Unit 3 - Seizure Disorders Flashcards

1
Q

epilepsy

A

seizures that are recurrent, spontaneous, and unprovoked. Seizures can affect functional status, social status, emotional status, cognition, and overall quality of life

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2
Q

what is a seizure?

A

Any sudden attack of altered behavior, consciousness, sensation or autonomical function that is produced by self-limited disruption of brain activity due to repetitive, simultaneous electrical discharges from hyperexcitable neurons in the cortex

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3
Q

epilepsy facts

A
  • affect 2.3 million americans
  • incidence highest for under 2 and over 65
  • males > females
  • 8% kids will have 1+ by age 15
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4
Q

for people with diagnoses with epilepsy

A
  • 65% achieve control after the first year
  • 15% achieve control at a later date
  • 20% resist control and seizures become refractory or uncontrollable
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5
Q

seizure types

A
  1. Generalized

2. Partial

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6
Q

generalized seizures and 4 types

A
  • affect both hemispheres of the brain simultaneously. They account for 40% of all cases of epilepsy
  1. tonic clonic
  2. absence
  3. atypical absence
  4. myoclonic
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7
Q

Tonic-clonic seizures (grand mal, major motor)

A
  • Most common variant in childhood
  • May result from fever, CNS infection, metablolic disturbance, tumor, developmental brain abnormality (CP), or hereditary tendency
  • PRIMARY generalized seizures appear to originate simultaneously in all areas of the brain
  • SECONDARY generalized seizures evolve from initially localized events in one area of the brain

*This localized event is often indicated by a brief, sometimes nonspecific aura or warning preceding the actual seizure.

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8
Q

tonic clonic phase details

A

Tonic stage: appears first and lasts about 30 sec. to 1 minute. The seizure can begin with eye deviation upward or to one side, sudden loss of consciousness, and rigidity. The child may stop breathing (color change).

Clonic phase: follows with rhythmical jerking of the body, lasting 1-3 minutes.
• The clonic phase is usually followed by lethargy or sleep
• Incontinence may occur in this postictal period
• Upon recovery, the child typically has no memory of the seizure itself.
• Some people can have purely tonic or purely clonic seizures.

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9
Q

Absence Seizures (formerly called petit mal)

A

• Much less common than tonic-clonic seizures
• Account for less than 5% of all seizure disorders
• Onset typically occurs in the first decade of life between 3 and 7 years of age
• The child abruptly stops all activity, assumes a glazed look, stares, and remains unaware of surrounding for several seconds
• The child maintains normal muscle tone which can protect the child from falling. Many times, though a child with severe absence seizures may wear a helmet to protect the head if the child falls during a seizure
• Video EEG has shown a high degree of subtle eye blinking, muscle twitching, or repetitive movement.
• Unlike daydreaming, absence seizures cannot be interrupted by verbal or tactile stimulation
• This type of seizure is difficult to detect
*due to brevity of the seizure and the LACK of any postictal confusion following the seizure. Many children can respond almost immediately to a question or resume activity where they have left off.
• Spontaneous remission can occur in 90% of childhood absence epilepsies

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10
Q

Atypical Absence

A
  • Involve complex staring spells and associate focal features
  • Starts gradually, lasts longer, and ends with postictal confusion
  • Typically seen in children with mental handicaps and may present with mixed type seizure patterns (ie. tonic-clonic, myotonic, atonic qualities)
  • Lennox-Gestaut syndrome is another name for these intractable mixed seizures that may be associated with mental handicaps and developmental disabilities
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11
Q

Myoclonic

A

• Sudden and powerful involuntary contractions of muscles
• A hand may fling out or spasms may involve the entire body and cause the child to be thrown to the ground
• Infantile spasms is a classic example of myoclonic seizures
*Infantile spasms may start at 4-8 months of age
*Occur in children with a variety of brain disorders as well as typically developing infants
*Can look like an exaggerated Moro reflex
*They occur during periods of drowsiness or arousal from sleep
*Occur in clusters of 5 or more, each separated by a few second and can last up to 5 minutes
*The spasms usually take the form of a sudden jackknifing of the body with forward bending at the waist with arms and legs outstretched
*More that 90% of children with symptomatic infantile spasms develop mental handicaps despite medical intervention (drugs)

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12
Q

Partial Seizures

A

The most common type of seizure disorder, account for ~60% of all cases. ~3/4 of all children affected by partial seizures have brain abnormalities, most commonly of prenatal origin. The signs and symptoms of the seizure depend on the seizure focus in a restricted area of one hemisphere

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13
Q

Simple Partial Seizures

A
  • Commonly first identified after 4 years of age
  • If the seizure focus involves the motor cortex, the result is usually rhythmic clonic activity of the face, arm, or leg. Can include isolated twitching of 1 extremity
  • If the seizure activity arises from the occipital or parietal lobes, visual hallucinations or illusions may occur
  • If the seizure activity arises from the temporal lobe, auditory hallucinations or olfactory sensation by occur
  • An aura may precede a simple complex seizure – a feeling of déjà vu
  • Consciousness is not lost, and the child can remember the sensations from the seizure
  • ~70% of simple partial seizures can be controlled by anti-epileptic drugs (AEDs)
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14
Q

Complex Partial Seizures (psychomotor, limbic, temporal lobe)

A
  • Most common seizure type in older children and adolescents, may not be seen in infancy
  • Resemble generalized absence seizures
  • Are distinguished by an aura that preceded the seizure, a duration longer than 10 minutes, and postictal confusion or actual sleeping
  • Most originate in the temporal lobe
  • Auras may include sudden familiar odor, an odd taste, a visual hallucination
  • The child may also have unprovoked emotional outbursts such as anger, laughter, or fear
  • The seizure could include eye blinking, lip smaking, facial grimacing, groaning, chewing/rumination, unbuttoning/buttoning clothing and aimless wandering
  • Spontaneous remission occurs in ~20% of cases, but many children respond well to AEDs
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15
Q

Diagnosis of Seizure Disorders

A

• EEG – Electorencelphalolgram
*~80% of all children with seizure disorders have abnormal EEG pattern between seizures (Batshaw, M., 2010).
*Often, physicians try to “evoke” seizures while child is undergoing an EEG by using various stimuli to see what may trigger a seizure (ie. light, sounds, sleep deprivation, medication changes)
• History and physical
• MRI and other scans of the brain
• Neuropsychological testing

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16
Q

Common Medication to Control Seizure Activity (Anti-Epileptic Drugs/AEDs):

A
  1. Depakote, Depakene
  2. Lamictal
  3. Topamax
  4. Zonegram
  5. Keppra
  6. Felbatol
  7. Tegretol
  8. Dilantin
  9. Phenabarbitol
  10. Diastat (used to arrest a seizure that will not stop)
17
Q

Long-term effects of seizures activity on infants and children

A

• Poor bottle feeding
• Poor absorption of food and poor weight gain
• GI difficulties including poor peristalsis
• Side effects of AEDs
 CNS: fatigue, tremors, dizziness, slurred speech
 Gait disturbance
 Decline in cognition, memory
 Behavior changes, flat affect, decreased “playfulness”
 Skin rash
 Repeated infections, anemias, increased bruising
 GI: older children have changes in appetite, stomach pain

18
Q

Ketogenic Diet

A
  • Restrictive diet that eliminates certain food items
  • 4:1 ratio of fats to proteins and carbohydrates
  • Places a child in a state of ketosis
  • Typically, family makes a 2 year commitment to try the diet, currently we do not know the long-term effects of a prolonged high fat diet
  • Improvement in seizures noted in 30-50% of patients with increased alertness
19
Q

The Ketogenic Diet in Pediatric Epilepsy

A
  • -Ketogenic diet helps control seizures in up to two-thirds of children refractory to anticonvulsant drugs
    • Children with partial seizures may not respond as well to the diet
    • The role of ketone bodies as markers of seizure control is imprecisely defined
    • Their role as direct anticonvulsant agents is also unknown
    • Tests for transporter defects and enzyme deficiencies help screen diet candidates
    • Important clinical questions about the ketogenic diet remain unanswered
20
Q

Vagal Nerve Stimulation

A
  • Electrical stimulation of the vagus nerve used as an adjunt to medication
  • Stimulation of the vagus nerve is thought to affect some of its connections to areas in the brain that are prone to seizure activity.
  • Patients who suffer from complex partial seizures or generalized seizures where consciousness is lost, and who do not respond to anticonvulsant medication, and patients who cannot undergo brain surgery are considered good candidates for vagus nerve stimulation therapy
  • Requires surgery to place vagal nerve stimulator and battery must be replaced every 8-10 years
21
Q

Surgery – Hemispherectomy or Focal Cortical Resection

A
  • Hemispherectomy is the surgical removal or disconnection of one side of the brain from the other
  • A functional hemispherectomy is a procedure in which portions of one hemisphere–which is not functioning normally, are removed, and the corpus callosum is split. This disconnects the communications between the various lobes of the epileptic hemisphere and between the two hemispheres, preventing the spread of seizures to the functional side of the brain.
  • This procedure is performed on epilepsy patients with medically intractable partial seizure activity
22
Q

What do you do if the child you’re treating has a seizure?

A
  1. Time seizure activity
  2. Remain calm
  3. Protect the child during the seizure
    • Do not restrain child
    • Ease child to the floor is they are standing or sitting when seizure occurs
    • Lay on side
    • Do not put anything into the child’s mouth
    • Loosen restrictive clothing
    • Remove objects around child that could injury child if bumped into
    • Allow seizure to end
  4. When the seizure has stopped, check for breathing; if the child is not breathing initiate Rescue Breathing/CPR
  5. Remain with child until the child is able to move
  6. Seek help when seizure is over
23
Q

Issues for OT

A

Important to discuss changes with parents/caregivers and child’s neurologist.

  1. Expect variability and inconsistency in developmental skills if the seizure activity is intractable
  2. Observe for changes in learning, behaviors, and motor skills after seizure activity or with medication changes (ie. seizure log in school setting; document in treatment notes)