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Flashcards in Seizure Types and Treatment Deck (37):
1

What are the two definitions of a seizure?

 

  • Occasional, sudden, excessive, rapid and local discharges or gray matter;
  • Alteration of behavior that results from abnormal and excessive activity of a group of cerebral neurons

2

Abnormal spikes are seen on ____ associated with cellular networks during a seizure

EEG

3

What are some possible triggers for a seizure?

 

  • Genetic predisposition
  • Trauma, ischemia, stroke, malformation of cortical development
  • Febrile illness, sleep deprivation

4

What neuron channels are associated with seizure pathophysiology?

 

AMPA and NMDA

5

What are the two types of seizure?

Partial and Generalized

6

What are the two types of partial seizures?

Simple and Complex

7

What are the types of generalized seizure?

  • Absence
  • Tonic
  • Atonic
  • GTC
  • Myoclonic

8

What is the most important component of a diagnosis of epilepsy?

 

HISTORY (then EEG, MRI, and labs)

9

What is epilepsy?

The tendency to have recurrent unprovoked seizures

10

Abnormalities in which levels of brain function can lead to epilepsy?

 

  • Neuronal networks
  • Neuronal structures
  • Neurotransmitters
    • Synthesis, inhibition, excitation
  • Synaptic development
  • Ion channels

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11

What is the term for epilepsies of undetermined type?

Lennox-Gastaut syndrome

12

What is a key distinguishing feature of simple partial seizures?

What are some signs and symptoms?

Consciousness is not impaired

  • Clonic movements of face, arm leg
  • Somatosensory and autonomic symptoms
  • Psychic symptoms: Deja vu; hallucinations; illusions

13

Are simple partial seizures long or brief?

What are the post-ictal symptoms?

 

Brief

No post-ictal symptoms (usually)

14

What is Todd paralysis (associated with simple partial seizures)?

Focal weakness in a part of the body after a seizure

15

What are other names for complex partial seizures?

What feature is often used to distinguish these from simple partial seizures?

"Temporal lobe" or "Psychomotor" seizures

Consciousness is impaired

16

What are some manifestations of compex partial seizures?

  • Staring
  • Automatisms: Facial grimacing; gestures; chewing; lip smacking; repetitive speech
  • Fragmented but coordinated motor tasks

17

How long do complex partial seizures last?

What are the post-ictal symptoms?

Lasts 30 seconds to a minute

  • Post-ictal impairment
    • Lethargy
    • Confusion
    • Lasts minutes to hours

18

What two parts of the brain are associated with complex partial seizures?

Temporal lobe and Frontal lobe

19

What are the features of an aura?

What brain region associated with complex parital seizures is responsible for auras?

 

  • Aura (associated with temporal lobe origin)
    • Fear
    • Stomach pain
    • Light headedness
    • Rising sensation in head or chest
    • Distortion of memory or time
    • De'ja vu

20

What post ictal symptoms are associated with a complex partial seizure of temporal lobe origin?

  • May have automatism
  • Fatigue or deep sleep (not well for hours afterwards)
  • Headache
  • Emesis

21

What symptoms are associated with complex partial seizures of frontal lobe origin?

  • Arrest of activity
  • Versive head and or neck movements
  • Blank stare (loss of contact)
  • Few automatisms
  • Abrupt on and off

22

What is a tonic-clonic seizure?

 

Loss of consciousness with stiffening of limbs (tonic phase) that has evolution to generalized jerking of muscles (clonic phase)

23

What are the post ictal symptom of a tonic-clonic seizure?

What age group is more likely to have these?

 

Deep sleep post-ictal

Majority in childhood

24

What are the typical features of an absence seizure?

How long does it last?

 

Abrupt cessation of activity and change in facial expression (blank stare)

Motor, behavioral and autonomic changes

Less than 30 seconds

25

Describe absence seizures in terms of...

Eye movement:

Head movement:

Autonomic phenomena:

 

  • Eye movement:
    • Clonic eye movements: Nystagmus; blinking
  • Head movement:
    • Head nodding
  • Autonomic phenomena:
    • Pupil dilation
    • Pallor
    • Flushing/sweating
    • Salivation

26

Which type of clonic seizure is associated with EEG changes?

What does a migrating clonus indicate?

Focal clonic seizures are associated with EEG changes

Migrating clonus indicates metabolic or anoxic damage

27

How long do tonic seizures last?

What are features of a tonic seizure?

 

Brief, 60 seconds

Sudden onset of increased extensor tone

Imparied consciousness

28

What are the features of an atonic seizure?

 

  • "Drop attacks" - sudden loss of tone
  • Usually only brief loss of consciousness

29

How long are myoclonic seizures?

To which locations are they generalized?

  • Sudden, brief (<350 mS)
  • Generalized or confined to face, trunk

30

Myoclonic Seizures may be seen prior to what other types of seizures?

Myoclonic seizures can also serve as a sign of ______ ____ _______

 

  • Can be seen prior to absence, tonic or tonic-clonic seizures
  • Myoclonic seizures can also serve as a sign of diffuse brain injury

31

Define Status Epilepticus

30 minutes of sustained seizure activity or two or more seizures without full recovery of consciousness between seizures

32

What are the two most important components of an evaluation of seizures?

 

History and Physical

33

What evaluations should be used for the following disorders...

  • Focal seizure:
  • Primary generalized epilepsy:
  • Developmental regression:

 

  • Focal seizure: MRI
  • Primary generalized epilepsy: EEG only
  • Developmental regression: Extensive evaluation

34

What initial lab studies should be done in the evaluation of seizures?

 

  • Glucose, electrolytes, BUN
  • ABG
  • Antiepileptic drug levels
  • CBC
  • Urinalysis

35

What second phase studies should be done in the evaluation of a seizure?

 

  • Lumbar puncture
  • Liver function tests
  • Toxicology screen
  • Metabolic testing
  • EEG
  • Brain imaging (CT or MRI)

36

What risks of therapy exist in treatment of seizures?

 

  • Idiosyncratic reaction
  • Systemic toxicity
  • Stigma
  • Expense

37

What are some side effects of antiepileptic medication?

  • Direct toxicity
  • Dermatologic
  • Bone marrow effects
  • Hepatic effects