Seizures Lecture Powerpoint Flashcards by Amitav Rahman

Telltale sign of a seizure

If you grab hold of their arm it will NOT stop seizing

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Ictal

Relating to or caused by stroke/seizure (during a seizure)

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Post-ictal

Altered state of consciousness after seizure

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New onset of seizures age 30 onward assume…

….tumor until proven otherwise

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Tonic

Producing tone or contraction of muscles within seizure

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Clonic

Alternating pattern of relaxation and contraction in muscles within seizure

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Aura (seizures)

Distinctive visual or sensation warning sign typically predictive of an impending seizure episode

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Clonic vs myoclonic vs myoclonic tonic

Very slow vs very fast (

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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

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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)

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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

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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

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Seizures

Uncontrolled electrical activity in the brain resulting in physical convulsion and other manifestations in the body

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Signs and symptoms of seizure (4)

Fever (may be indicative of infectious etiology - febrile seizure)
papilledema
headache
focal neurologic finding

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Todd’s paralysis

Focal residual abnormality such as paralysis of one sided limb that may suggest post - focal onset of seizure

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Seizure is not a ___, it is a ___

diagnosis, symptom

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Focal seizures can progress if left untreated for a period of time to…

….generalized (secondary generalized)

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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

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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)

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Things that mimic seizures (4)

syncope
sleep disorders
migraines
TIA

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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