Seizures Flashcards
Definition of Seizures
Change in cortical electrical activity through transient sensory, motor or behavior changes
What is Epilepsy
Recurrent unprovoked seizures secondary to an underlying cerebral disorder
What is Status Elipticus
Medical emergency where epileptic seizure continues or is repeated without regaining consciousness
What is an Aura
A subjective sensation experienced before onset of some disorders (feeling of pain, smelling burning wood)
What is Automatism?
Automatic, involuntary movement during a seizure
Provoked vs Unprovoked seizures?
Provoked- specific trigger
Unprovoked- Not associated with a precipitating cause
What is a another name for a Simple partial seizure?
Focal Aware seizure
What is another name for Complex partial seizure
Focal Impaired Awareness seizure
What are the 2 classifications of Focal seizures
- Focal Aware
2. Focal Impaired Awareness
Most common Etiology of epilepsy?
Idiopathic 50%
Etiologies of Epilepsy
Vascular disease Idiopathic (50%) Trauma Alzheimers Metabolic Infection Neuropathy Drugs
Differential Diagnoses/Seizure Imitators
Syncope (MC immitator)
Paroxysmal movement disorders
Sleep Disorders
Transient Ischemic Attack
What are the most important questions to ask when obtaining a history of seizure disorder
- Family history
- Any history of head trauma
- Alcohol and medications
What diagnostic studies are needed to determine seizures?
- EEG
- Neuroimaging
- Labs (CBC, CMP, PRL, CK, toxicology screening for alcohol)
What are some other possible diagnostic tests you could order for seizures
- EKG
2. LP
What is the reasoning behind ordering CMP, PRL, and CK
CMP= Liver function
CK- From increased muscle shaking and tremors during seizure
PRL- Increased levels from altering regulation of the hormone form the hypothalamus
Which is a preferred neuroimaging for seizures?
MRI- prefferrd over CT to identify any lesions, infarcts or tumors
What kind of Electricalencephalogram will yield the best results to test for seizures?
Serial EEG’s (taken over a period of time)
What does Focal onset mean?
Seizure activity originates in one part of the brain
What are the symptoms of a Focal Aware seizure
- No alteration of awareness (consiousness)
2. Symptoms vary depending on the site of origin of seizure activity
What is unique about the symptoms of Focal Aware (Simple Partial) seizures
The site of irritable focus determines which body functions are affected by a focal seizure
What are symptoms of Focal Impaired Awareness seizures?
- Impairment of awareness (consiousness)
- Purposeless automatisms (repetitive behaviors -facial grimacing, chewing, lip smacking, snapping fingers)
- Postictal confusion +/- fatigue
Symptoms seen in a Generalized Non-motor seizure (Absence)?
- Abrupt onset
- Sudden staring with impaired awareness (conciousness)
- Eyelid fluttering/minor automatisms
- EEG- will show a 3 Hz spike-and-slow wave pattern
Symptoms of a Generalized Motor seizure (Myoclonic)?
- No alterations in awareness
- Sudden muscle contractions (jerks) that affect the arms bilaterally
- Often multiple or in clusters
Symptoms/Components of a Generalized Motor Tonic-Clonic seizure
- Aura
- Tonic phase- stiffness of muscles
- Clonic phase- jerking and twitching of muscles
- Postical phase- patient is confused, fatigued
Symptoms of a Generalized Motor Atonic Seizure
- Loss of control of the muscles, particullarly in the legs
- Result in collapsing
- Poor overal prognosis
Another name for Generalized Motor Atonic seizures are?
Drop seizures
What is the most common type of Febrile seizures in children under 5?
Generalized tonic-clonic seizures
What are AAP guidelines for evaluating a child with Febrile seizures?
EEG, blood tests and neuroimaging should not be routinely performed
If a lab test is ordered it should focus on the cause of a fever not the cause of a seizure
What is the criteria to diagnose Status Epilepticus?
- Single seizure lasting more than 5 minutes
OR - Two or more seizures without full recover between seizures
1 cause of Status Epilepticus?
Non-compliance with antiepileptic medications in seizure patients
Basics of seizure management steps
- Determine the type of seizure
- Determine risk of recurrence
- Rule out secondary causes
- Referral to Neurology
- Antiepileptic drugs should not be recommended after one seizure
How is epilepsy treated?
ABC’s = Airway, Breathing, Circulation
IV Ativan (Lorazepam)
