Seizures Flashcards
What is the definition of seizures?
Episodes of abnormal neurological function caused by abnormal electrical charges in the brain
Abnormal electrical activity in the brain can cause:
- Strange sensations
- Strong emotions
- Convulsions and spasms
- Loss of consciousness
- Unusual behaviours
What is the WHO definition of epilepsy?
A chronic disorder characterised by recurring seizures, diagnosed after two (unprovoked) seizures
What are the causes of seizure?
Epileptic disorders Unknown ideology Underlying disorders - Metabolic disorders - Cerebral tumours - HI - Intracranial infections - Hypo/hyperglycaemia - Hypoxia - Drugs/alcohol - Intracranial haemorrhage - Stroke - Birth trauma - Stress/anxiety - Sleep disorders
Name the points of the acronym AEIOUTIPS
Arrhythmia/alcohol/acidosis Environmental/envenomation/epilepsy Infection Overdose Uraemia (kidney failure) Trauma/toxins Insulin Psychogenic Shock/sepsis
What are the side effects of seizures?
- Headache
- Dizziness
- Light-headedness
- Confusion
- Double/blurry vision
- Poor coordination/balance
- Unsteady gait
- Nausea
Name the stages of seizure
Beginning, ictal phase, and post-ictal phase
What (generally) happens in the beginning stage of a seizure?
Aura (strange taste or small), though not all pts have an aura
What is the ictal phase?
Period of time from the first symptoms (including the aura) to the end of seizure activity
What is the post-ictal phase?
Recovery phase
Are auras considered part of a seizure?
Yes
True or false: a seizure may start with loss of consciousness or change in awareness
True
What is the term for an aura occurring alone without change in awareness?
Focal seizure
What are some awareness/sensory/emotional/thought changes before a seizure?
- Smells
- Tastes
- Sounds
- Deja vu
- Strange feelings
- Fear/panic
- Vision loss/blur
- Racing thoughts
- Pleasant feelings
What are some physical changes before a seizure?
- Dizzy or light-headed
- Headache
- Nausea or ‘stomach rising’ feeling
- Numbness or tingling
True or false: some physical symptoms may be after-effects and not related to the ictal phase
True
What are some symptoms during a seizure?
Loss of awareness Confused, 'feeling spacey' Forgetfulness/memory lapses Distracted/daydreaming Loss of consciousness Hearing loss/altered auditory sense Vision loss/altered Unusual tastes/smells Visual hallucinations Numbness/tingling/electric shock feelings Out of body sensations Deja vu, jamais vu Body parts feel or look different Panic/fear/impending doom Pleasant feelings Difficulty speaking Unable to swallow/drooling Repeated blinking/movement of eyes/stare Lack of movement or muscle tone Tremors/twitching/jerking movements (may occur in one or more places, may begin in one area then spread, may be whole body) Rigid or tense muscles Automatisms (repeated non-purposeful movements) Repeated purposeful movements (may continue previous activity) Convulsions Incontinence (urine incontinence common) Sweating Pale or flushed Pupil dilation Teeth clenching/biting tongue
How long is the post-ictal phase?
May be immediate, minutes, or hours
Is the post-ictal phase effected by seizure type/affected brain region?
Yes
What are some symptoms that may follow a seizure?
Slow to respond Sleepy Confused Memory loss Difficulty talking or writing Feeling dizzy/light-headed/'fuzzy' Depressed/sad/upset Scared/anxious Frustrated/embarrassed/ashamed Injuries from ictal phase Headache/other pains Nausea Thirst General one-sided weakness Urge to use bathroom/incontinence
What are the two categories of seizure?
Generalised and focal
What is the definition of a generalised seizure?
Occurs across both hemispheres of the brain
What is the definition of a focal seizure?
Occurs in one area of the brain
What are the two subsets of generalised seizures?
Convulsive (tonic/clonic) and non-convulsive (absent)
Can focal seizures become generalised seizures?
Yes
Focal seizures were previously named…
Partial/simple
Name the subtypes of convulsive seizures
Tonic clonic Tonic Clonic Atonic Myoclonic
What is the common duration of a tonic clonic seizure?
1 to 3 minutes
What commonly occurs in a tonic clonic seizure?
Loss of consciousness Body becomes stiff (tonic) Jerking movements (clonic) Person may bite tongue or produce excess saliva Loss of bladder control Headache Deep sleep Confusion
What is characteristic of a tonic seizure?
Stiffening of the body (without jerking)
What is characteristic of a clonic seizure?
Bilateral rhythmic jerking of limbs (rare)
What is characteristic of an atonic seizure?
Sudden loss of muscle strength (person falls forward)
True or false: recovery after atonic seizures tends to be quite slow
False
Atonic seizures carry the risk of…
Injuries to the face/head.
What is characteristic of myoclonic seizures?
Jerking movements, mostly in the head and upper limbs
Myoclonic seizures are linked to…
Sleep patterns
Describe a typical absence seizure
- Pause in activity with a blank stare
- Occurs frequently
- Duration 5-10 seconds
- Rapid blinking/eye deviation
What can trigger a typical absence seizure?
Hyperventilation
Describe an atypical absence seizure
- Begins and ends gradually
- Duration >10 seconds
- Eye blinking/lip movements
Can atypical absence seizures be triggered by hyperventilation?
No
What are some motor signs of focal seizures?
Dysphasic Atonic Weakness Jerks/twitching Todd's paresis (temporary paralysis, often post seizure)
What are some non-motor aspects of focal seizures?
Olfactory Visual Somatosensory Gustatory Auditory Autonomic Psychic Automatisms
What is the two definitions of status epilepticus?
- Seizure activity lasting longer than five minutes
- Seizures less than 20 minutes apart with or without recovery (clustering)
Status epilepticus is more common in which population groups?
Extremes of age and the mentally handicapped
What is the concern with status epilepticus?
Continued seizure activity contributes to neuronal damage
What is neuronal damage from continued seizure activity exacerbated by?
- Hypoxia
- Hypoglycaemia
- Lactic acidosis
- Hyperpyrexia
What is a common issue with anti-convulsant medication?
Non-compliance
In which phase is it appropriate to give O2?
Post-ictal
What is the seizure-specific indication for midazolam?
Generalised or focal seizure with GCS less than or equal to 12
What are the contraindications for midazolam?
KSAR
What are the precautions for midazolam?
- Reduce dose for elderly/chronic renal failure/CHF/shock
- Myesthenia gravis (autoimmune disease that effects muscles)
- Multiple sclerosis
What are the side effects of midazolam?
Hypotension and respiratory depression
What is the adult dosage of midazolam?
5mg/1mL, 5mg every 10 minutes with a max of 20mg
What is the paediatric dosage of midazolam?
200mcg/kg, max 5mg in one dose, every 10 minutes with a total max of 10mg
