Patients with mental retardation, cerebral palsy, head injury, or strokes are at an increased risk for seizures and epilepsy -elderly

Epilepsy with no drugs Flashcards by Kim Grace

A sudden, disorganized electrical discharge in one or more
parts of the brain that interrupts normal brain signals and
disrupts the normal balance of inhibitory and excitatory input

Seizure

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A CNS disorder in which nerve cell activity in the brain becomes
disrupted, causing seizures or periods of unusual behavior,
sensations and sometimes loss of consciousness

Epilepsy

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Epilepsy is defined by the occurrence of at least ______________ unprovoked seizures,
with or without convulsions, separated by at least __________

two; 24 hours

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T/F: It can still be defined as epilepsy even if the seizure occured without convulsions

True

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T/F: Anything that disrupts the normal
homeostasis or stability of neurons can
trigger hyperexcitability and seizures

True

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Calming Neurotransmitter

GABA

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Excitatory Neurotransmitter

GLUTAMATE

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Too much __________: Anxiety, Preseverating, Restlessness, Migraines, Tics and Motorsterotypies

Glutamate

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Causes or Triggers of Epilepsy

Infections (meningitis and encephalitis, COVID-19)
Acquired brain injuries (head trauma)
High fever (febrile seizures)
Lack of sleep
Electrolyte Imbalance, Hypoglycemia
Sudden alcohol, smoking or drug withdrawal
Flashing lights
Medications (diuretics, analgesics, antidepressants)

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Seizures can start in any
of these lobes:

Occipital, Parietal, Frontal, Temporal

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Location: Back of the head

Occipital

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For processing visual information

Occipital

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visual disturbances,
temporary blindness, headache
and difficulty with spatial
orientation

Occipital

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Location: Behind frontal lobes

Parietal

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For processing sensory
information (touch, pain, taste)

Parietal

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: tingling or numbness,
difficulty understanding spatial
relationships or distances,
dizziness, vertigo, difficulty
reading and writing, pain
sensations

Parietal

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Behind the forehead

Frontal

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For movement, planning,
decision-making, emotion
regulation

Frontal

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jerking movements,
difficulty speaking or slurred
speech, abnormal sensations,
out-of-body experience, impaired
awareness, confusion, changes
in mood or behavior

Frontal

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Either side of head,
behind the temples

Temporal

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For memory, learning, emotions,
and auditory information

Temporal

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auras (strange
smells, tastes or déjà vu), altered
awareness or confusion,
automatisms, auditory
hallucinations, difficulty speaking
or understanding speech

Temporal

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Risk Factors

Patients with mental retardation, cerebral palsy, head injury,
or strokes are at an increased risk for seizures and epilepsy

-elderly

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n the elderly, the onset of seizures is typically associated
with _________ neuronal injury induced by _________,
____________________, and other
conditions

focal; strokes; neurodegenerative disorders (Alzheimer’s disease)

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Affect both sides of the brain or groups of cells on both sides of the brain at the same time

Generalized onset seizures

* Tonic-clonic (Grand Mal) * Absence (Petit Mal) * Atonic epilepsy

Generalized onset seizures

Grand Mal

Tonic-clonic

Absence

(Petit Mal)

Most dramatic type of generalized seizure

Tonic-clonic (Grand Mal)

May start as a focal seizure first, then generalized

Tonic-clonic (Grand Mal)

muscle stiffening of the entire body;

phase 1: tonic

rhythmic jerking of the limbs and face

phase 2: clonic

Last from seconds to several minutes

Tonic-Clonic

Typically patient loss consciousness

Tonic-Clonic

period of confusion or drowsiness

(Tonic-Clonic) Post-ictal phase

“daydreaming” or “spacing out”

Absence (Petit Mal)

”staring spell”

Absence (Petit Mal)

Brief lapses or impaired consciousness lasting from five to ten seconds

Absence (Petit Mal)

Often occurs in children

Absence (Petit Mal)

Patient may stare blankly, blink rapidly, or appear fidgety

Absence (Petit Mal)

Usually, no jerking movements or other physical manifestations, lip smacking

Absence (Petit Mal)

“Akinetic” or “Drop seizures”

Atonic epilepsy

Sudden loss of muscle tone, causing the person to fall

Atonic epilepsy

May involve the entire body or just certain muscle groups

Atonic epilepsy

Usually lasts for a few second

Atonic epilepsy

Brief loss of consciousness may occur

Atonic epilepsy

Can start in one area or group of cells in one side of the brain

Focal onset seizures

Simple partial seizures

Focal onset aware seizures

Individuals remain fully aware of their surroundings

Focal onset aware seizures

May experience unusual sensations, movements, or other changes related to the affected brain area

Focal onset aware seizures

Complex partial seizures

Focal onset impaired awareness seizures

Involves a degree of altered awareness or confusion

Focal onset impaired awareness seizures

Individual may appear dazed, unresponsive, or engage in automatic behaviors like hand rubbing, lip smacking or fidgeting without full control or awareness

Focal onset impaired awareness seizures

May later be diagnosed as a generalized or focal seizure

Unknown onset seizures

clonic, atonic, tonic, myoclonus, or epileptic spasms

Motor symptoms (Generalized)

Typical or atypical absence seizures

Non-motor symptoms (Generalized)

Automatisms or repeated automatic movements

Motor symptoms (Focal)

Changes in sensation, emotions, thinking or cognition, autonomic functions or lack of movement

Non-motor symptoms (Focal)

Either tonic-clonic or epileptic spasms

Motor seizures (UNknown)

Behavior arrest

Non-motor seizures (Unknown)

include somatosensory or focal motor features

Complex partial seizures or focal onset impaired awareness seizures

non-detectable with only very brief (in seconds) periods of altered consciousness

Absence seizures

major convulsive episodes and are always associated with a loss of consciousness

Generalized tonic-clonic seizures

T/F: Interictally or between seizure episodes, there are typically no objective or pathognomonic signs

true

T/F: No diagnostic laboratory tests for epilepsy

True

In some cases, particularly following GTC seizures, ____________ can be transiently elevated

serum prolactin levels

Diagnostic Tests:

ECG, MRI, CT scan

very useful in the diagnosis of various seizure disorders

ECG

imaging of the temporal lobes

MRI

typically not helpful except in the initial evaluation for a brain tumor or cerebral bleeding

CT scan

In the presence of suspected infection, __________ may also be performed

lumbar puncture

Not a first-line diagnostic tool for seizures * Supportive role in diagnosing seizures when other tests are inconclusive

Positron emission tomography (PET) scan and Single-photon emission computed tomography (SPECT)

General Approaches to Treatment:

* Assessment of seizure type and frequency * Identification of treatment goals * Development of a care plan * A plan for follow-up evaluation

If a decision is made to start AED therapy, _____________ is preferred, and approximately 50% to 70% of all patients with epilepsy can be maintained on one drug

monotherapy

When to stop AEDs?

The drug considered less appropriate for the seizure type, or the agent deemed most responsible for adverse events should be discontinued first Decreasing the number of AEDs can decrease side effects and increase cognitive abilities

Factors favoring successful withdrawal of AEDs: Seizure-free period of ___________ * Complete seizure control within _________ of onset * An onset of seizures after age _______, but before age __________ * A normal neurologic examination and _________

Seizure-free period of two to four years * Complete seizure control within one year of onset * An onset of seizures after age two, but before age 35 * A normal neurologic examination and EEG

AED Withdrawal is Generally not suggested for patients with

juvenile myoclonic epilepsy (JME), absence with clonic-tonic-clonic seizures, or clonic-tonic-clonic seizures

Non-pharmacologic Therapy

Diet, Surgery, Vagus Nerve Stimulation

Implanted medical device that is FDA-approved for use as adjunctive therapy in reducing the frequency of seizures in adults and adolescents older than 12 years of age with partial-onset seizures that are refractory to AEDs

Vagus Nerve Stimulation

T/F: Placing a spoon in a person’s mouth during a seizure to protect the tongue is NOT RECOMMENDED

True

T/F: For single unprovoked seizures, No AEDs are recommended unless there is presence of risk factors for recurrence

true

Special situations requiring treatment:

-recurrent unprovoked seizures -more than 1 episode of seizure -sleep-deprived individuals -abnormal EEG

Epilepsy with no drugs Flashcards

(82 cards)