Wk 4 Seizures

Question 1

Seizure

Answer 1

brief episode of abnormal electrical activity in nerve cells of the brain
- can involve motor, sensory, or cognitive manifestations

Question 2

Convulsion

Answer 2

more severe seizure characterized by involuntary spasmodic contractions of muscles

Question 3

Epilepsy

Answer 3

seizure disorder/disease
- chronic, recurrent pattern of seizures

Question 4

Myoclonic seizures

Answer 4

brief, shock-like jerks of a muscle or group of muscles
- can be focal or generalized onset depending on person

Question 5

Pathogenesis

Answer 5

“seizure focus” = where the seizure starts in the brain
- group of abnormal neurons that spontaneously fire abnormally
- often this area is found to have scar tissue (gliosis)

Question 6

Seizure focus

Answer 6

• functions autonomously
• emits excessive paroxysmal electrical discharges
• can “recruit” other neurons to discharge (spread)
• spread can be relatively local or global

Question 7

Etiology

Answer 7

Primary (idiopathic) = epilepsy, 50% of cases
Secondary
- Chemical Imbalances: blood sugar, drugs
- Febrile [most common in children]
- Brain Issues
- Traumatic brain injury
- Stroke
- Meningitis
- Tumors

Question 8

Epilepsy

Answer 8

a disease involving recurrent, paroxysmal seizure activity
- to be dx = must have no evidence of a reversible metabolic cause, have to have had more than 1
- an electrical storm

Question 9

EEG

Answer 9

electroencephalograph
- one way to diagnose

Question 10

Seizure threshold

Answer 10

complicates study of triggers
- person’s likelihood to have a seizure, higher it is, less likely a seizure is to happen
- want to try to keep seizure threshold high in pts with epilepsy
- certain things lower threshold such as alcohol, missed medication, stress, certain medications, illness

Question 11

Seizure classification

Answer 11

3 Key Features for Identification:
1. Area seizure originates
2. Level of awareness of the patient during the seizure
3. Other features [ex. motor, non-motor involvement]

Question 12

Generalized onset seizures

Answer 12

Formerly ‘grand-mal’
- Neuronal activity ORIGINATES simultaneously in BOTH hemispheres of the brain [grey matter]
Sub-types include:
- Tonic-Clonic
- Absence seizures

Question 13

Absence seizure

Answer 13

brief loss of awareness that commonly occurs with
repetitive spasmodic eye blinking for up to 30 seconds
- normally only in childhood

Question 14

Tonic-Clonic Seizure

Answer 14

Tonic Phase
- Prolonged skeletal muscle contraction
- “Cry”
Clonic Phase
- Alternating skeletal muscle contraction and relaxation
- Arms and legs jerk

Question 15

Focal onset seizure

Answer 15

Originate in a localized or FOCAL region (one lobe) of the brain
- further subdivided based on level of awareness by the patient

Question 16

4 Phases of a Seizure

Answer 16

1. prodromal = signs or activity that precede a seizure
2. aural phase = sensory warning
3. ictal phase = actual seizure
4. post-ictal phase = recovery after

1+2 = s/s and pt sensing a seizure is going to happen

Question 17

Prodromal/Aural phase

Answer 17

Subjective sense of impending seizure
- Important clue as to seizure focus

Question 18

Prodromal/aural phase characteristics

Answer 18

• Jerking, HA, lethargy, mood alterations, palpitations
• odors (e.g., smells flowers)
• taste (e.g., metallic taste in mouth)
• sound (e.g., ringing in the ears)

Question 19

Complication: Status Epilepticus

Answer 19

• continuing series of multiple seizures without recovery period
• lasts 30 minutes or more
• biggest concern with Tonic-Clonic Seizure
• life-threatening situation
• respiratory arrest -> hypoxia -> brain damage -> death

Question 20

Focal seizure -> generalized seizure

Answer 20

can progress if there is no recovery period/down regulation of neuronal activity, can progress and recruit others around it

Question 21

Anti-epileptic drugs (AEDs)

Answer 21

also called anticonvulsants, better term is anti-epileptic drugs
- these meds have LOTS of side effects-– difficult to balance seizure control and avoid adverse effects

Question 22

Goal of AED therapy

Answer 22

to control or prevent seizures while maintaining a reasonable quality of life
- most cases cannot eliminate seizures, so goal is to maximally reduce seizure incidence and minimize drug-toxicity

Question 23

AEDs duration

Answer 23

• typically must take these drugs for the rest of their life
• if seizure free for 1-2 years, can decrease dose or possibly stop with medical supervision
• do not ABRUPTLY stop = will cause seizures
• Not typically started after just 1 seizure

Question 24

AED drug choice

Answer 24

Drug chosen based on
- efficacy for type of seizure
- adverse effects
- drug interactions
- cost
- ease of use
- pediatric availability

Question 25

Therapeutic drug monitoring

Answer 25

Almost all AED require therapeutic monitoring - Evaluate effectiveness and adherence - Maintaining serum drug levels within therapeutic range helps control seizures AND reduce adverse effects (important to teach pt this) - Doses of meds are decided based on these serum drug levels

Question 26

Traditional AED meds

Answer 26

- barbiturates - hydantoins - iminostilbenes - valproic acid

Question 27

2nd and 3rd generation meds

Answer 27

tend to have fewer adverse effects and drug interactions so may benefit older adults who have to take multiple medications

Question 28

Pharm for Rapid management of Seizures

Answer 28

- most seizures stop spontaneously with NO intervention in about 2 minutes - HOWEVER, IV access is recommended for pts admitted with seizures/hx of seizures - AIRWAY

Question 29

IV push for seizures

Answer 29

IV push benzodiazepines are gold standard for seizures - diazepam, lorazepam - if outpatient, there are different forms of diazepam (rectal, jelly, etc)