Seizures Flashcards
when are seizures more prevalent during the lifespan?
early childhood and late adulthood
do you lose consciousness in a simple partial seizure?
no
do you lose consciousness in a complex partial seizure?
yes
may be motor, sensory, autonomic, psychic but without loss of consciousness
simple partial seizures
what do simple partial seizures usually look like?
clonic with repetitive flexion/extension
what is it called when motor activity begins distally, then spreads to the whole extremity?
jacksonian march
what is it called when there is a local paresis that lasts minutes to hours?
todd’s paralysis
what is it called when a seizure lasts hours to days?
epilepsia partialis continua
what other symptoms can you have during a simple partial seizure?
changes in somatic sensations, vision, equilibrium, ANS, and odd feelings
what is it called when focal activity progresses to loss of contact with the environment (e.g. a stare or amnesia)?
complex partial seizure
what are the stages of a complex partial seizure?
- aura of “feeling funny”
- ictal stage with involuntary behaviors
- post ictal confusion
how long does a complex partial seizure last
seconds to hours
what type of seizure is a complex partial seizure, and where in the brain is it most likely to occur?
tonic-clonic;
frontal lobe
are both hemispheres involved with a simple partial seizure?
what about a complex partial seizure?
no with simple;
yes with complex
what is it called when electrical impulses occur simultaneously in both brain hemispheres?
generalized seizure
which type of generalized seizure is a brief LOC without loss of postural control that usually lasts a few seconds
absence seizure (petit mal)
when do absence seizures usually occur in the lifespan?
onset in childhood and remisses in childhood
what is different about an atypical absence seizure?
symptoms last longer, may have more motor features, may be associated with another brain abnormality (like a delay), and are harder to treat
which type of seizure is most common when due to a metabolic derangement?
generalized tonic-clonic seizure (grand mal)
are patients more or less likely to have an aura with a generalized tonic-clonic seizure?
less likely - usually happens suddenly
what are the symptoms of a tonic-clonic seizure?
tonic activity, a change in respiration (e.g. cyanosis), sympathetic symptoms.
then clonic activity, a post-ictal state (unresponsive) and a post-seizure state (HA, aches)
what does an EEG look like during the tonic phase of a seizure?
increased low voltage with high amplitude spikes
what does an EEG look like during the clonic phase of a seizure?
spike and wave activity
which type of seizure involves a loss of motor tone for 1-2 seconds, followed by a brief LOC without post-ictal confusion?
atonic seizures
which type of seizure involves a brief contraction or jerk and is seen in brain injuries?
myoclonic seizures
what type of seizure in adolescence involves a bilateral jerk with maintained consciousness, is benign, and is worse when sleepy?
juvenile myoclonic epilepsy
which type of seizure is seen in children with developmental delay, trauma, infx, or neural injuries and is usu. associated with impaired cognitive fn?
lennox gastaut syndrome
with which seizure will you see hippocampal sclerosis on MRI?
mesial temporal lobe epilepsy
the influx of what two ions might induce seizures?
Ca and Na
what type of seizure occurs in 3mo-5y/os, is usually recurrent, and is associated with infections?
febrile seizures
what are the causes of seizures if the onset is in adulthood?
CVA (50%!), trauma, CNS tumors, degen diseases, medical problems
when you get an EEG, what is a montage?
you assess brain waves in different situations
what level might be elevated in the first 30 mins of a seizure?
prolactin
what is a psychogenic seizure?
not epileptic behavior, but seen with stress.
involves head turning, twitching, shaking, pelvic thrust, and no LOC
which meds are first line for seizures?
phenytoin [dilantin],
valproic acid [depakote],
carbamazepine [tegretol]
what 3 conditions is gabapentin [neurontin] used for?
partial seizures,
post herpetic neuralgia,
neuropathic pain
what 5 conditions do you use pregabalin [lyrica] for?
partial seizures, post herpetic neuralgia, neuropathic pain in diabetes, neuropathic pain in spinal cord, fibromyalgia
which drug has hirsituism (or whatever) as a side effect?
phenytoin
when should you stop a seizure drug treatment?
if pt is low risk, had one seizure and then was seizure free, has a normal exam and a normal EEG
status epilepticus is a medical emergency - what causes it?
metabolic problems, drugs, CNS infx or tumor, head injury, refractory epilepsy
what are the normal aspects of the status epilepticus?
may range from T-C seizure to more subtle movements (like eye movement)
what aspects of a status epilepticus make it a medical emergency?
CV implications, hyperthermia, metabolic derangements, and CNS injury may occur
how do you treat status epilepticus?
benzos, diazepam, midazolam.
phenytoin.
phenobarbitol.
anesthesia.
what kinds of surgery could you perform for refractory epilepsy?
temporal lobectomy,
focal lesion removal,
corpus callosectomy
what surgery can you do to increase the seizure threshold?
vagal nerve stimulator
