SEIZURES

Question 1

If a patient states they didn’t feel well, his co-worker reports that he then collapsed, his eyes rolled in the back of his head, he then tenses up and began shaking, what diagnosis?

Answer 1

Seizure

Question 2

What is the definition of a seizure?

Answer 2

A paroxysmal (comes and goes) event due to abnormal CNS discharge with resultant manifestations depending on area involved.

Question 3

What is the definition of epilepsy?

Answer 3

Recurrent seizures

Question 4

Physiologically, what’s occurring during a seizure?

Answer 4

Burst of electrical activity, influx of extracellular calcium and sodium – thus the propagation of action potentials

Question 5

In what population are seizures most common in?

Answer 5

Children

Question 6

If a child under the age of 5 has recurrent episodes of seizures, is it epilepsy?

Answer 6

NO

Question 7

What are some of the triggers for seizures?

Answer 7

Fevers in children, genetics, TBI, strokes, infection, stress, sleep deprivation, meds, and menses

Question 8

What can help you make the diagnosis of a seizure?

Answer 8

History is key, EEG, MRI (to R/O structural abnormalities), prolactin levels, possibly a lumbar puncture (if infection is suspected)

Question 9

What are the two basic type of seizures?

Answer 9

partial vs. generalized

Question 10

What are the types of partial seizures?

Answer 10

Simple partial or Complex partial

Question 11

If a patient has an abnormal jerky movement or stiffening of the body, or hear/smell/tastes things that are not there, and doesn’t not lose consciousness, what type of seizure is it?

Answer 11

Simple partial seizure

Question 12

What are 2 other ways a simple partial seizure can present?

Answer 12

Autonomic – strange or unpleasant sensations in the stomach, chest, head, or heart rate

Psychic – garbled speech, deja-vu

Question 13

Where is the brain is a simple partial seizure occurring?

Answer 13

ONE hemisphere

Question 14

What are 3 variations of simple partial seizures?

Answer 14

Jacksonian March – motor activity begins distally (fingers) and spreads to the whole extremity

Todd’s Paralysis – local paralysis for minutes to hours

Epilepsia Partialis continua – continues for hours to days

Question 15

If a patient has a continuous stare, but then doesn’t know what just happened for the past minute, what diagnosis are you thinking?

Answer 15

Complex partial seizure

Question 16

Where does a complex partial seizure occur in the brain?

Answer 16

Start in the temporal lobe → then quickly involve other areas

Question 17

What often accompanies the complex partial seizure stare?

Answer 17

Usually an aura – but often isn’t noticed by the patient

Ictal stage – chewing or picking (very subtle)

Post-ictal confusion – impaired consciousness (can just last a few second to a few minutes)

Question 18

How do you diagnose a complex partial seizure?

Answer 18

EEG

Question 19

What differentiates a generalized seizure from a partial seizure?

Answer 19

Generalized = both hemispheres of the brain are firing simultaneously

Partial = a portion of the brain is firing

Question 20

So, what is it known as/what part of the brain is involved, if the seizure begins as a partial but then spreads and becomes more generalized?

Answer 20

Partial seizure with secondary generalization

Frontal lobe

Question 21

What is the key difference in a generalized seizure, and what are the two types?

Answer 21

Generalized seizures = sudden loss of consciousness

Either Convulsive (gran-mal or tonic clonic) or Nonconvulsive (petit-mal or absence)

Question 22

What form of a seizure is common in kids and often presents like daydreaming for less than 10 seconds?

Answer 22

Simple absence seizure

Question 23

What is a simple absence seizure lasted longer than 10 seconds?

Answer 23

Complex or atypical absence seizure

Question 24

What does an atypical absence seizure correlate with?

Answer 24

Mental retardation

Question 25

What would you see on EEG with absence seizure?

Answer 25

Spike & wave that worsens with hyperventilation maneuver

Question 26

If a patient collapses and tenses then begins to shake, what type of seizure is this?

Answer 26

Tonic-clonic or grand mal

Question 27

Can a simple absence seizure be associated with tonic-clonic seizures?

Answer 27

YES

Question 28

What are the characteristics of a tonic-clonic seizure?

Answer 28

Unconsciousness, post-ictal obtundation and confusion (for minutes to hours), sudden onset, and it might have a prodrome.

Question 29

How would an EEG look during the tonic vs. clonic portions?

Answer 29

Tonic = increase in low voltage and fast activity; high amplitude polyspike discharges

Clonic = spike & wave activity

Question 30

What are the variations of the tonic-clonic seizures?

Answer 30

Atonic – 1-2 seconds lose motor tone, brief LOC, no post ictal confusion

Myoclonic – brief contraction or jerk (like when you fall asleep)

Question 31

What are 3 other types of generalized seizures?

Answer 31

juvenile myoclonic epilepsy

Lenox gastaut syndrome

Mesial temporal lobe epilepsy

Question 32

What type of generalized seizure has partial epilepsy when an MRI shows hippocampal sclerosis?

Answer 32

Mesial temporal lobe epilepsy

Question 33

What type of generalized seizure is seen in kids with EEG slowing, impaired cognitive function, and associated CNS disease?

Answer 33

Lennox gastaut syndrome

Question 34

What type of generalized seizure is also seen in kids with a bilateral jerk with maintain consciousness, that’s worse with awakening/sleep deprivation?

Answer 34

Juvenile myoclonic epilepsy

Question 35

In general, for seizures, what does treatment involve?

Answer 35

Basic life support – vitals & CPR

Treat cause if identified (infection, tumor, drugs)

Medications