Patho of seizures

Question 1

What can lead to seizures?

Answer 1

Impulses that do not maintain a systematic order (excitatory, inhibitory, & rest phase become irregular & chaotic)

Question 2

Define seizures

Answer 2

A single episode of abnormal electrical d/c from cortical neurons (too much OR too little) that results in abrupt & temporary altered state

Question 3

Define epilepsy

Answer 3

A group of syndromes characterized by unprovoked, recurrent seizures

Question 4

Define status epilepticus

Answer 4

Continuous seizure activity for more than 5 min or 2 or more sequential seizures that occur w/o full recovery of consciousness btwn attacks

Question 5

List 10 common causes of seizures

Answer 5

1) trauma
2) ETOH withdrawal
3) illicit drug use
4) brain tumor
5) congenital malformations
6) stroke
7) metabolic disorders
8) Alzheimer’s disease
9) Neurodegenerative disease
10) idiopathic

Question 6

List 2 examples of metabolic disorders that can cause seizures

Answer 6

1) uremia
2) electrolyte imbalances

Question 7

List 4 things that can trigger seizures (Hint: think environmental factors)

Answer 7

1) flashing lights
2) stress
3) certain drugs
4) metabolic changes

Question 8

List 5 common causes of epilepsy

Answer 8

1) genetic causes
2) head trauma
3) medical disorders
4) prenatal injury
5) developmental disorders

Question 9

Epilepsy may occur in genes coding for what 3 different things

Answer 9

1) ion channels
2) neuronal receptors
3) transcription factors

Question 10

List 3 medical disorders that can cause epilepsy

Answer 10

1) dementia
2) meningitis
3) encephalitis

Question 11

List 2 developmental disorders that can cause epilepsy

Answer 11

1) autism
2) down syndrome

Question 12

Who can have a seizure?

Answer 12

ANYONE

Question 13

For an actual seizure to occur what 3 things have to be occurring?

Answer 13

1) excitable neurons
2) increase in glutaminergic activity
3) reduction in activity of normal inhibitory GABA projection

Question 14

Pathophysiology of seizures (Hint: 3)

Answer 14

1) messages from body are carried by neurons of the brain through discharges of electrochemical energy
2) impulses occur in bursts
3) during periods of unwanted discharges, parts of the body may act erratically

Question 15

What are the 2 classifications of seizures?

Answer 15

1) focal or partial
2) generalized

Question 16

List 2 types of focal/ partial seizures

Answer 16

1) simple partial
2) complex partial

Question 17

List 4 types of generalized seizures

Answer 17

1) Absence (Petit-mal)
2) Tonic-clonic (Grand mal)
3) Atonic/ akinetic (drop attacks)
4) status epilepticus

Question 18

Where do focal seizures occur in the brain?

Answer 18

Start & remain in ONE hemisphere

Question 19

Pathophysiology of focal seizures

Answer 19

High frequency bursts of action potentials & hypersynchronization

Question 20

What can happen to a patient’s awareness when experiencing a focal seizure?

Answer 20

Awareness may be maintained or lost

Question 21

What is an aura? & what type of seizures can they be associated with?

Answer 21

Warning sensation before a seizure occurs
- can occur with focal seizures

Question 22

Focal seizures may have ___, ___, ____ Sx, & ____

Answer 22

Motor, sensory, autonomic Sx, & automatisms

Question 23

Autonomic Sx of focal seizures

Answer 23

Due to stimulation of ANS (i.e. pallor, sweating, pupillary dilation, epigastric sensation)

Question 24

What are automatisms seen in focal seizures?

Answer 24

Coordinated involuntary movements occurring during state of impaired consciousness either during or after seizure
-Patient is unaware; often associated w/ temporal lobe seizures

Question 25

Focal seizure when pt retains awareness is when? **Hint: 2**

Answer 25

1) Person is aware, & can experience body movements, like a jerk 2) May experience an aura

Question 26

Focal seizure with awareness is similar to what other type of seizure?

Answer 26

Partial seizures

Question 27

Focal seizure with altered/impaired consciousness is when?

Answer 27

Seizure may spread to the other hemisphere, causing loss of awareness

Question 28

Where do partial seizures usually begin?

Answer 28

In one hemisphere (typically temporal or frontal lobe)

Question 29

Partial seizures can be characterized as ___ or ___

Answer 29

simple or complex

Question 30

Pathophysiology of generalized seizures **Hint: 3**

Answer 30

1) starts in 1 hemisphere & spreads w/ involvement of both hemispheres 2) may have motor &/or nonmotor Sx 3) impairment of consciousness

Question 31

How are tonic-clonic (grand mal) seizures characterized?

Answer 31

Begin with rigid violent contractions (tonic) followed by repetitive (clonic) activity of all extremities **Body stiffness & relaxation**

Question 32

List 4 things seen in tonic-clonic seizures that help identify them

Answer 32

Muscle stiffness, dilation of pupils, altered respirations **usually lasts < 1 min**

Question 33

How are absence seizures characterized?

Answer 33

Short episodes of staring & loss of consciousness ~ 10 sec

Question 34

How are myoclonic seizures characterized?

Answer 34

B/L jerking of muscles w/ no loss of consciousness

Question 35

How are atonic seizures characterized?

Answer 35

Sudden loss of muscle tone; "drop to ground"

Question 36

Status epilepticus is identified by what 2 things?

Answer 36

1) continuous seizure activity for > 5 min 2) 2 or more sequential seizures that occur w/o full recovery of consciousness between attacks

Question 37

What seizure classification is considered a neurological emergency?

Answer 37

Status epilepticus

Question 38

Which type of seizure requires immediate intervention? & why?

Answer 38

Status epilepticus → b/c extreme energy expenditure & potential lack of O2 during prolonged seizures

Question 39

How do we Dx seizures? **Hint: 3**

Answer 39

1) H&P 2) neurological exam 3) diagnostic procedures (chemistries; toxicology screens; CT; MRI; EEG)

Question 40

What are the 3 phases of seizures?

Answer 40

1) Pre-ictal 2) Ictal 3) Post-ictal

Question 41

Define pre-ictal phase

Answer 41

May be started by a trigger &/or preceded by an aura

Question 42

Define ictal phases

Answer 42

**Actual seizure** Increases in metabolic demand

Question 43

Define post-ictal phase

Answer 43

**Post seizure** Has decreased responsiveness; feels fatigued