Seizure Lecture Flashcards by Cassidy Ruocco

Paroxysmal event due to abnormal CNS discharge with resultant manifestations

5-10% of gen pop will have

More prevalent in childhood and later adulthood

Seizure

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2 big classes of seizures?

Partial

Generalized

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Deranged area of cerebral cortex, often due to a STRUCTURAL ANOMALY most commonly

usually no LOC (but some exceptions)

Partial seizure

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2 classes of partial seizures?

Simple (NO LOC)
Complex (LOC)

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Diffuse region of brain firing simultaneously

often due to WIDESPREAD problem
(ie.. cellular disorder, biochemical disruption, structural issue)

Generalized seizure

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NO LOC**

EEG shows abnormal impulses in FOCAL area of brain*

Often clonic with repetitive flexion/extension
(ie..may get hand tremor on opposite side of abnormal brain activity)

Simple partial seizure

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Jacksonian March
Todd’s Paralysis
Epilepsia Partialis Continua

..subcategories of which type of seizure?

Simple partial seizure

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Motor activity begins distally (i.e. fingers) and spreads to whole extremity

..this describes which subcategory of simple partial seizures?

Jacksonian March

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Local paresis that can last minutes to hours

..this describes which subcategory of simple partial seizures?

Todd’s paralysis

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Changes in somatic sensation (parasthesias)
Change in vision
Change in equilibrium
Autonomic changes (flushing, sweating)

More symptoms seen in…..

Simple partial seizures

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FOCAL activity progresses to loss of contact with environment (ictal state)

*stare
*amnesia

Complex partial seizures

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Often begins with aura Followed by ictal state:
involuntary behaviors, picking, chewing

*can last seconds to hours

Complex partial seizures

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Partial seizures that occur in the FRONTAL LOBE are more likely to have….

secondary generalization

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A seizure that begins as a partial seizure
electrical discharge spreads and both hemispheres become involved

*results in TONIC CLONIC seizure

Partial seizure with secondary generalization

*common when partial seizures are in the frontal lobe

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Arise in both cerebral hemispheres simutaneously

include: Absence and Tonic-Clonic

Generalized seizures

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brief LOC without postural control
usually lasts a few seconds
NO POST ICTAL STATE

other subtle findings:
Eye blinking, chewing, clonic movements of hands

Absence seizure

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Onset is childhood
4-8 yo or early adolescence

account for 15-20% of childhood seizures

“day dreaming” or ADD like presentation

Absence seizure

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EEG will show symmetrical discharge
spikes and waves

will worsen with hyperventilation maneuver*

Absence seizure

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Grand mal
10% of patients with epilepsy

MC type of seizure due to metabolic derangement

*suddent onset!

Tonic-clonic seizure

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Increased muscle tone
Cry out/moan
Secretions pool
Cyanosis
Jaw clenches, can bite tongue
Sympathetis sxs: increase in BP and HR, pupil dilation

..which phase of a tonic-clonic seizure?

Tonic phase

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Muscles relax and contract
usually lasts about 1 minute

..which phase of a tonic-clonic seizure?

Clonic phase

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Unresponsive
Flaccid
Salivation or airway obstruction
Incontinence

Which phase of tonic-clonic seizure?

Post ictal phase

*can be mins to hours before awakening

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Headche
Fatigue
Muscle aches

..what phase of a tonic-clonic seizure?

Post seizure

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EEG showing:

Increased low voltage fast activity
High amplitude polyspike discharges

..which phase of tonic-clonic seizures?

Study These Flashcards

Tonic phase

EEG showing: Spike and wave activit develops ..which phase of tonic-clonic seizure?

Clonic

EEG showing: slowing then recovery ..which phase of tonic-clonic seizure?

Post-ictal

Atonic and Myoclonic seizures are variations of...

Tonic-clonic seizures

A variation of T-C seizures 1-2 seconds loss of motors tone brief LOC **no post ictal confusion**

Atonic seizures

A variation of T-C seizures brief contraction or jerk **seen in brain injuries** (the movement you get before you fall asleep)

Myoclonic

Juvenile Myoclonic Epilepsy Lennox Gastaut Syndrome Mesial Temporal Lobe Epilepsy ...subcategories of what type of seizures?

Generalized seizures

Seen in adolescence **bilateral jerk without LOC** \*worse with awakening and sleep deprivation \*benign..good response to tx. often self resolve

Juvenile Myoclonic

Multiple types...seen in children Associated with CNS disease: Developmental delay Trauma Infection Neural injuries \*usually impaired cognitive function

Lennox Gastaut

Partial epilepsy with characteristic features ## Footnote **MRI shows hippocampal sclerosis\*\*\***

Mesial temporal

Shift in balance of excitation and inhibition in CNS Mechanisms: Change in threshold (ie fevers) Genetics Traumatic brain injury Other events: stroke, infections Other factos: -stress, sleep deprivation, menses, meds

Etiology of seizures

Burst of electrical activity..**influx of extracellular calcium**\* Exctiatory moleciles, like NMDA may further Ca influx Spike discharge Inhibitory neurons overwhelmed by Ca and K Propogation of APs

What goes on during a seizure

birth injury congenital abnormalities maternal drug use ..causes of seizures in?

Neonates

MC cause of early childhood seizures?

Fever! (febrile seizures)

usually occurs 3mos to 5 years often caused by: otitis media, respiratory infection, gastroenteritis **recurrence occurs in about 1/3 of patients**

Febrile seizures

When does epilepsy become apparent?

During childhood

What must you think about if an adolescent has a seizure?

Trauma! \*worse trauma= worse seizures

What is the cause of 50% of new onset seizures in adults?

Cebrovascular disease

Cerebrovascular disease Trauma CNS tumor Degenerative disease Medical (hypo/hyper glycemia, renal failure, liver dz, drugs)

Causes of seizures in adults

Which one is inhibtory? Which one is excitatory? - Glutamate - GABA

Glutamate= excitatory GABA= inhibitory (seizure meds target these)

Alpha: 8-13 Hz Beta: \>13 Hz Theta: 4-7 Hz Delta: \<4 Hz ..these can be determined by which diagnostic?

EEG

- Awake/sleep - Eyes open/closed or with photo stimulation - Hyperventilation - Sleep deprivation ..all of these states should be assessed with?

EEG

Abnormal activity that starts/stops abruptly Abnormal activity during T-C seizures Inter-ictal may see sharp spikes or waves (40%)..**worse prognosis**

Key findings on EEG

EEG Imaging (**MRI=best!!**) Blood test (usually norm, prolactin may be increased within first 30 mins)

Work up for seizure

Block activity of ion channels or neurotransmitters Inhibit Na dependent APs Inhibit Ca channels **Decrease glutamate release Increase GABA availability**

Mechanisms that seizure meds work

Blocks voltage dependent calcium channels, modulating excitatory neurotransmitter release Gabapentin or Pregabalin?

Gabapentin

Binds alpha2-delta subunit of calcium channels, decreasing NT release, producing anti-nociceptive and anti-seizure effects Gabapentin or Pregabalin?

Pregabalin

When would you take a pt off seizure meds? How would you do it?

Can try taking off if: Low risk 1 seizure then seizure free Normal exam Normal EEG ## Footnote **must take off meds slowly! taper!**

**Continuous seizure (seizures follow one another without recovery of consciousness between)** Some say if more than 15-30 mins Others if \> 15 seconds May range from T-C seizure to more subtle (finger or eye movement) May need EEG to verify

Status epilepticus

**Medical emergency!** Cardiovascular implications Hyperthermia Metabolic derangements CNS injury

Status epilepticus

Metabolic problems Drug toxicity CNS infection or tumor Head injury Refractory epilepsy ..can all cause?

Status epilepticus

How do you stop/treat status epilepticus?

Benzos! Phenytoin Phenobarbital

What does a vagal nerve stimulator do?

Increase seizure threshold (this is a bipolar electrode in the **left** vagal nerve)

Seizures characterized by an aura, followed by impaired consciousness lasting seconds to minutes N/V, focal sensory preceptions and focal tonic or clonic activity may accompany

Complex partial

EEG will show spike and wave activity

Absence seizure (Tonic clonic seizures will have **generalized rapid spiking**)

Seizure Lecture Flashcards

(59 cards)