
Often occur only when witnesses present
Bizarre features - pts protect themselves from noxious stimuli, no incontinence or injury during episode, no post-ictal confusion, normal EEG
Physical Exam
Look for systemic illness that may have precipitated the attack
- v/s
- detailed neuro and mental status exam
Look for injuries resulting from seizure
- fxs, bruises
- tongue lac, broken teeth
- aspiration
- head/neck injury
Labs
Depends on suspected etiology and sz hx
Always check a glucose
Possibly: lytes, BUN/Cr, Ca, Mg, PO4
LP if suspect meningitis
Tox screen if ingestion suspected
Anticonvulsant levels in pt with known sz hx
