Seizures Flashcards
Recurrent , unprovoked seizures
Epilepsy
Abnormal electrical activity in the brain
Seizure
range from sensory symptoms, autonomic changes, psychic experiences
Confusion to full-blown convulsions
Semiology
Epilepsy
failure of 2+anti-eleptic Rx
Intractability –> Surgery Eval
Generalized Seizure
List
- Absence Seizure
- Myoclonic Seizures
- Tonic-clonic seizures
- Tonic
- Atonic
- Clonic
Absence Seizures
Types
- Typical
- Atypical
- With Special Features
- Myoclonic Absences
- Abscences w/ Eyelid Myoclonia
Myoclonic Seizures
- Myoclonic
- Myoclonic-Atonic
- Myoclonic-Tonic
Focal Seizures
Complex Partial
Focal discognitive WITH impaired awareness
- aura
- NO loss of consciousness
Focal Seizures
Simple Partial
Focal WITHOUT impairment of consciousness/awareness
*isolated motor s/s (tonic/clonic)
- Childhood/teenage onset
- Sudden onset, sudden offset
- NO aura
- Loss of consciousness
- Eyelid flutter/minor automisms
- 3-15 seconds duration
Absence Seizure
Absence Seizure
EEG:
3Hz Spike-Wave/HV Sensitive
- Sudden siffening
- Maximal extension in arms
- A few seconds long
- W/ Falls/Injury
Tonic Seizures
Tonic Seizures
Where in brain?
Extra-temporal
Tonic Seizures
EEG
Flattening/high frequency discharge
- Abrupt onset
- Sudden loss in tone
- 1-2 seconds long
- Head drop/Falls/Injuries
- Poor prognosis
- poor response to AEDs
Atonic Seizures
Atonic Seizure
EEG
Slow spike-wave/flattening
- Sudden jerks
- Bilateral, maximal in arms
- 1 second long, multiple usually
- possibly photic/sensory triggered
*Myoclonic Seizures
*Myoclonic Seizures
EEG
Generalized polyspike-wave burst
- Loss of Consciousness
- Post seizure Mental status change
- Focal/Generalized
- Tonic limb extension 20-40 seconds
- INTO Rhythmic Clonic Jerking of Extremities (30-50 secs)
- STOP Breathing, tongue biting, incontinence
- Post-ictal sleep
Tonic-Clonic
Tonic Clonic
EEG
Variable,
*maybe Obscured
Premature morality rate for Epilepsy sufferers
2-3x normal person
Epilepsy
Dx
*Hx
-Auras
-Witness reports
-Post-ictal s/s /b
-Experiences following
seizure
*EEG
-Generalized vs. partial seizures
*MRI
Epilepsy Foundation Goal of Treatment =
No Seizures + No Side Effects
Epilepsy
Tx
*Anti-seizure Rx
*Epilepsy Surgery
*Neuromodulation
-Vagal N Stimuation
-Responsive Neurostim
*Diet
(keto, mod atkins)
- 30 or more minutes of continuous seizure/repetitive seizures with no intervening recovery of consciousness
- generalized convulsive variant
Status Epilepticus (SE)
Generalized Tonic-Clonic Seizures
- Generalized Onset
- Childhood/Juvenile Onset
- Normal Brain
- Generalized Ictal Discharge on EEG
*GOOD Prognosis
1ary/2ndary?
1ary Generalized Seizure
Generalized Tonic-Clonic Seizures
- Partial Onset/Aura
- Any Age
- MRI/Exam May Be Abnormal
- Focal Sharp/Spikes
*VARIABLE Prognosis
2ndary Generalized
- NO Loss of Consciousness/Awareness
- Focal Seizure s/s
- Progress to Dyscognitive seizures/Tonic-Clonic Seizures
Focal Seizures without Impairment of Consciousness
Focal Seizures w/o Impairment of Consciousness
EEG
- Interictal-focal sharp/slow
* Ictal-rhythmic discharge = normal
- ALTERED Consciousness/Awareness
- 30 sec - 3 minutes
- Automatisms (Arms, Oral)
- Amnesia
Focal Dyscognitive Seizures
Focal Dyscognitive Seizures
EEG
Interictal-sharp waves or spikes; Ictal - focal or bilateral rhythmic sharp
Seizure Workup
Hx
Ask witness:
- act out/what look like
- Duration
- Fall? Hit body part?
- Describe patient AFTER episode. Awake? Drowsy?
- Urinate on self? Bite tongue?
- ETOH/Drugs prior to seizure?
Seizure Workup
PE
- Current Mental Status
- Full Body exam
- injuries
- Neuro exam
- Urinate?
Seizure Workup
Tests
- EEG
- Glucose
- Infxn cause
- ETOH/Drug screen
- MRI - brain abnormalities/strokes/tumors
Seizure Tx
Rx 1st line most seizures
Phenytoin
Valproic Acid
Carbemazepine
Seizure Tx
Rx 1st line = Generalized, non-convulsive seizures
Ethosuximide
valproic acid
Status Epilepticus
Tx
TREAT + ASSESS SAME TIME
1) Secure airway + High flow O2
2) Low glucose? Give glucose
3) Alcoholic? Thiamine + magnesium
4) Lorazepam
5) LORAZEPAM NO EFFECT? Phenytoin
6) PREVIOUS 2 NO EFFECT? Phenobarbitol / General anesth.
- only in front of others
- w/ stress/emotion
- rarely injured in seizure
- often w/ psyc issues
- SEIZURE RX NO EFFECT
Psychogenic Non-Epileptic Seizures (PNES)
S/s
Fake seizure for attention/avoid responsibilities
Factitious Disorder
NOT PNES
Syncope
Hx
- Feel anything b/f event?
- Other s/s of systemic illness?
- hypoglycemia/dehydration risks?
- FH Sudden Cardiac Death?
- Witnesses around?
Syncope
PE
- Fully alert/oriented now?
- Signs of injury (fall)?
- Orthostatic?
- Sinus rhythm?
- O2%?
- Systemic illness signs?
Syncope
Tests
- EKG
- Glucose
- Electrolyte
- CBC
- others….
Syncope
Tx
- Underlying cause
- Glucose + Hydration
- Rx dose decrease?
- ->Follow-up
