Seizures Flashcards
What is epilepsy?
Condition in which person has recurrent seizures due to a chronic, underlying procss
At least 2-3 seizures w/o clear precipitating factors!!
Tonic vs clonic
Tonic: rigid posturing, continuous muscle tension
Clonic: repetitive, flexion/extension movements
Types of partial seizures
Simple (no loss of consciousness or memory)
Complex (consciousness or memory impaired)
Secondarily generalized
Impaired consciousness with complex partial seizure
Unable to respond to visual or verbal commands
Reduced awareness of ictal period
May become partial with secondary generalization
General description of simple partial seizure (focal aware seizure)
Depending on areas involved
Pt can interact with others during and recall events
Simple partial seizure affecting motor cortex
Clonic movements starting in hand or foot and progressing to involve whole limb (Jacksonian seizure)
Todd’s paralysis: lasts minutes to hrs
Simple partial seizure affecting sensory cortex
Paresthesias, numbness of limb, face
Simple partial seizure affecting temporal lobe
Deja vu
Epigastric discomfort
Simple partial seizure affecting occipital lobe
Flashing lights
Visual changes
Most common type of seizure in adults with epilepsy
Complex partial seizure
Phases of complex partial seizure
May start with aura (psychic sx)
Ictal phase: sudden behavioral arrest or motionless stare and then automatisms (involuntary, automatic behaviors like chewing, swallowing, emotions, hand movements etc)
Posticital: HA, confusion, amnesia, somnolence
Generalized seizures
Bilateral electrical discharge arising from both cerebral hemispheres simultaneously
Absence (petit mal) seizure
Characterized by sudden brief LOS without loss of postural control
5-10 sec
No postictal confusion!!
EEG pattern of absence seizure
Generalized spike and wave pattern
Most common type of seizure due to metabolic problems
Tonic clonic (grand mal)
What is the typical grand mal seizure?
Sudden LOC, fall to ground Tonic phase (tonic contractions like body rigid or jaw clench or eyes roll back)-increase BP and HR Clonic phase (muscle groups relax and contract and may froth)- 30 sec to 3 min Postictal phase (minutes to hours with confusion or sleepiness)
Generalized myoclonic seziure
Sudden, brief generalized muscular contraction of limbs and trunk
Most common times to see generalized myoclonic seizures
Metabolic disorders
Degenerative CNS diseases
Anoxic brain injury
Benign form of myoclonus
Sudden jerking movements experienced as fall asleep
Atonic seizure
Sudden loss of postural tone for about 1-2 sec (briefly impair consciousness, no postictal confusion, can fall to ground)
Usually associated with another form of epilepsy
Tonic seizure
Typically, sudden stiffening of body with loss of balance
Very brief
Association with tonic seizures
Significant brain disease (poor prognosis)
Labs to do with a seizure
CBC, Ua CMP Serum Mg Toxicology Syphilis screen
Imaging for all new onset seizures
Cranial CT or MRI
CXR
Key diagnostic test for seizures
EEG
Tests for pts with refractory seizures
PET or single photo emission tomography (SPECT)
When to call 911 with a seizure
Person does not have epilepsy Longer than 5 min Second seizure before recover Regular breathing not return DM In water Pregnany If they were injured
Status epilepticus
Continous seizures or recurrence without gaining consciousness
Medical emergency! (heart and lung probs, metabolic derangements, hyperthermia, brain damage after 2 hrs)
Tx of status epilepticus
IV access (anticonvulsant-lorazepam or diazepam or phenytoin) 50% glucose, narcotic antagonist or thiamine
How to start AED therapy
Usually with 1 drug and titrated upwards
Drug to use with all types of seizures
Valproic acid
Surgical tx for refractory seizures
Temporal lobectomy
Lesionectomy
Corpus callostomy
Vagal nerve stim (implantable pacemaker for partial seizures)
