Seizures Flashcards
(12 cards)
What is the difference between generalized and partial seizures (think LOC), and btwn simple and complex partial seizures?
generalized seizures = decreased LOC
vs partial: a) simple = preserved LOC
b) complex = altered LOC
partial seizures can become generalized secondarily
What are types of generalized seizures (decreased LOC)?
tonic-clonic (grand- mal)
tonic
clonic
myoclonic
absence
atonic -> drop attack
What is a tonic-clonic seizure?
- prodrome: irritability, unease for hrs->days
- tonic phase: extreme muscle rigidity (think newborn when upset)
- clonic phase: repetitive violent jerking muscle movements of face/body, tongue biting, cyanosis, frothing, incontinence => everything possible
- post-ictal phase: flaccid limbs, confusion, headache, aching muscles, sore tongue, amnesia, elevated serum CK
What is absence seizure (petit mal)?
- usually children only
- unresponsive for 5-10 seconds, stop in current activity, “phasing out”, staring,blinking or eye-rolling, no convulsions
- no post-ictal confusion
- 3 Hz spike + slow wave activity on EEG
What are tonic, clonic, myoclonic and atonic seizures?
- tonic - muscle rigidity - hard to flex/extend
- clonic - repetitive jerking muscle movements
- myoclonic - sporadic contractions like in clonic, but localized (ex. 1 extremity)
- atonic - drop attack - complete loss of muscle tone
- all part of generalized seizures (with tonic-clonic = grand mal seizure) = decreased LOC vs partial seizure (no change or slightly altered LOC)
What are some examples of partial seizures? What is a partial seizure?
- LOC preserved (vs loss in generalized, but partial can secondarily become generalized seizure)
- motor: postural, forceful turning of eyes or head (local), focal muscle ridigity += Jacksonian march (spread from distal limb to ipsilateral face (overactivity of primary motor cortex)
- sensory: unusual sensations affecting vision, hearing, smell, taste, touch
- autonomic: epigastric, pallor, sweating, flushing, pupillary dilation
- psychiatric: more commonly complex partial
What are complex partial seizures?
- altered LOC
- may appear awake, but have impairment in awareness
- automatism - chewing, swallowing, lip smacking, scratching, fumbling, running, disorbing, etc
- other: deja vu, cognitive (disorientation to time), affective (anger), illusions, structured hallucinations (music, taste, etc)
Investigations in seizure?
- CBC, lytes, fasting blood glucose, Ca++, Mg++, ESR, Cr, liver enzymes, CK, prolactin
- consider toxicology screen, EtOH level, EAD level (antiseizure meds)
- CT/MRI (if without cause or new) - ex. r/o trauma
- lumbar puncture if fever or meningismus - could be due to fever, metabolic, etc
- EEG (dah)
Indications for anticonvulsant therapy?
Indication for therapy (anticonvulsants) = 2 or more unprovoked seizures, EEG with epileptiform activity, status epilepticus, abnormal neuroimaging or neuro exam
Status epilepticus - definition?
TN: unremitting seizure > 5 mins, or successive seizures without return to baseline state (lecture notes 30 mins vs 5)
Treating status epilepticus?
seizure > 2 mins
1. ABC
2. VITALS
3. LABS - if fever do CT, LP with gram stain, treat pre-emptively with antibiotics
4. Glucose 50 ml IV
5. Lorazepam 0.1 mg/kg IV at 2 mg/min - benzodiazepine
____
phosphenytoin 1000-1500 mg IV or phenytoin 20 mg/kg IV (blocks Na+ channels - decreases activity)
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phenobarbital 1000-1500 mg IV slowly (GABA channel open time increase)
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ICU
MOA of some antiseizure meds from lecture?
When GABA mentioned, GABA A - Cl- channel facilitator
phenytoin, carbomazepine (in the restaurant eating carbs, fan blowing - client having a seizure - salt on each table) - enhances Na+ channels - cell hyperpolarized -> harder to reach AP and be stimulated
barbiturates: allobarbitol, etc
GABA a (Cl-) channels - prolongs time they are open
benzodiazepines: lorazepan, etc
GABA a (Cl-) channels - more channels
think B type meds work on gaBa
