Seizure disorders Flashcards
(50 cards)
transient disturbance of cerebral function due to a sudden and abnormal neuronal discharge
seizure
recurrent unprovoked seizures
epilepsy
What can cause a provoked seizure?
-metabolic disturbance
-drug intoxication
-drug withdrawal
-medication induced lowered threshold
-infection
-vasculopathy
What are risk factors for seizures?
head trauma
stroke
infectious disorders
toxic-metabolic disorders
drug and alcohol withdrawal
origination within 1 cerebral hemisphere with signs/symptoms corresponding to specific region of brain affected
focal seizures
arise from both hemispheres believed to be from neurochemical and genetic abnormalities widespread throughout the brain with no focal injured brain region involved
generalized seizures
when is the best time for an EEG?
after seizure onset within 16 hours = look for epileptiform discharges, non-epileptiform discharges, normal
entire body becoming rigid
tonic
extremely brief muscle contraction resulting in jerky movements of muscles
myoclonic
involuntary muscle contraction then relaxation
clonic
myoclonus repitition
brain extremely active trying to stop the cells from firing to bring the seizure under control – confusion, fatigue, sore muscles
postictal period
muscles stiffen and LOC - -eyes roll back into their head as muscles contract and back arches –> lips turn blue, gargling noise
any attempt to open clenched jaw may cause harm
tonic seizure
muscles spasm and jerk – elbows, legs and head will flex and relax rapidly at first, frequency will gradually subside until they cease altogether
jerking stops = deep sign
clonic seizures
grand mal – tonic with clonic
tonic-clonic seizures
sudden LOC –> rigid w/ fall –> respiratory arrest (all <1min) –> clonic phase with jerking for 2-3 minutes (bite themselves, incontinence, injury) –> flaccid coma (recover, sleep, behave strangely, not remember, HA, confusion, drowsiness, nausea, soreness)
classic tonic-clonic seizure
What are common postictal symptoms and how does that help you differentiate it?
headache, disorientation, confusion, drowsiness, nausea, soreness
having postictal symptoms indicates a focal impaired seizure, secondary focal, generalized seizure (other than absence!!)
The risk of seizure recurrence is higher in who?
> 65
history of significant head trauma
partial/focal seizure
postictal Todd paralysis
focal findings on an EEG or brain MRI
generalized seizure within 48 hours of withdrawal
more concerning w/ focal features
ETOH withdrawal seizure
benzos can help :)
solitary seizure or several seizures in a few hours require
exclusion of an underlying cause that needs treatment
EEG w/n 24 hours
do NOT diagnose epilepsy or start prophlaxis
check for any provoking event and risk factors
Prodromes
Aura
Unpredictable onset, patterns of triggers
Flashing lights
epilepsy
Recurrent unprovoked seizures, idiopathic/cryptogenic or one of following causes – structural (pediatric, temporal sclerosis, trauma, tumors, diseases, degeneration), genetic, infectious, metabolic, immune
epilepsy
Continuous EEG monitoring
PE in between seizures
Post-inctal might find an extensor plantar response
BMP, CBC, LFTs, urine drug screen, blood alcohol, EKG, anti-epileptic drug levels, non-enhanced CT scans
epilepsy
how do you generally treat epilepsy?
Avoid life-threatening situations – should not drive 6 months after an unprovoked seizure
Medication – prevent any more attacks, continued until patient is seizure free for 2 years (increase dose as needed, can add 2nd med, consider teratogenicity)
Monitoring – must be consistent in taking meds
Discontinue if seizure free for 2 years, but if recurrence, must restart regimen
Surgery: resection, DBS
what are the ways to categorize focal seizures?
Divided into aware and unaware
Motor and nonmotor symptoms
