Seizures Flashcards
What should be included in the DDx for seizures?
- Syncope
- TIA
- Migraine
- Hypoglycemia
- Parasomnia
- Pseudoseizure
- Movement disorder
What inc the risk of seizures?
- Brain injury
- FHx
- Neuro or Psych d/o
- Drugs that dec threshold for seizures
- Illicit drugs or alcohol
What is a Non-Epileptic seizure?
Spells of convulsions or non-convulsive events d/t a provactive stimulus
What are the provocative stimulus events that cause Non-epileptic seizures?
- Prolonged sleep deprivation
- Alcohol cessation after a prolonged binge
- Excessively low Na, Ca, Mg or glucose
- Drugs which “lower seizure threshold”
Do Non-epileptic seizures occur w/o provocative stim?
No
Is there a FHx of epilepsy in Non-epileptic seizures?
No
What will be found on PE in Non-epileptic seizures?
- PE normal unless going thru alcohol w/ drawal
- Tetany w/ very low serum Ca
- Tachycardia & ABN behavior if under influence of drugs
What are the technical features in Non-epileptic seizures?
- Interictal events EEG is usually normal
- Serum Ca or Na may be very low during the event
- Brain imaging usually normal
What causes Non-epileptic seizures?
Physio & physical changes can disturb the excitability of brain neurons permitting them to discharge spon
What is the tx for Non-epileptic seizures?
Reverse cause if possible
What is Epilepsy?
Seizures w/o a reversible cause
How do you dx epilepsy?
Based on hx of pt or witness
Who gets Partial seizures?
Happens at any age
What does Simple Partial seizure mean?
Consciousness not affected
What does Complex Partial seizure mean?
Consciousness affected
What is the location of Partial seizures?
Unilateral
What are the sx of Simple Partial epilepsy based on cortex of origin?
- Motor sx= motor cortex
- Sensory sx= parietal cortex
- Visual sx= occipital lobe
What are the Psychic sx of Simple Partial Epilepsy?
Freightful or angry but awake & alert esp around temporal lobe
What is found on PE on Simple Partial Epilepsy?
- Interictal exam may be normal
- Reflect damage to area of brain where seizure originates
What are the technical feaures of Simple Partial Epilepsy?
- EEG will be normal >50% of the time
- When EEg reveals “spikes” or seizures discharges, they typically emanate from the specific ABN area of cortical dysfx
- +/- Brain imaging
- MRI w/ & w/o contrast ~15% more sensitive than CT in localizing seizure onset
Which epileptic pts should should get brain imaging?
MRI w/ or w/o contrast in adults w/ new onset seizure, children w/ ABN neuro exams or clearly focal seizures
What causes Simple Partial Epilepsy?
Seizures us. result from damage to cerebral cortex
Most d/t brain lesions but some genetic
What is Todd’s Postictal Paralysis?
Inhibitory neurons have turned off excitatory neurons to a focus→ limb paralysis→ CI to TPA (for stroke)
How does Complex Partial Epilepsy begin?
Begin as a simple seizure & become secondarily complex or may begin as a complex seizure
What are the assoc sx of Complex Partial Epilepsy?
Motor, sensory or autonomic
Are Complex Partial Seizures convulsive or non-convulsive?
May become convulsive or non-convulsive
What are the technical features of Complex Partial Epilepsy?
- MRI may show mesial temporal lobe sclerosis
How do pt w/ mesial temporal lobe sclerosis respond to meds?
Refractory to medicine (15%)
Of the mesial temproal lobe sclerosis pts that are refractory to meds, how many can be controlled by surger & meds?
85%
Which area of the brain is suited to sugical success w/ low morbidity?
Medial temporal lobes
What causes Partial Onset-Secondarily Generalized Epilepsy?
Simple or complex partial onset comes secondarily generalized convulsive
What do pts w/ Partial Onset-secondarily generalized Epilepsy experience w/ convulsions?
Injuries, tongue biting or urinary incontinence
What is Convulsive Status Epilepticus?
Convulsions >30 min or series occuring repetitively over 30 min w/o regaining consciousness
Medical Emergency!!
What is found on PE in Partial Onset-secondarily generalized epilepsy?
Injuries or tongue biting from convulsions
Neuro intact or neuro & intellectual deficits
What is the cause of Primary Generalzied Epilepsy (PGE) (or Absence, Petit mal)?
All are genetic (AD) & begin during childhood or adolescence
Are Absence seizures convulsive?
No! non-convulsive
What are the sx of Absence seizures?
- No postural change
- Eyes flutter
- No postictal confusion
What activities can pt w/ Absence seizures continue?
Routine activities like walking, drawing or eating
What can Absence seizures be precipitated by?
Hyperventilation (presumably d/t alkalosis)
What is the prognosis of Absence seizures?
- 1/3 disappear by adolescence or later
- 1/3 persist
- 1/3 develop other types of PGE
What are the technical features of Absence seizures?
- Brain imaging is usually normal
- EEG shows char generalized spike-wave discharges; most typically 3/second
What causes Primary Generalized Epilepsy (Myoclonic)?
Genetic
What are the characteristics of Primary Epilepsy (Myoclonic)?
Generalized brief (whole body or both arms) jerks or spasms
What are the technical features of Myoclonic epilepsy?
Same as Absence seizures expect the waves are 4-6/sec range
What are Generalized convulsive or Grand mal seizures?
- Most dramatic
- Injuries common
- Cannot tell were convulsions begin partially or primary generalized
What are the technical features of Generalized convulsive or Grand mal seizures?
- Generalized EEG ABN
- Brain imaging normal unless brain injured from repeated head trauma
