Seizures (Adult) Flashcards
What does Status Epilepticus refer to?
> 5 mins of continuous seizure activity or multiple seizures without full recovery of consciousness (back to baseline) between seizures
What is subtle status epilepticus?
Subtle SE may develop from prolonged or uncontrolled GCSE it is characterised by coma and ongoing electro graphical seizure activity with or without subtle convulsive movements (e.g. rhythmic muscles twitches or tonic eye deviation). It is difficult to diagnose prehospitally but should be considered in patients who are witnessed to have GTC convulsions initially and present with ongoing come and no improvement in conscious state
Recite the Seizures CPG (Adult)
What is the pathophysiology of a seizure?
- A seizure is defined as a transient disturbance of cerebral function caused by abnormal neuronal activity in the brain.
- Patient presentation may range from obvious convulsions to abnormal behaviours or subjective experiences.
What is epilepsy?
Epilepsy is a disorder of brain function that takes the form of recurring seizures and is due to many diverse aetiologies
What is a focal seizure?
- A focal seizure is where the abnormal neuronal activity originates and is limited to one hemisphere of the cerebral cortex.
- Seizure symptoms are representative of the area of the cerebral cortex where the abnormal neuronal discharge exists
- Focal seizures can evolve and become bilateral convulsive seizures
- Focal seizure activity does not impair awareness or responsiveness
- Focal dyscognitive - seizure activity where awareness or responsiveness is reduced but the patient is not unconscious
What is a generalised seizure?
- Where the abnormal neuronal activity rapidly engages both hemispheres of the cerebral cortex
What are the different types of generalised seizures?
- Absence
- Myoclonic
- Tonic Clonic
What is an Absence seizure?
- Absence - brief loss of awareness or responsiveness, usually lasts <10 seconds with no post-ictal phase
What is a myoclonic seizure?
Myoclonic - a brief, sudden jerking action of muscle or muscle group that may occur in a series leading to a TC seizure
What is a tonic-clonic seizure?
Tonic Clonic - an abrupt loss of consciousness that is concurrent with involuntary muscular contractions (tonic phase) followed by symmetrical jerking movements (clonic phase), typically lasts 1-3 minutes and the patient experiences a post ictal period
What is status epileptics?
- A medical emergency defined as seizure activity > 5 minutes in duration or recurrent seizure activity where the patient does not recover to a GCS 15 prior to another seizure
- these seizures are often associated with
- hypoxia, hypercarbia
- progressive lactic acid and respiratory alkalosis
- hyperthermia, hypertension, tachycardia
- hypo/hyperglycaemia
- hyperkalaemia
What can trigger seizures in epilepsy?
- Lack of sleep
- Stress
- Sudden stopping or changing medications
- Fever, infection
- Diarrhoea, vomiting, dehydration
- Alcohol/illicit drug use
- Menstruation
- Photosensitivity
- Extreme temperatures - particularly heat
- electrolyte disturbance
What is a psychogenic non-epileptic seizure?
Previously known as pseudo seizures, are episodic behavioural events that mimic seizure activity but are not epileptic seizures. PNES arise due to different factors in different individuals.
What can provoke a seizure?
- hypoxia/hypercarbia
- Hypotension
- Metabolic (hypoglycaemia, hyponatraemia, hypocalcaemia, hyperthyroidism)
- Pregnancy - eclampsia
- meningitis/encephalitis
- hyperthermia/febrile convulsions
- drugs/toxins (intox/withdrawal)
- cerebral pathology (tumour, stroke, trauma)
