Epilepsy essentials of dx 3

recurrent unprovoked seizures characteristic EEG changes accompany seizures mental status abnormalities or focal neurologic sx

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 cognitive sx 3

speech arrest deja vu jamais vu

Focal Seizure example of autonomic sx 4

epigastric sensations sweating flushing pupillary dilation

Absence Seizures describe 4

lapses in awareness absent staring begin and end abruptly, brief more common in children

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

Seizures & Epilepsy Flashcards by Mikaela Koller

define a seizure

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

the event

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define epilepsy

> 2 seizures unprovoked by systemic or acute neurologic insults

the disease itself

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Epilepsy

essentials of dx

recurrent unprovoked seizures
characteristic EEG changes accompany seizures
mental status abnormalities or focal neurologic sx

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describe a generalized seizure

electrical disruption involves entire brain

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Focal Seizure

describe

restricted to one part of the cerebral hemisphere

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Focal Seizure

components

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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Focal Seizure

examples of associated sensory loss

paresthesia/tingling
gustatory
olfactory
visual
auditory

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Focal Seizure

examples of cognitive sx

speech arrest
deja vu
jamais vu

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Focal Seizure

example of emotional sx

fear

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Focal Seizure

example of autonomic sx

epigastric sensations
sweating
flushing
pupillary dilation

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Tonic-Clonic Seizure

what type of seizure is this?

generalized

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Tonic-Clonic Seizure

Describe what this looks like

sudden LOC
rigidity
pt falls to ground
pt is arrested
clonic phase: convulsions themselves

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Tonic-Clonic Seizure

what may occur post-ictally?

HA
disorientation/confusion
drowsiness
nausea
muscle soreness

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Tonic-Clonic Seizure

describe atonic seizures

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

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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

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Absence Seizures

what type of seizure is this?

generalized

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Absence Seizures

describe

lapses in awareness
absent staring
begin and end abruptly, brief
more common in children

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Seizure Etiologies

age
genetic
structural
metabolic
immune
infectious
idiopathic

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causes of seizures in infancy

prenatal/birth injury
inborn error of metabolism
congenital malformation

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causes of seizures in childhood

idiopathic/genetic syndrome
CNS infection
Trauma

causes of seizures in adolescence and as a young adult

trauma
drug intoxication, withdrawal

causes of seizures in older adults

stroke
brain tumor
acute metabolic disturbances
neurodegenerative

common seizure triggers

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

1. hypoxia 2. hypotenson 3. acidosis 4. 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

1. keto diet 2. 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