Seizures Flashcards
what is the #1 cause of childhood seizures?
Trauma
then CNS infection, arteriovenous malformations, other congenital defects
What should be suspected in a teenager/young adult with the first seizure of their life?
Drug/Alcohol usage
What should be assumed for an older adult with their first seizure?
Tumor! Until proven otherwise…
can also be alcohol withdrawal seizure
What is a seizure? prodrome? aura?
abnormal rhythmic neuronal discharge
prodrome = mood or behavioral changes that may precede the event by days or hours
aura = symptom just prior to a seizure (de ja vu or smell burning rubber)
epilepsy
stereotyped recurrent seizure secondary to abnormal neuronal disharges
status epilepticus
a state of continuous or frequent seizures
a failure to return to a normal mental status between two seizures
what are the 3 classifications of seizures?
1) primary generalized = both cerebral hemispheres involved at the onset of seizure
2) Focal = seizure begins in one are of the brain
- simple focal = no change in level of consciousness
- complex focal = change in level of consciousness (not necessarily to ground)
3) Secondary (reactive) seizures = due to metabolic changes
- hypoglycemia
- hyponatremia (only hypokalemia will NEVER cause a seizure)
- alcohol withdrawal
- trauma
- toxins
- infection
- eclampsia
Discuss seizures located in all 4 lobes
frontal = shaking parietal = additional sensation (painful etc)... likely a brain tumor
occipital = tough to distinguish from migraines (usually usually see black and white) vs occipital seizures are colorful… both cause unformed visual hallucinations
temporal = hallucinations of actual things (ie mickey mouse)
Features of generalized seizure
*ENTIRE BRAIN* NO aura postictal confusion bowel/bladder incontinence *lateral tongue trauma*
6 types of generalized seizures
1) tonic = go stiff
2) tonic clonic = “grand mal” shaking
3) clonic = jerking
4) atonic = brief loss of muscle tone, may involve all musculature resulting in a fall, may only involve nuchal musculature resulting in head drop
5) petit mal (“absence”)
6) myoclonic
Absence seizure (petit mal)
pediatric epilepsy syndrome specific to children
resolve by adolescence
staring spell
lasts 5-15 seconds
provoked by hyperventilation - extremely sensitive test —> blow a string as fast as u can
Myoclonic
infantile
Juvenile Myoclonic Epilepsy
*most common inherited epilepsy
—> early morning myoclonic events (lifetime duration treatment of choice Valproic Acid)
Adult - most commonly associated with anoxic injuries to brain
4 types of focal seizures
motor = tonic or clonic movements, turn head to side OPPOSITE the side of seizures at onset
autonomic/visceral = gustatory, olfactory, epigastric fullness, nausea
sensory = positive phenomena (visual hallucinations)
psychic = dejavu
Why don’t you use a focal seizure treatment as the “default” seizure medication
if you treat a general seizure with focal seizure medication, you can actually cause more generalized seizures
Febrile seizures, why is it important to know if they are simple or complex?
They are associated with high temperature (specifically rate of change)
seen in children 6 months to 6 years
- Simple = no focal features thus no increased risk of epilepsy
- complex = focal feature thus IS an increased risk of epilepsy
