Neuro 58: Siezures

Question 1

What is a seizure & what causes it?

Answer 1

• transient disturbance of cerebral fctn
• caused by episodes of excessive firing w/in a network of neurons –> leads to changes in excitatory or inhibitory receptors and c
• overexcitation can be caused by increased excitatory NTs (glutamate/aspartate) or excessive depol currents
• disinhibition can be due to defective hyperpol currents or decreased inhib NTs (GABA)

Question 2

Who can have a siezure?

Answer 2

-anyone under the right combination or metabolic derangements or systemic withdrawls!

Question 3

Epilepsy

Answer 3

• siezure disorder
• have recurrent unprovoked siezures
• can be primary or secondary condition

Question 4

Epidemiology of siezures

Answer 4

• fairly common

- more common at extremes of age

Question 5

2 major classes of seizures?

Answer 5

1. partial - anatomically restricted region in on of the hemispheres (local)
2. generalized - bihemispheral w/out local onset

Question 6

Partial seizures w/ elementary syptomatology

Answer 6

• AKA simple partial seizures
• generally w/out impairment of conciousness
• can have: motor sx, somatosensory or special sensory hallucinations, autonomic sx, psychic sx (impending doom deja vu)

Question 7

Partial seizures w/ complex symptomatology

Answer 7

• usually have impairment of conciousness

- may or may not include automatisms

Question 8

Automatisms

Answer 8

• repetitive seemingly sensless behaviors
  ex. blinking, smaking lips, etc.
• can be more complex like dressing and undressing, pilling objects on top of each other, etc.

Question 9

Partial seizures secondarily generalized

Answer 9

-like a match thrown in a garbage can and eventually the curtains catch on fire and then the whole room

Question 10

Ictus

Answer 10

• sudden attack

- refers to the siezure itself

Question 11

Post-ictal

Answer 11

• period immediately following the seizure
• the pt may be sleepy or confused
• usually lasts 5-15 minute
• can have some focal deficits during this time
• NOT present in absence seizure

Question 12

Aura

Answer 12

• simple partial seizure

- may serve as a “warning” that a complex partial or secondarily generalized seizure may occur

Question 13

Psychic symptomatology

Answer 13

• distortions of memory = deja-vu

- or other disturbances = feeling of impending doom

Question 14

Autonomic symptomatology

Answer 14

-for example: epigastric, nausea/vomitting, pup dilation, flushing, sweating, etc

Question 15

Convulsion

Answer 15

• generalized seizure w/loss of conciousness and clonic activity of the extremities
• many seizures are NOT convulsions!

Question 16

Absence seizures

Answer 16

• breif (5-10 sec) episodes of loss of consciousness w/out loss of postural tone
• blank look, unresponsiveness, cessation of ongoing activity
• may have associated eye-blinking
• NO post-ictal period
• genetically transmitted
• always begin in childhood (age 4-10) and usually do not persist past age 20yr
• usually a have a lot of these per day (~10) if not treated!
• can be preceeded by hyperventillation

Question 17

Tonic-clonic seizures

Answer 17

• loss of conciousness
• tonic contraction of muscles followed by clonic activity & rythmic jerking of limbs
• pts may have tongue biting or urinary incontinence
• may lase 30sec-2min

Question 18

Simple partial seizure

Answer 18

• focal motor, sensory, or autonomic phenomena w/ NO loss of consciousness
• sx depend on the coritcal region involved
• sx can begin in one are and the spread to a contigious portion of the motor cortex = jacksonian march

Question 19

Complex partial seizure

Answer 19

• impaired consciousness that arrises from the temporal lobe or medial frontal lobe
• can have variety of sx and they differ with the pt
• can associated automatisms
• can be preceded by simple partial seizures w/ hallucinations, pyschic sx or autonomic sx

Question 20

Status epilepticus

Answer 20

-continuous siezure activity for more than 30 min or 2 or more subsequent sieures w/ out full recovery of consciousness inbtwn