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Flashcards in seizure disorders Deck (63):
1

antiepileptic drug black box warning

monitor for notable changes in behavior indicating emergence/worsening of suicidal thoughts, behavior

2

convulsion

seizure that results in physical movements/motor actiity

3

epilepsy

two or more seizures experienced by a person; chronic disorder in which repeated unprovoked seizure activity occurs
- may be caused by an abnormality in electrical neuronal activity; imbalance of neurotransmitters (especially GABA), or combo of BOTH!

4

focus

localized area of neurons within brain where seizures can start

5

seizure

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness, motor or sensory ability, and/or behavior

6

seizure threshold

point at which cells become unstable, allowing for possibility of seizure

7

idiopathic seizures

no identified cause

8

idiopathic seizures incidence

70-75%

9

epilepsy etiology

any condition or process that disrupts neuron cell membrane stability can result in seizures

10

only place where t-currents are large enough to cause action potential firing

certain hypothalamus neurons

11

cell damage: significance regarding seizures

damaged cells increase the risk for seizure
- subsequent seizures result in more damaged cells
- also consider head injury destroying CNS cells

12

seizure initiation*

two CONCURRENT events*

1) influx of extracellular Ca
2) hypersynchronization

13

hypersynchronization

of action potentials.
- associated with Ca, K
- surrounding cells enticed to join in

14

diseases increasing risk of epilepsy

children: mental retardation, cerebral palsy, cpmr

alzheimer, stroke, hx of one unprovoked

some linked to mom or dad with epilepsy

15

most frequent known causes of epilepsy

- head trauma
- brain tumor, stroke
- poisoning
- infections
- maternal injury

16

preventable epilepsy risk factors

- decreased sleep
- emotional distress
- EtOH withdrawal
- excess caffeine
- fever
- hypoxia

17

preictal phase

right before seizure
- identifiable by some patients

18

ictal phase

seizure occurs

19

postictal phase

immediately after seizure; because brain has had increased activity, recovery necessary (lethargy, somnolence, confusion)

- not all patients have one, depends on seizure effect on level of consciousness during seizure. if no substantial LOC, no postictal phase.

20

interictal

time between seizures; can be hours to days
- can involve changes in personality, behaviors
- key assessment period!

21

preictal auras: autonomic

- stomach "fullness"
- blushing
- respiration changes

22

preictal auras: cognitive

- deja vu
- jamais vu
- dreamy states

23

common preictal symptoms (3 types)

affective: fear, panic, depression, elation
sensory: "tastes like a penny"
automatisms

24

jamais vu

opposite of deja vu, person in familiar situation but it feels unfamiliar

25

common preictal symptoms (3 types)

affective: fear, panic, depression, elation
sensory: "tastes like a penny"
automatism/involuntary: lip smacking, chewing, rubbing, odd behaviors

26

common postictal states

slurred speech, confusion, inability to follow commands, lethargy

27

unprovoked seizure

primary, idiopathic

28

provoked seizure

secondary or acute symptomatic
- precipitated by fever (febrile seizures), metabolic conditions (hypoglycemia), or primary insult to CNS

NOT EPILEPSY: treat cause = treat seizures

29

simple partial seizure

aura before: deja vu, offensive smell, sudden pain
- focal twitching; one-sided movement of extremity
- visual sensations
- feelings of doom
- arrest of speech (can't speak but CAN write)
- autonomic symptoms: hr, skin flush, epigastric discomfort

- conscious throughout therefore NO POSTICTAL STATE

30

complex partial seizure

1 to 3 minutes
- syncope/black out
- automatisms
- patient unaware of environment; may wander at start
- patient typically unaware of seizure, amnesia
- may progress to this from simple partial
- impaired consciousness, awake
- temporal lobe most often; aka "psychomotor" or "temporal lobe" seizures
- most common among older adults, difficult to diagnose

- POSTICTAL STATE (no complete LOC but level of activity enough to cause)

31

generalized: absence seizure

seconds; brief loss of consciousness, blank staring/unresponsive, "daydreaming"
- automatisms
- NO POSTICTAL: immediate return to baseline

fomerly petit mal
if untreated, may occur frequently throughout day
common in kids, tends to run in families

32

generalized: tonic-clonic seizure

- 2-5 minutes
tonic phase: rigidity of all muscles (esp arms/legs) + LOC
clonic phase: rhythmic jerking of all extremities
-- possible incontinence, tongue biting
- POSTICTAL PHASE: fatigue, acute confusion, lethargy, up to an hour

formerly grand mal

33

generalized: atonic seizure

few seconds
impaired consciousness + sudden loss of muscle tone; "drop attacks"/falls

most resistant to drug therapy

NO POSTICTAL PHASE; however - postictal CONFUSION

34

generalized: myoclonic seizure

- few seconds
brief jerking/stiffening of extremities (singly or in groups, symmetric or asymmetric)
no impaired consciousness

NO POSTICTAL PHASE

35

status epilepticus

MEDICAL EMERGENCY
UNRELENTING tonic-clonic lasting > 5 min
OR
consecutive seizures w/o recovery (some defn 30")

can result in permanent neurologic injury or death
- generalized convulsive!

36

partial seizures: 2 types

simple
complex

37

generalized seizures: 6 types

absence (petit-mal)
atonic
myoclonic
tonic-clonic (grand mal)
tonic
clonic

38

status epilepticus: therapeutic management

1. airway, oxygen (turn on side to prevent aspiration)
2. IV access
3. labs: electrolytes, ABG, toxicology
4. * IV BENZOS * until seizure has stopped
- dilantin drip, Mg
5. concurrent IV anticonvulsants
6. search for cause (to treat!)

39

sudden unexpected death in epilepsy

sudep; rare; cause unknown; syndrome, not illness

- person with epilepsy suddenly dies NOT as a result of drowning or injury following a seizure NOR status epilepticus

preventing seizures, awareness of night time seizures MAY reduce risk

40

seizures: diagnostic tests

CT, MRI, EEG
SMA-6, Cr, BUN, toxicology, ABG

41

SMA-6

serum concentrations of sodium, potassium, chloride, glucose, blood urea nitrogen, and carbon dioxide

42

glutamate

?

43

seizure: therapeutic management to protect from injury during seizure

- turn on side
- do NOT restrain
- protect from hitting body parts
- nothing in mouth
- observation, reassurance

44

seizure: therapeutic management post-seizure

- airway clearance, maintenance, oxygen
- assess for injury
- monitor LOC

45

generalized seizure

involves both cerebral hemispheres

46

tonic seizure

30 sec - several minutes
abrupt increase in loss of muscle tone, LOC, autonomic changes

47

clonic seizure

several minutes
muscle contraction and relaxation

48

automatism

behavior of which the patient is not aware and is not under patient's control
- lip smacking, picking at clothes

49

partial seizures

aka focal or local seizures

begin in part of ONE cerebral hemisphere
- can become generalized tonic-clonic, tonic, or clonic
- most often seen in adults
- generally less responsive to medical treatment

50

primary or idiopathic epilepsy + tx

not associated with any identifiable brain lesion or other specific cause; genetic factors most likely play a role in development

management typically successfully through pharm

51

secondary seizures + causes + triggers + tx

result from underlying brain lesion, most commonly tumor or trauma

also may be caused by: metabolic disorder, acute alcohol withdrawal, electrolyte disturbances (hyperkalemia, water intox, hypoglycemia), high fever, stroke, head injury, substance abuse, heart disease

triggers: increased physical activity, emotional stress, excessive fatigue, alcohol/caffeine consumption, certain foods or chemicals

tx underlying condition, tx seizure
NOT CONSIDERED EPILEPSY

52

assessment questions

how many seizures?
how long they last?
pattern of occurence?
describe manifestations?
aura?
taking prescribed drugs, herbs?
head trauma?
high fever?
alcohol, illicit drug hx?
other medical conditions? (stroke, htn)

53

breakthrough seizure

occurs despite the use of anticonvulsants that have otherwise successfully prevented seizures in the patient

54

cyanosis during generalized tonic-clonic seizure

typically self-limiting with no treatment necessary

55

acute seizures

occur in greater intensity, number, or length than the usual seizures, may also appear in clusters different from typical seizure pattern

- lorazepam or diazepam may be given to stop clusters to prevent development of status epilepticus

56

status epilepticus: common causes

- sudden withdrawal from anti-epileptic drugs
- infection
- acute alcohol, drug withdrawal
- head trauma, cerebral edema
- metabolic disturbances

57

status epilepticus: ABG

drawn to determine arterial blood gas levels and to identify metabolic, toxic, and other causes of uncontrolled seizure

58

status epilepticus: metabolic changes if left untreated

hypoxia, hypotension, hypoglycemia, dysrhythmias, lactic/metabolic acidosis

muscle breaks down -> myoglobin accumulates in kidneys -> renal failure, electrolyte imbalance

59

*notable seizure cause: neonates

perinatal hypoxia, ischemia

+ metabolic disturbances, drug withdrawal

60

*notable seizure cause: kids >1 mo

febrile seizures

61

*notable seizure cause: adolescents 12-18y

trauma

+ infection, still!

62

*notable seizure cause: young adults 18-35y

trauma

63

*notable seizure cause: older adults > 35y

cerebrovascular disease

+ metabolic disorders (uremia, hepatic failure, electrolyte abnormalities, hypoglycemia)