Seizures Flashcards
Epileptic Seizures
result from abnormal discharges in cerebral cortex generated by cortical neurons
Idiopathic, symptomatic or myoclonic (sub-cortical focus)
Epilepsy Morbidity
Recurrent, unprovoked seizures Head trauma/body injury Social ostracism Learning/behavior difficulty Endocrine/pregnancy TX side effects Osteoporosis Death (SUDEP) - 1% - seizures affect HR, RR in sleep
Generalized Seizure
Whole brain
Tonic - stiff
Clonic - rhythmic jerking
Tonic-clonic - should lose consciousness
Absence - zone out (kids) - 3 spike, 3 slow per second (EEG)
Myoclonic - symptom of other types of disorders
Atonic/Akinetic - kids or significant brain disease - freeze up/fall down
Infantile spasms
Partial seizure
One side - 80% of seizures
Simple partial (focal) - motor sensory, autonomic, psychic; maintain consciousness/interaction
Complex partial - altered consciousness
Secondary generalization - focal to generalized
MRI shows
Hippocampal atrophy
Recognition of Seizure episodes
Episodic behavior changes Stereotypy of events Automatisms Post-event confusion Non-directed behavior Recurrent, unexplained obtundation/confusion resolving spontaneously over minutes/hours
SX of Convulsive Seizure
Single/multiple body jerks (myoclonus) Stiffening of body Jerking of body Sudden truncal flexion Drop attacks Tongue biting Bowel/bladder incontinence
SX of Nonconvulsive seizure
Altered awareness Staring, blinking Chewing, swallowing Picking at objects Repetitive movements Head/body turning Posturing of extremities
Non-Epileptic SX
Continuous aberrant behavior No post-event confusion Variable behavior Directed aggression Identifiable emotional trigger Secondary gain No response to TX
Epilepsy eval
H/P
Labs - blood chem, LP
Brain scan - MRI, CT
EEG
First aid for Seizures
Position (on side, head dependent) Clear objects Loosen neck clothing Minimal restraint Nothing in Mouth ***** Secure airway Observe until over ****
Epilepsy TX
Prophylaxis - avoid trauma Treat causation - infection, temp, intoxication Anticonvulsant therapy Dietary - ketogenic diet Surgery Vagus nerve stimulator Psycho-social support
Goals of Therapy
Complete Seizure control***
Few AE
Improved QOL
Affordable
Anticonvulsant Therapy
Choose right med, low dose, avoid polypharmacy
Anticonvulsant Interaction
Influence by absorption, protein binding, hepatic enzymes
Status Epilepticus
Frequent seizures without recovery
One seizure > 30 min
Generalized SE = true medical emergency
Status Epilepticus TX
ABC H/P IV + labs O2 thiamine, glucose, IV Lorazepam Fosphenytoin Persisting seizures - IV phenobarbital, levetiracetam, valproate, propofol
Women’s Issues
Epilepsy/anticonvulsants affect menstrual cycles and interact w/birth control
Pregnancy = risk of breakthrough seizures/bleeding and fetal teratogenesis
No risk with breastfeeding
