Seizures Flashcards
seizure
transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge
excessive amount of excitatory activity
pts can’t remember them, can’t control themselves
dz w/ recurrent, unprovoked seizures
epilepsy
what would provoke a seizure
hypoglycemia
febrile seizures
alcohol/drug withdrawal
etiologies of epilepsy (8)
- Tumor
- Trauma
- Idiopathic
- Infection
- Congenital/perinatal
- genetics
- CNS vascular dz (stroke)
- CNS degenerative dz (Alzheimers)
CNS vascular dz and epilepsy
secondary to stroke
mc cause of seizures with onset above 60 yrs
trauma anf epilepsy
particularly a cause in young adults, but terms must be met
more likely if dura mater is present, occurs after first couple of weeks following event
tumors and epilepsy
must be exclude
what must be excluded when any patient presents with new onset seizures?
tumors/space occupying lesions of the CNS
rare in childhood (bc tumors of childhood go to cerebellum)
ILAE classifies seizures based on which criteria? (3)
- Where?
- Aware?
- Other
types of seizures
General
Partial
Partial Seizure
only restricted portion of one cerebral atmosphere
may become generalized
typically less obvious (auditory or olfactory)
types of partial seizures
simple partial seizures (aware)
complex partial seizures (LOC, post ictal)
simple partial seizures (def + manifestation)
focal aware seizure with no LOC
PT is able to respond
motor, sensory, psychic, autonomic
complex partial seizures
starts focally and causes impairment of conciousness
last 30-120 seconds
pt is unresponsive and does not recall event
where do complex partial seizures typically originate?
temporal lobe
aura
simple partial seizure that lasts only a few seconds
typically precedes temporal lobe complex partial seizure
automatisms
non purposeful stereotyped and repetitive behaviors that occur during the seizure
pt doesn’t recall
mc oral or manual (lip smacking, fumbling hands)
types of general seizures
absent
atypical absent
myoclonic
tonic clonic
pt population most likely to have complex partial seizure
older adults >60
absence seizures
impairment of consciousness without loss of posture (pt. is unware of this loss)
no warning, no post ictal state
typically described as “daydreaming”
pt population most likely to get absence seizures
begins in childhood (4-8) or early teens
occurs in children with above average intelligence
freq., brief seizures thru our day, older children and adults have less, more time
atypical absence seizures
similar to absence seizure but obvious changes in muscle tone and more gradual onset and termination
do not respond well to medication
tonic clonic seizures
generalized seizure with two phases
associated with post ictal state
mc found in adults >60 with brain lesion, rare in neonates and infants
tonic phase
entire body is rigid
apnea occurs, pt falls to ground, increased HR/BP, 10-20 seconds
clonic phase
jerking of body for 2-3 minutes
periods of atone followed by episodes of violent flexion
pupils dilate and contract, tongue bites/urinary incontinence
post ictal phase
HA, disorientation, nausea, drowsiness and muscle soreness
increased lactic acid
gradually returns to awareness 10-15 min later
post epileptic automatisms
follows tonic clonic seizure
may display abnormal behavior and have no memory
pt convulsions continue without recovery of consciousness > 30 minutes
status epilepticus
medical emergency due to apnea, acid/base abnormalities
second tonic clonic seizure after regaining consciousness
serial seizures
prodrome
occurs hours before a generalized seizures
HA, jerking motions, lethargy, irritability, mood alteration
provocation?
seizures that result from external precipitators
I.e. menstruation, photo sensitivity, caffeine
clinical evolution of seizures
- neuroimaging
- EEG
- LP
- Drug levels
neuroimaging done in seizures
done to rule out mass lesions
MRI of brain w/ and w/o contrast
CAN do CT (Pacemaker or metal in body)
lab tests done in seizure work up
CBC + glucose + LFT/Renal FT
+/- VRDR, prolactin levels
study of choice for seizure evaluation
EEG
will be normal until pt seizes
LP in seizure work up
evaluation of pts with possible meningitis/encephalitis
obtunded
SAH
DDX seizures
- Syncope
- TIA
- Cardiac Dysrhythmia
- brainstem ischemia
syncope v seizures
preceded by pallor, sweating, nausea
recovery occurs rapidly (no post ictal)
when is AED used in tx
is NOT given after single seizure, bc recurrence is high
report to public health dpt
encouraged to avoid dangerous situations
admitted to ICU
mc cause of status epilepticus
non compliance with seizure meds
tx of status epilepticus
high mortality rate, risk of neurological sequel
- Benzo (diazepam or Ativan IV over 2 min, repeat if needed, monitor for respiratory depression)
- intubation + D50 IV
- Fosphenytoin (Cerebyx) loading for cartiac arrhythmia and HoTN
drug levels are monitored
- after treatment is initiated
- after dosage is changed or another drug added
- when seizures are poorly controlled
mc cause of lower than expected AED serum levels
non compliance
when are meds DC
seizure free for at least 3 yrs
taper off and see if they reoccur
SUDEP
sudden unexpected death not due to drowning or trauma
thought to have a seizure over night that causes terminal apnea and asystole
SUDEP risk factors
UNCONTROLLED EPILEPSY**/non compliance >3 tonic clonic sz/yr young (<40) polypharmacy nocturnal seizure
management of SUDEP
effective seizure control
caregiver/nocturnal supervision
solitary sz
pt without history of seizure has 1 and sent to ER
MRI and EEG done
risk/recurrence of solitary sz
- MRI, - EEG
one tonic-clonic but no abnormalities and evidence of focal onset
risk is low, no AED
who is started on AED after one seizure
abnormal MRI (I.e. CA metastasis on brain) or abnormal EEG
risk/recurrence of solitary sz
+ MRI, + EEG
high recurrence risk
AED begun
risk/recurrence of solitary sz
either + MRI/-EEG or -MRI/+EEG
unsure
risk is 30-50%, consult and decide
metabolic causes of provoked seizure
uremia
hypoglycemia
withdrawal from alcohol/drugs
delirium tremens
occurs in alcohol withdrawal (lack of inhibition = over excitation)
highest risk > 48hrs after drink
must ask if history, monitor q 4 hrs
tx of delirium tremens
benson to manage if bad enough
seizures are typically self limiting and don’t req. AED
types of fever provoked seizure
simple febrile seizure, complex febrile seizure
occurs in children 3mo-5 yrs (18-24), typically during acute phase (OM, URI)
simple febrile seizure
symmetric seizure
brief
no future risk of epilepsy
complex febrile seizure
focal, repeated. prolonged
associated with risk of epilepsy
