Seizures Flashcards
1
Q
Seizure definition
A
- Abnormal electrical activity in the brain
- Too much excitation vs too little inhibition
- Paroxysmal event
2
Q
Where are seizures generated?
A
- From the cortex
- Specifically from layers 3 and 5 of the pyramidal cells
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
4
Q
What are the four components of a seizure?
A
- Prodrome
- Aura
- Ictus
- Post ictus
5
Q
What is the prodrome?
A
- Period of time before a seizure
6
Q
How long can prodrome last?
A
- A few days
7
Q
Signs of prodrome
A
- Changes in behavior
- Attention seeking
- Hiding
- Fearful
8
Q
What is an aura?
A
- Period of time immediately preceding a seizure
9
Q
What is ictus?
A
- The seizure itself
10
Q
What can happen during ictus?
A
- Loss of consciousness and recumbency
- Tonic
- Clonic
- Autonomic discharges –> urination and defecation
11
Q
What is tonic?
A
- Extensor rigidity
12
Q
What is clonic?
A
- Flexion
13
Q
How long can the post-ictal period last?
A
- Minutes to days
14
Q
Characteristics of post-ictal period?
A
- Blindness
- Pacing
- Hunger/thirst
- Sleepy
- Ataxic
15
Q
What are the types of seizures?
A
- Generalized
- Partial (simple vs complex)
- Behavioral/psychomotor
- Atypical
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
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
Questions to ask to determine which epilepsy does the patient have?
- 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
Structural epilepsy
- Physical abnormality in the brain
| - e.g. hydrocephalus
27
Causes of structural epilepsy
- Tumors
- Inflammatory conditions (immune mediated vs infectious)
- Anomalous --> hydrocephalus
- Trauma
- CVA (strokes)
28
Intracranial structural diseases (as well as what age they tend to occur)
- Neoplasia (>7 years of age)
- CVA (older patients)
- Anomalous (younglings)
- Inflammatory - MUO (Young to middle aged toy breeds)
- Trauma (based on hx)
29
What is one of the hallmark features of structural epilepsy?
- 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
What are the causes of reactive seizures?
- Extra-cranial
31
Examples of causes of reactive seizures
- Portosystemic shunts or liver dysfunction**
- Hypoglycemia**
- Toxins - ethylene glycol, metaldehyde, etc.
- Typically symmetrical deficits if present
32
What age do genetic seizures tend to occur?
- Ages 1-5 years
33
Inter-ictal period in genetic seizures?
- Normal inter-ictal period
34
How to diagnose genetic seizures (i.e. idiopathic epilepsy)?
- Need MRI/CSF for diagnosis
| - Diagnosis of exclusion ultimately
35
Which breeds are predisposed to genetic epilepsy?
- Golden Retrievers
- Labradors
- Belgian Shepherds
- Legato Romagnolo
- Border Collies
- Australian Shepherds
- Boerboels
36
Diagnostic workup for the patient with seizures
- 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
What's the difference between a seizure and epilepsy?
- Seizure = abnormal electrical activity in the brain
| - Epilepsy = at least 2 unprovoked epileptic seizures separated by 24 hours
38
Cluster seizure definition
- 2 or more seizures in a 24 hour period
39
Status epilepticus
- Seizure lasting >5 minutes
| - Incomplete recovery between seizures
40
When to institute therapy for seizures?
- >1 seizure per 6 months
- Structural disease present (e.g. brain tumor)
- Cluster seizures
- Status epilepticus
41
Goals of epilepsy therapy
1. Decrease severity of seizures
2. Decrease number of seizures
3. Ideally 1 seizure every 2-6 months
RARELY DO WE COMPLETELY ELIMINATE!
