Seizures and Epilepsy Flashcards
What is a seizure?
abnormal electrical activity of the brain that involves all or limited to single part of the brain
can range from muscular convulsive activity or experiential phenomena (physical or personal)
What is ictal?
when person is in a seizure
Postictal?
how long it takes from someone to get back to normal after seizure
WHat is epilepsy?
recurrent seizures: 2+ unprovoked seizures
Normally, brain is…?
balanced between excitable and inhibited
can have seizure under appropriate circumstances
How does brain change overtime?
criteria for having seizures change: triggers from 4yo can be different from today’s triggers
Seizure - RF?
family hx
head trauma
druggie
ETOH
How do antiepileptic drug act?
blocking initiation/spread of seizure throughout the brain
Seizure- cx?
unknown
Classification of seizure?
partial seizure
generalized seizure
status epilepticus
Classification of partial seizure?
simple
complex
Simple partial seizure?
pt is aware of seizure that is happening - conscious
Types of simple partial seizure?
jacksonian march
todd’s paralysis
Jacksonian march?
motor seizure
starts in limited areas (fingers) to larger areas (arm)
Todd’s paralysis?
temporary paresis of the area that had the seizure attack
Complex partial seizure?
not conscious
Complex partial seizure - sx/pe?
staring
automatisms -involuntary autonomic movements (lips smacking, chewing)
Partial seizure + secondary generalization?
starts as partial seizure but turns into a generalized seizure
Pt eyes blink –> lips smacking –> seizure?
partial seizure + secondary generalization
Partial seizure + secondary generalization - dx?
EEG
Generalized seizure?
seizure that is on both cerebral hemispheres
NO focal onset
Types of generalized seizures?
absence seizures generalized + tonic-clonic/Grand mal atonic myoclonic psychogenic
What is absence seizure?
loss of consciousness NO postictal seconds of staring \+/-chewing/smacking 100x day
When does absence seizure occur the most?
childhood
Parent gets a phone call from school that child is “daydreaming”?
Absence seizure/petit mal
Generalized tonic clonic seizure/grand mal?
most common in adults
Generalized tonic clonic seizure/grand mal - phases?
tonic
clonic
postictal
Generalized tonic clonic seizure - tonic phase?
ictal cry
contraction of muscles
cyanosis
sympathetic discharge (BP and pulse incr, pupils dilate)
Generalized tonic clonic seizure - clonic phase?
alteration of tonic-clonic-tonic phase (contraction/no contraction/contraction, etc)
Generalized tonic clonic seizure - postictal phase?
patient is no longer in seizure but is not “normal/self” yet
excess salvia
bladder/bowel incontinence
Keep in mind about generalized tonic clonic seizure?
not always in tonic-clonic-postictal phase
could be purely tonic, clonic
How to tell if pt is faking generalized seizure?
pt doesnt turn cyanotic
Atonic seizure?
sudden loss of postural muscle tone and BRIEF unconsciousness
NO postictal
Atonic seizure-hallmark?
head drop
Atonic seizure-what to be careful of?
head trauma d/t head drop
Myoclonic seizure?
sudden brief muscle contraction (twitch when you’re falling asleep)
Myoclonic seizure - cx?
metabolic disorder
CNS dz
Pyschogenic seizure?
not a seizure that resembles a seizure
Status epilepticus?
continuous simple partial seizure
continuous seizure for 5-30 min
Status epilepticus also called?
Generalized Convulsive Status Epilepticus (GCSE)
Status epilepticus - cx?
anticonvuslant withdrawal
metabolic disturbances
CNS infxn
Neonate seizures - cx?
CNS infxn - ANY abnormality, go to ER and LP!
postpartum drug withdrawals - careful if mom is druggie
postpartum hypoglycemia - careful if mom is diabetic
Early childhood seizures?
seizures w/fever but NO CNS abnormalities
3mo - 5yr
peak at 18-24mo
Early childhood seizures - cx?
CNS infxn
Childhood seizure- 8-12yo cx?
generalized seizures: idiopathic, temporal lobe epilepsy, mesial temporal lobe scleorsis
partial seizures: CNS development
Early adulthood seizure cx?
drug abuse
head trauma
Older adulthood seizure x?
CNS tumor
head trauma
metabolic disturbances - ETOH, hypoglyecmia
What to check first w/ seizure pt?
vita signs
respiration
cardiovascular (need anything for the heart?)
What will rule in seizure instead of TIA, syncope, vasovagal, etc?
aura (note: also in migraines)
cyanosis (key for differentiating between fakers)
unconsciousness (but not always - simple partial seizure: they are conscious)
postictal
muscle soreness (usually tremors, tics do not cause this)
motor manifestation
When to do LP w/ seizures?
HIV pts
anyone who is suspicious of CNS infxn
Seizures - labs/imaging?
EEG
*normal? does not r/o seizure disorder
Generalized seizure - tx?
do not restraint
be mindful of anything thats around them that could hurt them
make sure to put them in lateral position - in case they vomit
Seizure - tx?
underlying condition (metabolic disturbance) avoid triggers (lights, ETOH) drug therapy ketogenic diet surgery
Seizure drug therapy?
prevent seizures
- recurrent
- cx cannot be corrected (known)
Status epilepticus - tx?
anticonvulsant therapy STAT
What can happen if status epilepticus is not tx ASAP?
probs of the cardiorespiratory
metabolic
irreversible neoruonal damage
Adult w/ new seizure - imaging?
CT to r/o tumor
Most likely tx for seizures?
Keppra
