Seizures & Epilepsy Flashcards
Definition of seizure
abnormal, synchronized excessive discharge from an aggregate of CNS neurons
Highest RF for chronic seizure disorder
penetrating head trauma
Precipitating factors of seizure
sleep deprivation, stress, extreme fatigue, drug/etoh withdrawal, fever, cocaine use
Causes of seizures in neonatal/early infancy
CNS infection
postpartum drug withdrawal (mother using drugs/etoh)
hypoglycemia
Causes of seizures in late infancy/early childhood
febrile seizures
CNS infection
Causes of seizures in childhood
develop “epilepsy”
idiopathic
temporal lobe
Causes of seizures in adolescence
CNS lesions
head trauma
illicit drug use
Causes of seizures in adults
cerebral vascular disease
trauma
tumor
metabolic disturbances (ethos withdrawal, uremia, hepatic failure, hypoglycemia)
ictal, post-ictal states
ictal: seizure state
post-ictal: symptomatic time frame after seizure
RF of seizures
head trauma, stroke, CNS infection, electrolyte or metabolic disturbances, drugs, alcohol, FHX
Most common type of seizure
complex partial
PE work up of seizure
- Search for signs of systemic illnesses (liver, renal)
- Signs of head trauma
- CV (heart, carotid arteries)
- Complete neuro exam: mental status, visual fields, motor/sensory fx, DTRs, gait, coordination
Lab/imaging in seizure work up
CBC, Chem 20, toxicology, lumbar puncture (if suspect infx or if has HIV), EEG, CT/MRI
Definition of epilepsy
recurrent seizures; 2 or more unprovoked seizures
partial vs generalized seizures
partial = limited to discrete region of brain generalized = whole brain
partial seizure where consciousness is fully preserved
simple partial
partial seizure where consciousness is impaired
complex partial
febrile seizures
- 3 mon to 5 yrs old
- occurs when temp rising
- typically isolated event, brief, symmetric
- likely to recurr
First priority in treating possible seizure
STABILIZE - look at vitals, respiration, CV
DDX of possible seizure
vasovagal reaction, MI, TIA, migraine
What is the best imaging for detection of cerebral lesions in epilepsy?
MRI > CT
Mainstay tx for seizures
anti-epileptic drugs
o Generalized: Levetiracetam (Keppra), Valproic acid or lamotrigine
o Absence: Ethosuximide
o Partial: Carbamazepine, phenytoin, lamotrigine and topiramate
When should anti-epileptic drugs be started?
- recurrent seizures of unknown cause
- cause can’t be treated
- usually not for single seizure unless thought to be epileptogenic
How to discontinue antiepileptic meds?
most patients with complete control of seizures for significant time may d/c
withdraw very slowly over 2-3 months
What kind of diet may help seizures?
ketogenic diet
“Jacksonian March”
simple partial seizure that begins in small area and progresses to larger area (fingers to arm)
“Todd’s Paralysis”
localized paresis for minutes to hours in involved region after simple partial seizure
partial seizure with secondary generalization
begins as partial seizure and propagates throughout cortex to become generalized
How are partial seizures treated?
Carbamazepine, Phenytoin, Iamotrigine, Topiramate
5 types of generalized seizures
absence, myoclonic, grand mal, tonic, atonic
Most common type of seizure in CHILDREN
absence (petit mal)
absence seizure
- only last few seconds
- brief lapses of consciousness w/o loss of posture or post-ictal confusion
- TX: Ethosuximide
tonic-clonic more commonly known as _______.
grand mal seizure
3 phases of grand mal seizure
1) Tonic: muscle contraction, ictal cry, foaming of mouth, sympathetic effects (BP, pulse, pupils dilate)
2) Clonic: alternate contraction & relaxation
3) Post-ictal: regains consciousness, confusion, unresponsive
atonic seizures
sudden loss of postural muscle tone with brief impairment of consciousness for a few seconds
usually head drop, if longer fall risk
myoclonic seizure
sudden brief muscle contraction involving part or all of body
psychogenic seizure
non-epileptic behaviors that resemble a seizure
Definition of status epilepticus
continuous seizure or recurrent seizures without return to baseline between them
Prolonged seizure of status epilepticus may cause what?
cardiorespiratory compromise, metabolic derangement, irreversible neuro damage
Common cause of status epilepticus
anticonvulsant withdrawal or noncompliance
others: CNS infection, tumor, drug toxicity, metabolic
Status epilepticus treatment
IMMEDIATE anticonvulsant
1) IV Lorazepam
2) Phenytoin if seizure continues
Ultimately anesthesia to shut off CNS
Imaging for febrile seizures
No imaging needed, plus CT not good for < 18 yo
If inconsistent hx or PE do lumbar puncture
Febrile seizure treatment
Reassurance and parent education
Tylenol and ibuprofen to control fevers
