Seizures Flashcards
define epilepsy
- a condition in which a person has recurrent sz due to a chronic, underlying process
- at least 2-3 sz w/o clear precipitating factors
interictal
- between seizures
clonic
- repetitive, flexion/extension movements
tonic
- rigid posturing, continuous muscle tension
epileptogenic
- factors that lower one’s sz threshold
epileptiform
- having the appearance of sz activity
list the types of partial sz
- simple partial
- complex partial
- partial with secondary generalization
list types of generalized sz
- absence
- generalized tonic clonic
- myoclonic
- atonic
- tonic
partial seizures arise from what area of the brain
- focal area
differentiate between simple partial and complex partial sz
- simple: no alteration of consciousness
- complex: impaired consciousness
jacksonian seizure
- type of simple partial sz
- clonic movements starting in hand or foot and progressing to involve whole limb
todd’s paralysis
- focal weakness in a part of the body after a seizure.
- typically affects appendages and is localized to either the left or right side of the body
- usually subsides completely within 48 hours
simple partial sz in temporal lobe usually presents as
- deja vu
- epigastric discomfort
describe complex partial sz
- combination of focal motor and focal sensory activity with alteration of consciousness
automatisms
- involuntary, automatic behaviors
- e.g chewing, lip smacking, swallowing, hand movements, emotional outburst
define generalized seizures
- bilateral generalized electrical discharge arising from both cerebral hemispheres simulataneously
which sz is characterized by a sudden brief loss of consciousness lasting only a few seconds without loss of postural control
absence “petit mal”
absence “petit mal” sz may be confused with
daydreaming
is absence “petit mal” associated with postictal confusion
no, consciousness returns promptly
during a absence “petit mal”, pt is absent to during the attack
higher cortical function
most common type of sz due to metabolic syndromes
tonic-clonic “grand mal”
describe tonic clonic sz
- sudden loss of consciousness
- tonic phase (10-40 sec): body rigid
- clonic phase (30 sec - 3 min): muscles relax and contract, lose bowel/bladder control
- postictal phase (min to hours)
define status epilepticus
- continuous sz, or recurrence without regaining consciousness
status epilepticus is a medical emergency and can lead to
- cardiorespiratory dysfunction
- metabolic derangement
- hyperthermia
- irreversible brain damage after 2 hr
which type of sz presents as sudden, brief generalized muscular contraction of limbs and trunk
- generalized myoclonic sz
generalized myoclonic sz is most commonly seen in what conditions
- metabolic disorders
- degenerative CNS disease
- anoxic brain injury
what are atonic seizures
-
sudden loss of postural tone lasting 1-2 sec
- consciousness briefly impaired, no postictal confusion
- may cause brief drop of head or nodding movement
- longer -> fall to ground
what are some drugs that lower sz threshold
- theophylline: PDE inhibitor
- anticonvulsants
why should serum magnesium level be ordered in pt presenting with sz
low magnesium -> sz
key diagnostic test for sz
EEG
immediate treatment of acute sz
- ABC
- do no try to put anything in patient’s mouth
- turn pt on side, protect head
acute treatment of status epilepticus
- IV lorazepam or diazepam +
- IV phenytoin
acute treatment of status epilepticus that continue after lorazepam and phenytoin tx
- add phenobarbital
- midazolam
Antiepileptic drugs therapy is almost always started with how many drugs
-
single drug
- titrated upward
first line drugs for partial seizuers
- carbamazepine
- phenytoin
- valproic acid
first line drugs for generalized tonic-clonic
- valproic acid
- carbamazepine
- phenytoin
first line drugs for absence seizuers
- ethosuximide
- valproic acid
first line drugs for myoclonic seizuers
- valproic acid
first line drugs for atonic seizuers
- valproic acid
what is vagal nerve stimulation
- tx of refractory partial sz
- implantable pacemaker-like device
