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CMT > Seizures & Epilepsy > Flashcards

Seizures & Epilepsy Flashcards

1
Q

define a seizure

A

clinical manifestation of abnormal and excessive excitation and synchronization of population of cortical neurons

the event

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2
Q

define epilepsy

A

> 2 seizures unprovoked by systemic or acute neurologic insults

the disease itself

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3
Q

Epilepsy

essentials of dx

3

A
  • recurrent unprovoked seizures
  • characteristic EEG changes accompany seizures
  • mental status abnormalities or focal neurologic sx
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4
Q

describe a generalized seizure

A

electrical disruption involves entire brain

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5
Q

Focal Seizure

describe

A

restricted to one part of the cerebral hemisphere

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6
Q

Focal Seizure

components

4

A
  • motor (clonic jerking)
  • nonmotor (sensory sx, behavioral arrest, cognitive sx)
  • Can spread or march
  • Can evolve to bilateral tonic-clonic seizures
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7
Q

Focal Seizure

examples of associated sensory loss

5

A
  • paresthesia/tingling
  • gustatory
  • olfactory
  • visual
  • auditory
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8
Q

Focal Seizure

examples of cognitive sx

3

A
  • speech arrest
  • deja vu
  • jamais vu
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9
Q

Focal Seizure

example of emotional sx

1

A

fear

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10
Q

Focal Seizure

example of autonomic sx

4

A
  • epigastric sensations
  • sweating
  • flushing
  • pupillary dilation
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11
Q

Tonic-Clonic Seizure

what type of seizure is this?

A

generalized

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12
Q

Tonic-Clonic Seizure

Describe what this looks like

5

A
  • sudden LOC
  • rigidity
  • pt falls to ground
  • pt is arrested
  • clonic phase: convulsions themselves
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13
Q

Tonic-Clonic Seizure

what may occur post-ictally?

5

A
  1. HA
  2. disorientation/confusion
  3. drowsiness
  4. nausea
  5. muscle soreness
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14
Q

Tonic-Clonic Seizure

describe atonic seizures

A

very brief loss of muscle tone, falls (epileptic drop attacks)

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15
Q

Tonic-Clonic Seizure

first aid for these seizures

(outside of hosp)

A
  • 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
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16
Q

Absence Seizures

what type of seizure is this?

A

generalized

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17
Q

Absence Seizures

describe

4

A
  • lapses in awareness
  • absent staring
  • begin and end abruptly, brief
  • more common in children
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18
Q

Seizure Etiologies

7

A
  • age
  • genetic
  • structural
  • metabolic
  • immune
  • infectious
  • idiopathic
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19
Q

causes of seizures in infancy

3

A
  • prenatal/birth injury
  • inborn error of metabolism
  • congenital malformation
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20
Q

causes of seizures in childhood

3

A
  • idiopathic/genetic syndrome
  • CNS infection
  • Trauma
21
Q

causes of seizures in adolescence and as a young adult

2

A
  • trauma
  • drug intoxication, withdrawal
22
Q

causes of seizures in older adults

4

A
  • stroke
  • brain tumor
  • acute metabolic disturbances
  • neurodegenerative
23
Q

common seizure triggers

8

A
  • medication non-adherence
  • sleep deprivation
  • metabolic/electrolyte imbalance
  • intoxication or withdrawal
  • hormonal fluctuation
  • stress
  • fever/systemic infection
  • head injury
24
Q

Syncope

describe

3 components

A
  • characteristic warning, usually gradual
  • typical precipitants
  • minimal to no postictal confusion
25
Q

describe psychogenic nonepileptic seizures

A
  • psychiatric disease (tx w/ anti-psychs will fix)
  • may co-exist w/ epilepsy
  • EEG monitoring for dx
26
Q

work up/evaluation of a pt’s first seizure

5 components

A
  • Labs: CBC, CMP, magnesium, phosphate
  • LP if meningitis/encephalitis suspected
  • UA drug screen
  • EEG
  • CT or MRI brain
27
Q

medical tx

A
  • controversial to tx first seizure- meds may reduce relapse
  • AEDs
28
Q

what factors increase relapse risk

4

A
  • abnormal imaging
  • abnormal neuro exam
  • abnormal EEG
  • FH increase
29
Q

different AED choices

3 drug classes, 2 drug names

A
  • Sodium Channel Blockers
  • GABA Inhibitors
  • Ethosuximide
  • Levetiracetam
  • Glutamate Blockers
30
Q

which meds are sodium channel blockers?

5

A
  • phenytoin
  • carbamazepine
  • lamotrigine
  • oxcarbazepine
  • divalproex
31
Q

MOA sodium channel blockers

A

reduces activity in sodium channels to prevent action potentials

32
Q

which meds are GABA inhibitors?

2

A
  • Gabapentin
  • Divalproex (Valproic Acid)
33
Q

when is gabapentin usually used?

(but can also be used in seizures)

A

neuropathies

34
Q

which meds are glutamate blockers?

2

A
  • topiramate
  • lamotrigine
35
Q

reproductive considerations of prescribing AEDs

A
  • known teratogenic effects
  • may limit effectiveness of OCPs
36
Q

what to evaluate after seizure recurrence?

3

A
  • is this a progressive pathology?
  • is there a known trigger?
  • do they need to begin meds/adjust meds?
37
Q

when to discontinue medications?

A

seizure free for > 2 years

38
Q

how to discontinue medications?

A

taper over several weeks to months

39
Q

lifestyle modifications for seizures

4

A
  • ensure adequate sleep
  • avoid alcohol/stimulants
  • avoid known triggers
  • avoid stress
40
Q

surgical tx options for seizures

2 components

A
  • resecting the epiletogenic region while trying to avoid new neurologic deficit
  • if palliative care: just resect or disconnect that area
41
Q

Status Epileptiucs

define

A

seizures that last 5+ minutes without a return to baseline

42
Q

Status Epileptiucs

complications

4

A
  1. hypoxia
  2. hypotenson
  3. acidosis
  4. hyperthermia
43
Q

Status Epileptiucs

management

6

A
  • maintain airway
  • IV access
  • broad lab work
  • AED administration
  • consider: glucose, vitamin B therapeutically
  • EEG monitoring
44
Q

Febrile Seizures

describe

A

seizures occuring in childhood after 1 mo old which are associated with a fever of at least 100.4degF

45
Q

Febrile Seizures

almost all occur between what ages?

A

6 mo and 3 y/o

46
Q

Febrile Seizures

describe simple

3

A
  • < 15 mi
  • generalized
  • do not recur within 24 hrs
47
Q

Febrile Seizures

describe complex

3

A
  • > 15 min
  • focal
  • recur within 24 hrs
48
Q

non pharmacolgic tx of seizures

2

A
  1. keto diet
  2. vagus nerve stimulation
49
Q

Epilepsy

describe resolved epilepsy

A
  • 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

CMT (78 decks)

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