Seziures Flashcards
A one-time event – a single surge of electrical activity in the brain.
Seizure
Multiple seizures. Diagnosis requires at least two “unprovoked” (natural) seizures.
Seizure Disorder
Triggered “provoked” by a disorder, event, or other condition that irritates the brain (febrile, birth trauma, brain tumor, pseudo seizures)
Non-epileptic Seizure
Once a person has a single unprovoked seizure, he/she has what chance of having another seizure and a 2nd seizure?
- 50% for another
- 2nd seizure often occurs within 6 months of first - If had two seizures, ~80% chance of recurrent seizures.
high-risk features that increase seizure recurrence after a 1st unprovoked seizure:
- Epileptiform abnormalities on EEG.
- Remote symptomatic cause, as identified by clinical history or neuroimaging (eg, brain tumor, brain malformation). Acute symptomatic seizures have a lower risk for subsequent epilepsy.
- Abnml neuro exam, including focal findings and intellectual disability.
risk factors for seizures
7
- age - very young or old (>60)
- some children will outgrow them - brain infections/tumors
- dementia
- FHx
- vascular dz
- other: head injuries/brain trauma, inadequate O2 to the brain, cerebral edema
- chronic diseases: metabolic, autoimmune, kidney or liver failure, hypoPTH, vit B6 def
no real correlation with ethnicity or gender - caucasians MC generalized epilepsy; certain genders may be more likely to develop certain subtypes of epilepsy.
possible drugs that can cause seizures
- Buspirone (Wellbutrin)
- Camphor (hydrocarbon)
- Chlorpromazine (Thorazine)
- Ciprofloxacin
- Chloroquine
- Clozaril (clozapine)
- Cyclosporine
- Imipenem (Primaxin)
- Indomethacin
- Meperidine (Demerol)
- Phenytoin (Dilantin)
- Theophylline
- Tramadol (Ultram)
- Tricyclics (OD)
recreational drugs that can cause seizures
Amphetamines
Cocaine (OD)
Drug Withdrawal after heavy use
toxins that can cause seizures
Lead
Strychnine
precipitating factors of seizures
- fatigue
- decreased physical health
- alc
- emotional stress
- flashing lights
- menstrual cycle
- hypoglycemia
- sleep deprivation
- stimulants
- withdrawal
- substance abuse
- high fever
- lyte disturbances
- hypoxia
stages of seizure activity
- prodromal
- pre-ictal or aura - Actually, a focal onset seizure
- ictal - During the seizure (the part of the seizure outsiders can witness)
- post-ictal
s/s of pre-ictal
Precedes the seizure by sec to min - may alert onset
Vary depending on type of seizure and area of the brain affected. Most people who have auras have the same type each time
presentation of post-ictal
- AFTER the active part of the seizure
- The body begins to rest, and after-effects may set in
- The type and length vary from person-to-person
- Numbness, HA, Fatigue, Focal weakness (Todd’s paralysis), Stupor, Confusion and Agitation, LOC or Unresponsiveness, Loss of bowel or bladder control
Two Primary Types of seizures
- focal
- generalized
- unknown
types of focal seizures
- Focal seizure w/ retained awareness (previously simple partial seizure) - Typically cause few symptoms, often overlooked or mistaken for another condition. No LOC. No memory loss
- Focal seizure w/ impaired awareness (previously complex partial seizure) - Like simple but they HAVE alter consciousness or awareness; unaware of what occurred; Unusual, repetitive movements (hand rubbing, chewing, swallowing or walking in circles)
Abnormal activity generated affects only one area of brain – the whole hemisphere or part of a lobe
focal seizure
Seizures that involve all areas of the brain. With the exception of myoclonic, all involve LOC. Because they spread quickly, it can be impossible to tell point of origin.
Generally NOT preceded by an aura. Categorized as Motor onset or Non-motor onset.
generalized seizures
types of generalized seizures
- Absence
- Myoclonic
- Atonic
- Tonic
- Clonic
- Tonic-Clonic
- Only non-motor onset, all other generalized seizures are motor onset
- staring and subtle body movement with impairment of consciousness. (ex. lip smacking); “spacey”
absence seizures
If lasting >45 sec or pt has a post-ictal phase = focal seizure instead
- sudden, irregular, brief jerks or twitches (myoclonic jerks) of the arms and legs, jaw, or generalized throughout the body, milliseconds in duration but ongoing for >30 min w/ partial retained awareness.
- jumps inside the body that may affect the limbs, jaw, or other body parts.
myoclonic seizures
- a rare condition characterized by non-epileptic spasms. The spells begin before age 1 yr and are self-limited. The EEG is invariably normal, and neurologic development is not affected.
- commonly mistaken with myoclonic seizures
benign myoclonus of infancy
- Sudden loss of muscle control w/o myoclonic or tonic features for < 2 sec
- Head, neck, or limbs.
- slumping or nodding briefly before recovering to sudden fall or collapse.
- pt is unaware of what happened.
- Usually associated w/ intellectual impairment.
Atonic Seizures (Drop Attacks)
- Cause muscles - often of the bilateral arms, legs, and back - to tighten and stiffen. Lasts seconds-minutes.
- Most fall to the ground bc of muscle rigidity.
- May turn blue if breathing is impaired.
- associated w/ intellectual impairment.
Tonic Seizures
- Convulsive movements - associated with bilateral rhythmic, jerking muscle movements; usually affecting the neck, face and arms.
Clonic Seizures
how to differentiate clonic from myoclonic
clonic - rhythmic jerking (vs. irregular jerking) as well as altered consciousness.
- Sometimes associated with loss of bladder/bowel incontinence, tongue biting, loss of body secretions (foaming of the mouth).
- Can last from several minutes up to 20 min. After the shaking stops, it may take 10-30 min for the person to return to normal (post-ictal phase)
- Characterized by LOC, violent shaking, and body stiffening.
- Bilateral, symmetrical generalized motor involvement.
Tonic Clonic Seizures
what is West syndrome
- infantile spasms - Reflect abnormal interactions between cortex and brainstem; may be related to an immature CNS
- Age-specific epileptic disorder of infancy and early childhood - 90% dx under a year of age - (MC 4 - 7 mo)
how are infantile spasms diagnosed
hypsarrhythmia on EEG (very high voltage, random, slow waves and spikes in all cortical areas)
Common features of infantile spasms:
Symmetric, synchronous
Sudden, brief contractions of one or more muscle groups
80% occur in clusters
Average duration of spasm 4 - 6 sec
A physical manifestation of a psychological disturbance - frequently occur in conversion disorder.
A non-epileptic seizure, but superficially resemble an epileptic seizure. Nothing physically wrong.
Pseudo seizures (PNES or NEAD)
Not false, fraudulent, or produced under any sort of pretense (vs. factitious disorder)
Pseudo seizures are MC in who
women
