UNIT 2 SEIZURES AND EPILEPSY Flashcards
What is a seizure?
- Transient, uncontrolled electrical discharge of neurons in brain, interrupting normal function
What are some metabolic disturbances associated with seizures?
- Acidosis
- Electrolyte imbalance (sodium)
3.Hypoglycemia - Hypoxia
- Alcohol or barbiturate withdraw
- dehydration or water intoxication
True or false: Seizures resulting from systemic or metabolic disturbances are not considered epilepsy if the seizures stop when all the underlying conditions have been corrected.
True
What are some extracranial disorders associated with seizures?
- Hypertension
- Heart, lung, liver, kidney disease
- Systemic lupus erythematosus
- DM
- Septicemia: All patients with sepsis are high risk
What is epilepsy?
Disease w/continuing predisposition to seizure w/consequences “chronic” reoccurrence of unprovoked seizures and mutually unpredictable
What is the patho of Epilepsy?
Group of abnormal neurons spontaneously firing. It is important to know where the seizure originates and the pattern of spread/extent of involvement.
When a patient is sent to the epilepsy monitoring unit, they are going to want the patient to have a min of _____ seizures in order to narrow location down.
3
What are the two major classes of seizures?
- Generalized
- Focused
What are the different types of focal seizures?
- Simple
- Complex
What are the different types of generalized seizures? List 6
- Tonic-Clonic
- Absence
- Myoclonic
- Atonic
- Tonic
- Clonic
What are the 4 phases of seizures?
- Prodromal phase: Only pt is aware- sensation or behavioral changes
- Aural phase: Sensory warning that is similar each time but different for each patient
- Ictal phase: 1st symptom that last up until the end of seizure, we don’t exactly know when this starts/ends on EEG
- Postictal phase: “recovery phase” end of seizure
What can trigger a seizures?
- Anything extreme- drinking, flashing lights, emotions, up all night, exercise, stress, abrupt medication stop
What are generalized tonic-clonic seizures characterized by?
Loss of consciousness and falling. Body stiffens (Tonic) with subsequent jerking of extremities (clonic)
postictal- muscle soreness and fatigue, may sleep for hours, may not feel normal for days, NO memory of seizure
What might a patient in a tonic-clonic seizure (generalized) present with?
- cyanosis, excessive salivation, tongue, or check biting and incontinence may occur
What are interventions for generalized tonic-clonic seizures?
- Seizure pads, fall precautions, tele sitter, suction available
How long do the tonic-clonic phases last?
Tonic- 10-20 seconds
Clonic 30-40 seconds
When do we normally see typical absence seizures?
- Usually occurs only in children and rarely beyond adolescence
Generalized typical absence seizures can be precipitated by what?
- Flashing lights and hyperventaltion
Typical symptoms of a generalized typical absence seizure can include what?
- Staring spell “day dreaming”- last few seconds and may have 100’s per day.
True or false: An EEG can demonstrate patterns unique to a typical absence seizure?
- True
What is a generalized atypical absence seizure?
- Characterized by staring spell with other manifestations
- Eye blinking, chewing
- Jerking movements of the lips
- Last more than 10 seconds
-Can continue through adulthood
What is a generalized myoclonic seizure?
- Characterized by sudden, excessive jerk or twitch of body and extremities, brief altered mental status this can be forceful enough to cause falls and may occur in clusters
What is a generalized atonic seizure?
- Involves tonic episodes or paroxysmal loss of muscle tone also known as the “drop attack”. It begins suddenly and person falls. Typically last less than seconds. Person usually remains conscious and can resume normal activity immediately. This type of seizure puts them at great risk of falling. Hard to dx because they believe they are clumsy
What is a generalized clonic seizure?
- Begins with loss of consciousness and sudden loss of muscle tone followed by rhythmic limb jerking that may or may not be symmetric these are relatively rare
What are focal seizures?
Also called partial or partial focal seizures. They begin in a specific region or cortex in 1 hemisphere of brain.
How are manifestations determined with a focal seizure?
Based on function of area of brain involved
What are characteristics of a simple focal seizure?
Person remains conscious and alert
Experience unusual feelings or sensations that take many forms.
- Sudden and unexplainable feelings of joy, sadness, anger or nausea
- May hear, smell, taste, see or smell things that are not real
What is a complex focal seizure?
- Patients have a loss of consciousness or alteration in awareness.
- Eyes remain open but cannot interact
- May display strange behaviors
- Automatisms- repetitive, purposeless actions
- Do not remember an activity started before or continued during seizure
- Last between 30 seconds and 2 mins
What is a psychogenic focal seizure?
Can be misdiagnosed as epilepsy
1. History of emotional or physical abuse or a specific traumatic event.
2. Accurate dx usually requires use of video-EEG monitoring
What is status epilepticus (SE)
- State of continuous seizure activity or condition when seizure recurs in rapid succession without return to consciousness between seizures.
- Any seizure lasting longer than 5 mins it is considered an NEUROLOGICAL EMERGENCY and can occur with ANY type of seizures and my result in permanent brain damage
What diagnostic information do we need from a seizure patient.
- H&P
- Seizure history
What are some diagnostic studies for seizure patients?
- CBC
- UA
- Electrolytes
- Creatinine
- Fast blood glucose
- lumbar puncture for CSF analysis
- Electroencephalography EEG
What are some antiseizure medication side effects?
- Sedation,
- mental dulling,
- impaired memory and concentration,
4, mood changes, - GI upset,
- dizziness
What are drugs for simple and complex focal seizures?
- Carbomazepine
- Fosphenytoin, Phenytoin
- Valproic acid
- Primidone, Phenobarbital
What are drugs for primary generalized tonic-clonic, absence, atonic seizures?
- Carbamazepine
- Phenytoin
- Pnenobarbital, valproic acid
- Levetiracetam
What are the goals of medication treatment for seizures?
- Reduce seizures to a level that allows the patient to live as normal of a life as possible
- Balance the desire to complete seizure control w/acceptable side affects
How do antiepileptic drugs work
- Suppress discharge of neurons w/in a seizure focus
- Suppress propagation of seizure activity from the focus to the other area of the brain
What are the mechanisms of action for antiepileptic drugs?
- suppression of sodium influx
- suppression of calcium influx
- suppression of potassium influx
- Blockage of receptors of glutamate
- Protient of gamma-aminobutyric acid (GABA_
Why is monitoring plasma drug levels so important for antiepileptic drugs?
Serves as a guide for dosage adjustments
How can we promote patient adherence to their seizure medication?
- education about importance of adhering to prescribed regimen
- Monitoring plasma levels to encourage and elevate adherence
- Deepening patient and family involvement by maintaining a seizure frequency chart
What is the management of acute seizures & status epilpticus?
- Lorazepam (ativan) #1 IVP recommended as 1st line treatment
- Diazepam (valium)- Short duration
- Phenytoin (Dilantin)
- Fosphytoin (less irritating)
- Magnesium sulfate
What patients are at risk for potential seizures?
- Brain surgery, head trauma, hypoxia, hypoglycemia, drug overdose, alcohol withdrawal.
