Seizures Lecture Powerpoint Flashcards
Telltale sign of a seizure
If you grab hold of their arm it will NOT stop seizing
Ictal
Relating to or caused by stroke/seizure (during a seizure)
Post-ictal
Altered state of consciousness after seizure
New onset of seizures age 30 onward assume…
….tumor until proven otherwise
Tonic
Producing tone or contraction of muscles within seizure
Clonic
Alternating pattern of relaxation and contraction in muscles within seizure
Aura (seizures)
Distinctive visual or sensation warning sign typically predictive of an impending seizure episode
Clonic vs myoclonic vs myoclonic tonic
Very slow vs very fast (
Epilepsy epidemiology
3.4 million americans, 1% of population, 50% of people with it develop by age of 25 but can get it at any time, twice as many with epilepsy who are 60 or older as children aged 10 or younger
Localized/partial epilepsy
Seizure located on one side or part of body initially that may evolve into entire body involvement (secondarily generalized), either simple (not lost consciousness) or complex (have change in state of consciousness)
Generalized seizures and their subclasses (5)
Seizure that occur over whole body symmetrically without local onset including several classes such as:
- tonic clonic (grand mal)
- absence (petit mal)
- myoclonic
- clonic
- atonic
70% of epiplepsy is ___, most common causes of provoked include the following (5)
idiopathic,
- head trauma
- infection
- brain tumor
- genetic anomalies
- prenatal disturbance of brain development
Seizures
Uncontrolled electrical activity in the brain resulting in physical convulsion and other manifestations in the body
Signs and symptoms of seizure (4)
- Fever (may be indicative of infectious etiology - febrile seizure)
- papilledema
- headache
- focal neurologic finding
Todd’s paralysis
Focal residual abnormality such as paralysis of one sided limb that may suggest post - focal onset of seizure
Seizure is not a ___, it is a ___
diagnosis, symptom
Focal seizures can progress if left untreated for a period of time to…
….generalized (secondary generalized)
Epilepsy
Recurrent seizures unrelated to fever or acute cerebral insult with no underlying provocation, generalized tonic-clonic characterized by rigidity (tonic phase) followed by repetitive clonic activity (of all extremities), may be accompanied by oral frothing, resp distress, cyanosis, incontinence, blackout, and convulsions
Psychogenic nonepipleptic seizures
Seizure activity characterized by sudden and time limited disturbances of motor, sensory, autonomic, cognitive, and/or emotional functions, mimics seizures but not associated with physiological CNS dysfunction (as measured on an EEG), tends to last longer than 2 min, pelvic thrust but no incontinence, can still communicate, forced eye closure, and no increase in prolactin levels (which is always seen in a true seizure)
Things that mimic seizures (4)
- syncope
- sleep disorders
- migraines
- TIA
Nonepileptic seizures (pseudoseizures)
More common in females that present with asynchronous movements, fluctuating course, extended duration, tight eye shuts, pelvic thrusting, etc. that shares distinct differences from a true seizure
Lennox gastaut syndrome triad of presentation
- developmental delay
- absence and tonic seizures
- slow spike wave discharges on EEG
Lennox gastaut syndrome
Infantile spasms onset 2-7 years
Complex partial seizures (psychomotor seizures)
Represents events of focal cerebral onset, characteristically manifests with variety of motor, sensory, or behavioral alterations, motor activity during complex partial seizure may remain focal
Juvenile myoclonic epilepsy
Recessive inherited epilepsy that is distinct in that it does not have a bad prognosis
Rhabdo and seizures
prolonged hours of seizing is concern
Febrile seizures
Most common in children, affect 3-5% of kids, does not indicate likelihood of developing seizures later in life, typically have tonic clonic motor activity lasting 1-2 min with rapid return to consciousness, tend to occur in conjugation with rapid rise in body temp
Atypical febrile seizure
Deviate from febrile seizure either by being prolonged exceeding 15 min, focal seizure manifestations, or multiple in the same febrile illness
Alcohol withdrawal seizures
Most commonly seen in alcohol dependent patients when sudden cessation, often precede other classic symptoms of withdrawal, untreated may progress to delirium tremens, most common 12-36 hrs after withdrawal, CT often considered for initial to rule out underlying process
Delirium tremens and 2 treatments
Rapid onset of confusion following alcohol withdrawal, treated with valium or ativan (lorazapem)
Seizure diagnosis (4)
- Clinical assessment
- EEG
- CT
- Neurologic exam
Tuberous sclerosis/von recklinghausen
Common type of neurocutaneous syndrome that is neurofibromatosis type I clinically diagnosed by hypmelanotic macules as first manifestation followed by progression and eventual seizures
Classic triad of tuberous sclerosis
adenoma sebaceum, seizures, and developmental delay
common seizure triggers (6)
- missed medication (#1)
- stress/anxiety
- hormonal changes
- fatigue
- photosensitivity
- fever
Seizure treatment principles
Control frequency while limiting side effects, medication depends on etiology, acute management includes benzos, often require sedation
Absence (Petit mal) seizures
Generalized seizures with spells lasting up to 10 sec a piece and occurs dozens of times daily, patients have no recollection of events and will resume previous activity without any postictal symptoms
Classic EEG finding for absence seizures
3 cycle per second spike and waves
Status epilepticus
Seizure lasting longer than 30 min or occurrence of serial seizures from which there is no return to same level of consciousness as occurred prior to seizure, can be febrile, idiopathic, or symptomatic status
Treatment principles of status epilepticus (ABCDD)
Airway
Breating
Circulation (hypertension is normal finding)
Dextrostix (may be hypoglycemic)
Draw blood (get glucose, electrolytes, etc.)
Seizure episode treatment options (8)
- Lorazepem (ativan)
- diazepam (valium)
- phenobarbital in neonatal first line
- Phenytoin (dilantin) DOC, cannot be given IM
- mannitol (brain swelling)
- dexamethasone (same)
- Valproic acid (useful in treating generalized and artial seizure disorders)
- Ethosuximide (zarontin) DOC for absence epilepsy but other meds can make the condition worse
Not all initial, brief, uncomplicated seizures need to be…
….treated if no underlying pathology found, just treat underlying disorder (its possible to just have one)
Diagnostic studies for seizures (5)
- EEG with provocation testing
- MRI
- Metabolic panel
- Lumbar puncture
- EKG
Phenytoin ADR’s (4)
- gingival hyperplasia
- hirsutism
- lymphadenopathy
- hepatotoxicity
CT and MRI findings in seizure patients
- CT findings not visualized
- MRI present in 100% of cases, see streaky linear or wedge shaped lesions extending from ventricles
Potential complications of epilepsy (2)
- sudden unexpected death in epilepsy
- brain damage
Alternative treatment options for seizures (3)
- ketogenic diet
- lifestyle mods
- marijuana
Positive characteristics of new seizure meds (4)
- efficacy at least equal to older meds
- safer and more tolerated
- blood testing not necessary
- less drug interactions
Anticonvulsant withdrawal
Indicated only slowly after 2 years of seizure free activity in child with no underlying contributing neurological or systemic dz
Surgical treatment for seizures (3)
- Resection when foci can be isolated
- laser ablation
- vagal nerve stimulator inplantation
Safety issues for patients with epilepsy (4)
- Cannot drive for year after last seizure
- shouldn’t swim or bathe alone
- cooking should be monitored
- taking care of children can be challenging
Best anticonvulsant for pregnant women
Lamotrigine
