Flashcards in Adult Seizure Disorder Deck (38):
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Seizure
Episode of abnormally synchronized and high frequency firing of neurons resulting in abnormal behavior or experience.
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Epilepsy
Chronic brain disorder of various etiologies characterized by RECURRENT, UNPROVOKED seizures
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WHat are some conditions that may provoke seizures
fever, acute head trauma, metabolic disorders such as hypo or hyperglycemia, electrolyte disturbances such as hyponatremia
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Increase in rate of epileptic seizures in pts over 60. WHy?
High rate of strokes in that age group and strokes predispose to epileptic seizures
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Epilepsy incidence peaks?
Children and the elderly
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causes of adult onset epileptic seizures
- cerebrovascular disease
- Trauma
- Tumors
- Infection
- Cerebral degeneration
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What are partial seizures
- Focal onset seizures that emanate from a specific cortical region. They affect 1 area of the brain and most commonly originate in the median temporal lobe. May spread to become generalized
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Generalized seizures
no focal onset, thought to originate from brainstem structures; with spread to both hemispheres at the same time.
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Simple partial seizure
consciousness intact
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Complex Partial
Impaired consciousness
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So what are the two types of partial seizures
simple and complex
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Partial seizure with secondary generalization
consciousness lost + bilateral cerebral involvement
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Simple partial seizures emanating from the motor cortex may demonstrate what
Jacksonian March. That is, they start at the hand and march up to involve the arm and face on the same side.
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Simple partial seizures involving the sensory cortex involve what
tingling or numbness of an extremity or side of face
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Simple partial seizures involving autonomic
Rising epigastric sensations, nausea,
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Simple partial seizures that are psychic involve
Fear, deja vu, jamais vu
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Complex partial seizures
impaired consciousness
- Remmeber that partial is interchangeable with focal in seizure talk
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Complex partial seizures typically emanate from the temporal or frontal lobe
ok
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Complex partial seizures last how long
about 1 minute
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Features of complex partial seizures
- Blank stare
- Oral automatisms: chewing and lip smacking movements
- Typical hand automatisms are hand rubbing or picking movements
- contralateral dystonic posturing- sustained muscle contractions on one side of the body cause twitching. A result of a spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia.
- Post-ictal amnesia and confusion
- Focal abnormality of EEG
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What are the 6 types of Primary Generalized seizures
- Absence
- Tonic-clonic
- Clonic
- Tonic
- Myoclonic
- Atonic
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Absence Seizure
- Brief Loss of consciousness
- Staring spell
- No post-ictal confusion
- Subtle myoclonic
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Tonic-Conic Seizure
- loss of consciousness
- muscular rigidity (tonic)
- jerking movements (clonic)
- tongue-biting/ injury common
- bladder/ bowel incontinence
- post-ictal confusion/ sleep
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Myoclonic seizure
- Brief muscle contractions (clonic) of the head and upper extremities
- Usually symmetrical and bilateral
- consciousness preserved
- precipitated by awakening or falling asleep
- may progress into tonic-clonic seizures
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Atonic
- Impaired consciousness
- loss of muscle tone
- head drop
- fall
- brief duration
- injury common
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Seizure diagnosis
- history from patient and witness (very important)
- Physical and neurological exam
- CBC, metabbolic panel (CMP), AED (anti-epileptic drug levels...helps determine whether pt has not been taking meds or screwed up the dose)
- inter-ictal EEG
- Epilepsy protocol MRI
- Video-EEG monitoring
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Serial EEGs reveal epileptiform discharges in what percent of patients
80-90....way better than inital EEG
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Outside of Serial EEGs, what are some good ways to detect epileptiform changes
studies with sleep deprivation and extended recording times
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Sharp waves, spikes, sharp and slow wave discharges?
All examples of epileptiform abnormalities
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Bilateral and symmetrical spke and wave activity occuring at a frequency of 3 per second (3 hz) is classic EEG for
Absence seizure
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Receont onset epilepsy in adults requires
MRI
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Causes of tumors in adults
tumors, trauma, stroke, infection
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Epilepsy MRI protocol
- You want high res T1 weighted volume set, coronal slices, through the whole brain
- ALso a coronal T2 weighted sequence, using 3mm thin sections, should also be done to detec hippocampal sclerosis
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Video- EEG monitoring
simultaneously records EEG and seizure.
- Useful in differentiating epleptic seizures from non
- Essential for pre-surgical localization of seizure focus
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In most neuronal circuits, GABA inhibition exerts a powerful suppression of excitability
This inhibition is overcome during the development of a focal seizure.
- A seizure results when excitation significantly exceeds inhibition. Know that most antiepileptic medications work by attempting to restore the excitation inhibition balance by reducing glutamate-mediated excitation or by increasing GABA mediated inhibition
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Two types of remission when fighting epilepsy
Medical remission: seizure free with no side-effects on 1 or 2 AEDs
Disease Remission: Seizure free off all AEDs...generally a result of surgery
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Intractable epilepsy
Disabling seizures- seizures causing impaired quality of ife, limited educational or occupational apportunities, physical injuries, or social compromise.
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