Seizures & Epilepsy Flashcards
define a seizure
clinical manifestation of abnormal and excessive excitation and synchronization of population of cortical neurons
the event
define epilepsy
> 2 seizures unprovoked by systemic or acute neurologic insults
the disease itself
Epilepsy
essentials of dx
3
- recurrent unprovoked seizures
- characteristic EEG changes accompany seizures
- mental status abnormalities or focal neurologic sx
describe a generalized seizure
electrical disruption involves entire brain
Focal Seizure
describe
restricted to one part of the cerebral hemisphere
Focal Seizure
components
4
- motor (clonic jerking)
- nonmotor (sensory sx, behavioral arrest, cognitive sx)
- Can spread or march
- Can evolve to bilateral tonic-clonic seizures
Focal Seizure
examples of associated sensory loss
5
- paresthesia/tingling
- gustatory
- olfactory
- visual
- auditory
Focal Seizure
examples of cognitive sx
3
- speech arrest
- deja vu
- jamais vu
Focal Seizure
example of emotional sx
1
fear
Focal Seizure
example of autonomic sx
4
- epigastric sensations
- sweating
- flushing
- pupillary dilation
Tonic-Clonic Seizure
what type of seizure is this?
generalized
Tonic-Clonic Seizure
Describe what this looks like
5
- sudden LOC
- rigidity
- pt falls to ground
- pt is arrested
- clonic phase: convulsions themselves
Tonic-Clonic Seizure
what may occur post-ictally?
5
- HA
- disorientation/confusion
- drowsiness
- nausea
- muscle soreness
Tonic-Clonic Seizure
describe atonic seizures
very brief loss of muscle tone, falls (epileptic drop attacks)
Tonic-Clonic Seizure
first aid for these seizures
(outside of hosp)
- turn on side with face toward ground to maintain airway
- do not put anything in their mouth
- txfr to hospital if: multiple seizures, pregnant, injured, diabetic, or new onset of seizures
Absence Seizures
what type of seizure is this?
generalized
Absence Seizures
describe
4
- lapses in awareness
- absent staring
- begin and end abruptly, brief
- more common in children
Seizure Etiologies
7
- age
- genetic
- structural
- metabolic
- immune
- infectious
- idiopathic
causes of seizures in infancy
3
- prenatal/birth injury
- inborn error of metabolism
- congenital malformation
causes of seizures in childhood
3
- idiopathic/genetic syndrome
- CNS infection
- Trauma
causes of seizures in adolescence and as a young adult
2
- trauma
- drug intoxication, withdrawal
causes of seizures in older adults
4
- stroke
- brain tumor
- acute metabolic disturbances
- neurodegenerative
common seizure triggers
8
- medication non-adherence
- sleep deprivation
- metabolic/electrolyte imbalance
- intoxication or withdrawal
- hormonal fluctuation
- stress
- fever/systemic infection
- head injury
Syncope
describe
3 components
- characteristic warning, usually gradual
- typical precipitants
- minimal to no postictal confusion
describe psychogenic nonepileptic seizures
- psychiatric disease (tx w/ anti-psychs will fix)
- may co-exist w/ epilepsy
- EEG monitoring for dx
work up/evaluation of a pt’s first seizure
5 components
- Labs: CBC, CMP, magnesium, phosphate
- LP if meningitis/encephalitis suspected
- UA drug screen
- EEG
- CT or MRI brain
medical tx
- controversial to tx first seizure- meds may reduce relapse
- AEDs
what factors increase relapse risk
4
- abnormal imaging
- abnormal neuro exam
- abnormal EEG
- FH increase
different AED choices
3 drug classes, 2 drug names
- Sodium Channel Blockers
- GABA Inhibitors
- Ethosuximide
- Levetiracetam
- Glutamate Blockers
which meds are sodium channel blockers?
5
- phenytoin
- carbamazepine
- lamotrigine
- oxcarbazepine
- divalproex
MOA sodium channel blockers
reduces activity in sodium channels to prevent action potentials
which meds are GABA inhibitors?
2
- Gabapentin
- Divalproex (Valproic Acid)
when is gabapentin usually used?
(but can also be used in seizures)
neuropathies
which meds are glutamate blockers?
2
- topiramate
- lamotrigine
reproductive considerations of prescribing AEDs
- known teratogenic effects
- may limit effectiveness of OCPs
what to evaluate after seizure recurrence?
3
- is this a progressive pathology?
- is there a known trigger?
- do they need to begin meds/adjust meds?
when to discontinue medications?
seizure free for > 2 years
how to discontinue medications?
taper over several weeks to months
lifestyle modifications for seizures
4
- ensure adequate sleep
- avoid alcohol/stimulants
- avoid known triggers
- avoid stress
surgical tx options for seizures
2 components
- resecting the epiletogenic region while trying to avoid new neurologic deficit
- if palliative care: just resect or disconnect that area
Status Epileptiucs
define
seizures that last 5+ minutes without a return to baseline
Status Epileptiucs
complications
4
- hypoxia
- hypotenson
- acidosis
- hyperthermia
Status Epileptiucs
management
6
- maintain airway
- IV access
- broad lab work
- AED administration
- consider: glucose, vitamin B therapeutically
- EEG monitoring
Febrile Seizures
describe
seizures occuring in childhood after 1 mo old which are associated with a fever of at least 100.4degF
Febrile Seizures
almost all occur between what ages?
6 mo and 3 y/o
Febrile Seizures
describe simple
3
- < 15 mi
- generalized
- do not recur within 24 hrs
Febrile Seizures
describe complex
3
- > 15 min
- focal
- recur within 24 hrs
non pharmacolgic tx of seizures
2
- keto diet
- vagus nerve stimulation
Epilepsy
describe resolved epilepsy
- individuals who had age-dependent epilepsy syndrome but are now past the applicable age or who have remained seizure free for 10 yrs w/ no AEDs for at least 5 yrs
