SZ Flashcards
Seizures
Can be a symptom of CNS irritability from non neurological issues or medical illness like DM, substance abuse, dehydration, water intoxication, liver, renal, cardiac or lung disease, HTN, sepsis, fever, trauma
If antes when systemic or metabolic issue is corrected it is not epilepsy
A single seizure does not constitute epilepsy
Epilepsy criteria
2 unprovoked seizures more than 24 hours apart or
One unprovoked seizure and a probability of future seizures similar to general recurrence risk
Seizure disorders are considered resolved when
Those age dependent epilepsy syndrome and are now past applicable age
Those who are seizure free for 10 years and off meds last 5 years
Classification
-Generalized- tonic clonic, clonic, tonic, atonic, Absence- typical, atypical, absence with special features (myoclonic absence, eyelid myoclonia), myoclonic-myoclonic atonic, myclonic tonic
-Focal-limited to one hemisphere
-Unknown-insufficient evidence to characterize as focal, generalized, or both
Risk factors
Single; unprovoked seizures
Alzheimer’s
Stroke
Stroke is cause of 50% of all seizures and 30-50% if epilepsy in older adults
Etiology
Synaptic structure or deranged chemical neurotransmitter
Generics
Head injury especially with hematoma
Physical abuse or fall or accident
May be symptom of other condition-Cerebrovascular disease, arteriosclerosis, AVM, tumors, brain abscess, CNS infection, surgical brain procedure, Alzheimer’s
Metabolic-high or low glucose, high or low sodium, low calcium, uremic and hepatic encephalitis, hypertensive encephalopathy, toxins
Medication etiology
Antibiotics, psychotropics, anti arrhythmias, anesthetic, barbiturates; benzos
Etoh, cocaine, amphetamines, abused drugs, also associated with overdose and withdrawal of meds
Seizure pathology
Significant cerebral malfunction that affects neurons and can become epileptogenic focus and begin rapid discharge
If brain stem is involved there may be total LOC
Inhibitory neurons that are present can act in conjunction with the exhausted excitatory neurons to stop the seizure
When it ends may still have inhibition of the CNS leading to depression, impairment of consciousness and somnolence
Can be autoimmune or inflammatory epilepsy against GABAN or NMDA
Phases
Prodrome
Ictal -duration of actual seizure activity
Interictal -emotional changes
Postictal -changes in LOC and behavior
Prodromal phase can last several days preceding a seizure generally characterized as malaise or emotional change
Aura may occur
Exacerbating factors
Sleep deprived
Mental and physical stress
Acute illness
Excess fatigue
Flashing lights
Hyperventilating
Use or abuse or stimulants or etoh
Generalized seizure
Synchronous involvement of the entire brain with diffuse EEG abnormalities
Thought to originate from structure deep within the brain, radiating outward to the cortical surface
May have LOC, convulsions, falls or muscle spasms
Types-absence, tonic-clonic, tonic, clonic, myoclonic, and atonic types
Absence seizures
Rare in adulthood
Brief altered LOC like staring
No loss of postural tone
Automatism-chewing or rapid blinking can occur during the seizure there is loss of awareness
No postictal period
Tonic clonic, tonic and clonic seizures
Tonic lasts 30-60 seconds
Clonic- repetitive movement of the body, including arms, neck, and hips
Excessive saliva, shallow breathing, cyanosis
Progressive slowness
Flaccid and exhausted
Incontinence can occur
Myoclonic seizure
Quick muscular jerky movement can be whole body or specific part
Consciousness if briefly impaired
Atonic seizures
Drop attack
Sudden collapse and or fall with the legs unable to support the body
Unconscious during the event but will regain consciousness 10-60 seconds
Postictal period is short
Focal seizure
Disorder of brain network
One region hemisphere
Simple versus complex
Twitching or jerking movements
Fully awake
May have some post paralysis
Autonomic seizure symptoms-change in HR, RR, increased sweating, goose bumps, flushing or unpleasant sensations in visceral or head
Psychic seizures may have emotional changes
Deja vu feeling
Unclassified seizure
Do not fit into one category
Diagnosis
Past head trauma, accident, or injury, development history, family history, history of seizures, meds, allergies, drug use, sleep pattern
PE
Psychogenic pseudoseizures
Need EEG and video monitoring to DX
Appear similar to epileptic seizures
Injuries uncommon
Event does not follow neuroanatomic pattern
PET
Older adults
Usually due to underlying condition
Alzheimer’s patients may develop
Be more cautions with meds due to decrease metabolism and risk for ADR
Women
May experience epilepsy different from man due to hormonal changes
Estrogen can stimulate and progesterone can inhibit some neurons involved in seizure activity
During puberty may see less seizures or increase in amount during pre menstrual days this is called catamenial seizure disorder
Contraceptive important for lots of antiseizure drugs
