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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

Seizure definition

A
  • Abnormal electrical activity in the brain
  • Too much excitation vs too little inhibition
  • Paroxysmal event
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2
Q

Where are seizures generated?

A
  • From the cortex

- Specifically from layers 3 and 5 of the pyramidal cells

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3
Q

What questions do you need to get with regards to history of seizures?

A
  • Description of episode (don’t assume it’s a seizure until you get a description)
  • Time of occurrence (most common when the patient is sleeping)
  • Description of patient before and after the episode
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4
Q

What are the four components of a seizure?

A
  • Prodrome
  • Aura
  • Ictus
  • Post ictus
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5
Q

What is the prodrome?

A
  • Period of time before a seizure
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6
Q

How long can prodrome last?

A
  • A few days
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7
Q

Signs of prodrome

A
  • Changes in behavior
  • Attention seeking
  • Hiding
  • Fearful
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8
Q

What is an aura?

A
  • Period of time immediately preceding a seizure
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9
Q

What is ictus?

A
  • The seizure itself
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10
Q

What can happen during ictus?

A
  • Loss of consciousness and recumbency
  • Tonic
  • Clonic
  • Autonomic discharges –> urination and defecation
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11
Q

What is tonic?

A
  • Extensor rigidity
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12
Q

What is clonic?

A
  • Flexion
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13
Q

How long can the post-ictal period last?

A
  • Minutes to days
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14
Q

Characteristics of post-ictal period?

A
  • Blindness
  • Pacing
  • Hunger/thirst
  • Sleepy
  • Ataxic
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15
Q

What are the types of seizures?

A
  • Generalized
  • Partial (simple vs complex)
  • Behavioral/psychomotor
  • Atypical
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16
Q

Generalized seizures

A
  • Loss of consciousness
  • Recumbent
  • Tonic (muscle rigidity)
  • Clonic (contraction and relaxation of muscles)
  • Autonomic discharges (urination, salivation, defecation)
  • Must cross the corpus callosum
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17
Q

How long do generalized seizures last?

A
  • 1-1.5 minutes

- Feels like it lasts forever, but it doesn’t

18
Q

Behavioral/psychomotor seizures

A
  • They would spaz out on their limbs depending on the surface
19
Q

Simple partial seizure

A
  • Clinical manifestation is localized to one body region

- Mentally appropriate

20
Q

Partial complex seizure

A
  • Altered mental status
  • Clinical manifestation localized to one body region
  • In general, no loss of consciousness
21
Q

Psychomotor seizure signs

A
  • Fly biting, tail biting

- Difficult to discern from behavior issue

22
Q

Paroxysmal episodes (NOT SEIZURES!)

A
  • vestibular disease
  • Narcolepsy/cataplexy
  • Syncope
  • REM disorders
  • Pain (cervical)
  • Movement disorders
23
Q

Epilepsy definition

A
  • 2 or more unprovoked epileptic seizures separated by 24 hours or more
  • CHRONIC condition
24
Q

Causes of epilepsy in veterinary patients

A
  • many different causes
  • Structural
  • Genetic/idiopathic (are they teh same?)
  • Reactive seizures (not epilepsy)
25
Q

Questions to ask to determine which epilepsy does the patient have?

A
  • Is the episode a seizure?
  • What is the patient signalment?
  • Age of onset?
  • Is the patient normal between episodes?
  • Are there inter-ictal deficits
26
Q

Structural epilepsy

A
  • Physical abnormality in the brain

- e.g. hydrocephalus

27
Q

Causes of structural epilepsy

A
  • Tumors
  • Inflammatory conditions (immune mediated vs infectious)
  • Anomalous –> hydrocephalus
  • Trauma
  • CVA (strokes)
28
Q

Intracranial structural diseases (as well as what age they tend to occur)

A
  • Neoplasia (>7 years of age)
  • CVA (older patients)
  • Anomalous (younglings)
  • Inflammatory - MUO (Young to middle aged toy breeds)
  • Trauma (based on hx)
29
Q

What is one of the hallmark features of structural epilepsy?

A
  • INTERICTAL DEFICITS
  • e.g. 3 seizures once a month but pacing and change in bheavior
  • e.g. neuro deficits post-seizures lasting more than 7 days
  • Typically lateralizing*
30
Q

What are the causes of reactive seizures?

A
  • Extra-cranial
31
Q

Examples of causes of reactive seizures

A
  • Portosystemic shunts or liver dysfunction**
  • Hypoglycemia**
  • Toxins - ethylene glycol, metaldehyde, etc.
  • Typically symmetrical deficits if present
32
Q

What age do genetic seizures tend to occur?

A
  • Ages 1-5 years
33
Q

Inter-ictal period in genetic seizures?

A
  • Normal inter-ictal period
34
Q

How to diagnose genetic seizures (i.e. idiopathic epilepsy)?

A
  • Need MRI/CSF for diagnosis

- Diagnosis of exclusion ultimately

35
Q

Which breeds are predisposed to genetic epilepsy?

A
  • Golden Retrievers
  • Labradors
  • Belgian Shepherds
  • Legato Romagnolo
  • Border Collies
  • Australian Shepherds
  • Boerboels
36
Q

Diagnostic workup for the patient with seizures

A
  • Thorough physical/neurological examination
  • CBC/Chem/UA
  • Bile acids test (pre + post) +/- NH4
  • +/- 3 view thoracic radiographs
  • Brain MRI +/- CSF analysis
  • +/- EEG (Gold standard in people)
37
Q

What’s the difference between a seizure and epilepsy?

A
  • Seizure = abnormal electrical activity in the brain

- Epilepsy = at least 2 unprovoked epileptic seizures separated by 24 hours

38
Q

Cluster seizure definition

A
  • 2 or more seizures in a 24 hour period
39
Q

Status epilepticus

A
  • Seizure lasting >5 minutes

- Incomplete recovery between seizures

40
Q

When to institute therapy for seizures?

A
  • > 1 seizure per 6 months
  • Structural disease present (e.g. brain tumor)
  • Cluster seizures
  • Status epilepticus
41
Q

Goals of epilepsy therapy

A
  1. Decrease severity of seizures
  2. Decrease number of seizures
  3. Ideally 1 seizure every 2-6 months

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Neurology (14 decks)

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