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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

Define:

  • seizure
  • epilepsy
  • convulsion
A

Seizure: sudden excessive disorderly discharge of neuronal activity in the brain

epilepsy: recurrent unprovoked seizures
convulsion: body muscles contract and relax rapidly and repeatedly, uncontrolled shaking of the body

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2
Q

Causes of Epilepsy?
Prevalence?

Seizures beginning after age 20 are usually d/t what?

A
  • genetic mutations
  • hypersensitive neurons
  • epileptogenic neurons (fire more intensely, more often, and with greater amplitude)

Prevalence:

  • highest in children, 2-5yrs and at puberty. *usually idiopathic or primary generalized epilepsy
  • pts older than 50yo

Seizures beginning after age 20 are usually due to a focal process or metabolic derangement.

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3
Q

What are the most common causes of seizures:

  • infancy childhood
  • adolescence
  • young adult
  • middle age
  • late life
  • other
A

infancey/childhood: fever, trauma, hereditary metabolic, injury, infections

adolescence: idiopathic

young adult: trauma, alcohol, drugs

middle age: cancer, alcohol, vascular dz (stroke)

late life: vascular dz, cancer, degenerative brain disorders

Other: sleep deprivation, fever, withdrawl

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4
Q

What is the difference between provoked and unprovoked seizures?

A

unprovoked seizures occur in the setting of persistent brain pathology whereas provoked are triggered by factors in an otherwise healthy brain.

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5
Q

exacerbations of seizure disorders are most commonly due to?

Mortality of epilepsy patients is d/t?

A
  • medication noncompliance
  • alcohol use
  • menses

Mortality d/t underlying cause of epilepsy or sudden unexpected death of epilepsy (SUDEP; sudden, unexpected, nontraumatic, nondrowning)

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6
Q

Describe the Phases of seizures:

  • prodrome
  • aura
  • middle
  • ending
A

prodrome: feeling, sensation or changes in behaviors hours or days before seizure..deja vu, smell, sounds, taste, fear, HA, nausea
aura: 1st sx of a seizure and considered part of the seizure

Middle: “ictal phase”
-sx: loss of awareness, confusion, distracted/daydreaming, difficulty talking, unable to swallow, repeated blinking of the eyes, lip smacking or chewing movements.

Endin: “postictal phase”
Sx: slow to respond, sleepy, confused, injuries, HA, nausea

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7
Q

What are the types and Describe the difference between focal and generalized seizures?

A
  • focal: limited to one cerebral hemisphere
  • -focal seizure without impairment of consciousness
  • -focal seizure with impairment of consciousness

Generalized: involves the cerebral cortex of both sides of the brain

  • -absence (petit mal)
  • -myclonic
  • -clonic, tonic, atonic
  • -tonic-clonic (grand mal)
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8
Q

Focal seizures w/o impaired consciousness can be categorized into what groups?

A
  • Motor (jacksonian march; jerking stays on one side of the body, weakness, affected speech, coordination of actions)
  • sensory: changes sense of smell and taste, clicking, ringing, pins/needles, floating in space, illusions, hearing voices
  • autonomic: chest discomfort, changes in heart rate and breathing
  • psychic: garbled speech, written language is off, trouble word finding
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9
Q

Features of focal seizure w/o impaired consciousness

A
  • prodrome/aura
  • Todds paralysis (temporary, unilateral, 30min-36hrs)
  • can progress to focal seiz w/ impaired consciousness to tonic clonic seizure
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10
Q 
Focal seizure WITH impaired consciousness 
-what?
-arise from which lobe?
-sx 
-duration 
-
A

what: produce unresponsiveness

arise from the temporal lobe

duration: 30seconds to 2 minutes

Sx:

  • same sx as focal w/o impairment, but these pts cannot talk to you.
  • confusion and tiredness follow seizure for about 15mins
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11
Q

Generalized onset seizures: Absence

  • aka
  • what?
  • onset
  • duration
  • consciousness?
A

aka: “petit mal seizures”

What: non-convulsive epileptic events

Onset: typically occur in childhood and cease in adulthood.

Duration: onset and termination of attacks are abrupt

Consciousness: disturbances in consciousness; impairment so brief pt is unaware of it, lasts 10seconds

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12
Q

Generalized: Absence seizures:

-typical manifestations

A
  • blank stare
  • motionless
  • stop talking mid sentence
  • mild clonic, tonic, or atonic components
  • may have automatisms
  • no postical period
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13
Q

Generalized: Atypical absence seizures

  • onset
  • duration
  • appearance
  • consciousness?
A

onset: gradual onset
duration: do not resolve abruptly
appearance: loss of muscle tone in neck and face. twitching of mouth…
consciousness: may not have an altered level of consciousness.

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14
Q

Generalized Myoclonic Seizure:

  • what is this?
  • most common time of occurrence?
A

What: rapid recurrent brief muscle jerks that can occur:

  • bilaterally
  • unilaterally
  • synchronously
  • asynchronously
  • may terminate into generalized tonic-clonic seizure

Most commonly occur shortly after waking or while falling asleep

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15
Q

Generalized: Atonic seizure

  • aka
  • characterized by what?
A
  • aka: “drop attacks”

- characterized by sudden loss of muscle tone that may result in falls with self-injury

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16
Q

Febrile Seizures

  • most common in who?
  • temp is usually what?
  • what are the 2 types?
  • appearance
  • tx
A

Fever is most common cause of convulsions in children.

temperature is usually greater than 38 (100.4)

2 types: simple and complex

appearance: body becomes stiff and arms and legs twitch, lose consciousness, Simple lasts 15mins or less, complex lasts greater than 15minutes and happens multiple times in 24hr period
tx: IV lorazepam

17
Q

Tonic Clonic Seizure

  • aka
  • what?
  • cause
A

aka: Grand Mal

What: major motor seizure involving all extremities and characterized by sudden loss of consciousness.

Cause: may be primary arising from deep brain structure or represent a focal seizure with secondary generalization

18
Q

tonic clonic seizure:

  • what is tonic?
  • what is clonic?
  • appearance
  • describe the postictal scene
  • postictal sx
A

Tonic: rigid, LOC, collapse, respiratory arrest
this usually last less than 1 min

Clonic: jerking
may last 2-3 minutes

Appearance:

  • tongue and lips may be bitten
  • urinary or fecal incontinence
  • injury may occur

Postictal scene:

  • may recover consciousness, drift into sleep, have further convulsions w/o recovery of consciousness between attacks (status epilepticus)
  • have no memory of this

Posticatl sx:

  • HA
  • disorientation
  • confusion
  • drowsiness
  • nausea
  • sore muscles
19
Q

Secondary Generalized Seizure tonic clonic:

  • what is this?
  • dx
  • tx
A

seizure that becomes generalized (spread to both sides of brain) after the initial event (focal seizure) has already begun.

dx: EEG and MRI
tx: carbamazepine

20
Q

Post traumatic epilepsy

  • what?
  • most common causes
A

What: seizures post trauma, depends on degree of head injury

Causes:

  • penetrating head wounds
  • cerebral contusion
  • intracerebral hematoma
  • unconsciousness or amnesia lastin more than 24hrs
21
Q

Objectives of Seizure Dx

A
  • determine if pt has epilepsy
  • classify the seizure and type of epilepsy accurately and determine if the clinical data fit a particular epilepsy syndrome.
  • identify, if possible, a specific underlying cause
22
Q

What 4 conditions can mimic a seizure? What is each?

A

-REM behavior disorder: sudden arousals from REM sleep immediately followed by complicated often aggressive behaviors for which the pt is amnestic

transient ischemic attack

Transient global ischemia: short term memory deficit without other cognitiev or motor impairment

Migraine

23
Q

Seizure WOrk up:

  • what is the most important dx test?
  • what labs might you order?
A
  • eeg; classifies seizures, identifies epileptic syndromes, helps in making therapeutic decisions
  • MRI and CT as alternative

Labs:

  • anti-epileptic drug levels (AED)
  • CMP, TSH, CBC, drug screen, glucose
  • LP
  • EKG
24
Q

Status Epilepticus:

  • what?
  • causes
  • tx
A

WHat: any seizure lasting greater than 30 minutes or prolonged flurry of seizures without return to previous level of consciousness between seizures
*life threatening, especially if generalized tonic clonic status

Cause:

  • drug noncompliance or sudden withdrawl
  • fever
  • alcohol or drug withdrawl
Tx: 
-ABC's 
-IV thiamine and glucosse 
-Ativan(lorazepam) 
-fosphenytoin 
-phenytoin 
if the above are ineffective: phenobarbital or depacon ....if these fail; general anesthesia w/ ventilator assistance with NMJ blockade
25
Q

All seizure tx

-provoked vs unprovoked

A

Provoked: tx underlying cause

Unprovoked:
1st seizure = no tx

2nd seizure = diagnosed with epilepsy and treat

other tx options:
-medication

  • surgery; Anterior temporal lobectomy, corpus callostomy, amygdala-hippocampectomy
  • ketogenic diet: high fat; low carb
  • vagal nerve stimulator: implantation of device to stimulate vagus nerve to abort seizure
  • biofeedback
26
Q

Seizure Tx

-3 basic MOA of medications

A
  1. Voltage dependent Na or Ca channels:
    - Na channel blockers effective for tonic-clonic and partial seizure
    - Calcium channel blockers effective for absence seizures
  2. Increasing inhibitory neurotransmission (GABA)
  3. Decreasing excitatory neurotransmission (glutamate and aspartate)
27
Q

Seizure Tx

  • common medications & therapeutic plasma conc.
  • serious SE
A
  • Dilantin (phanytoin) (first line focal and generalized tonic clonic, plasma conc= 10-20mcg/mL)
  • Na and Ca channel
  • Tegretol (carbamazapine, 1st line for focal and generalized tonic clonic) Plasma conc = 4-12mg/L
  • -may cause toxic epidermal necrolysis & steven johnson syndrome
  • Na channel
  • Depacon (1st line focal, generalized tonic-clonic, absence, myoclonic, atonic, and atypical absence) –Plasma conc = 50-100mg/L
  • -BBW: liver dysfunction less than 2yrs old
  • GABA
  • Phenobarbital (2nd line for focal and generalized tonic-clonic)
  • -plasma conc = 15-40mg/L
  • -SE: suicide
  • GABA enhancement

-Zarontin (1st line for absence)
–plasma conc = 40-100mg/L
–SE: bone marrow suppression
*depress motor cortex
Category C

  • Valium (diazepam)
  • Ativan (lorazapam)
  • Klonipin
28
Q

What are the common side effects of the seizure medications?

A
  • lethargy
  • memory difficulties
  • cognitive or concentration difficulties
  • hyperactivity
29
Q

General guidlines for all seizure medications

A
  • baseline Cr
  • LFTs and CBC
  • newer meds may be less sedating
  • start low and slow; titrate up
  • never stop abruptly
  • dont stop one agent until another has been added
  • can D/C drugs if pt is seizure free of 3 years
  • pregnant women with epilepsy should continue their seizure medication

Neurology (10 decks)

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